玻璃体切割手术联合41G超微针视网膜下注射平衡盐溶液治疗难治性黄斑裂孔的疗效观察  

Clinical observation of hysterectomy combined with 41G ultramicroneedle for subretinal injection of balanced salt solution in the treatment of refractory macular hole

作　　者：胡寒英 杨婷[1] 游志鹏[1] 李少川 柴宛璇 苏晓涵 Hu Hanying;Yang Ting;You Zhipeng;Li Shaochuan;Chai Wanxuan;Su Xiaohan(The Affiliated Eye Hospital of Nanchang University,Jiangxi Eye Hospital,Jiangxi Provincial Key Laboratory of Ophthalmology,Jiangxi Provincial Institute of Ophthalmology and Visual Science,Jiangxi Provincial Branch of National Clinical Medical Research Center for Otolaryngological Diseases,Nanchang 330006,China)

机构地区：[1]南昌大学附属眼科医院、江西省眼科医院、江西省眼科疾病临床医学研究中心、江西省眼科学与视觉科学研究所、江西省眼科学重点实验室、国家耳鼻喉疾病临床医学研究中心、江西省分中心、江西省卫生健康玻璃体视网膜疾病重点实验室,南昌330006

出　　处：《中华眼底病杂志》2024年第5期353-359,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金(82260212);公立医院高质量发展科研公益项目(GL-C002);江西省教育厅科学技术研究青年项目(GJJ210258);白求恩•朗沐中青年眼科科研基金项目(BJ-LM2021002J)。

摘　　要：目的观察微创玻璃体切割手术(PPV)联合内界膜(ILM)剥除和41G超微针视网膜下注射平衡盐溶液(BSS)治疗难治性黄斑裂孔的有效性和安全性。方法前瞻性临床研究。2023年1~6月于南昌大学附属眼科医院检查确诊的难治性黄斑裂孔患者20例20只眼纳入研究。患眼裂孔基底直径(BD)均>1000μm,黄斑裂孔指数(MHI)<0.5。患眼接受23G PPV联合ILM剥除及41G超微针视网膜下注射BSS治疗。患眼手术前及手术后1、2、3、6个月均行最佳矫正视力(BCVA)、微视野、光相干断层扫描血管成像(OCTA)检查。采用标准对数视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力。采用MP-3微视野计行微视野检查,记录中心凹12°范围内视网膜平均光敏感度(MS)。采用OCTA仪测量黄斑中心凹无血管区(FAZ)面积、FAZ周长(PERIM)、视网膜血管长度密度(VLD)、血流灌注密度(VPD)。对比分析手术前后患眼BCVA、MS、FAZ面积、PERIM、VLD、VPD变化。同时观察患眼手术后以及裂孔闭合状态和并发症发生情况。手术前及手术后不同时间观察指标比较采用单因素方差分析。手术后6个月各观察指标与手术前裂孔最小直径(MD)、BD、裂孔高度的相关性采用Pearson相关性分析。结果20例20只眼中,男性2例2只眼,女性18例18只眼;年龄(61.45±8.56)岁。患眼logMAR BCVA、MS、FAZ面积、PERIM、VLD、VPD分别为1.46±0.21、(16.20±5.81)dB、(0.40±0.17)mm^(2)、(2.89±0.99)mm、(6.23±3.59)mm^(-1)、(0.17±0.10)%。手术后6个月,20只眼中,裂孔闭合、不完全闭合分别为18(90.0%,18/20)、2(10.0%,2/20)只眼。logMAR BCVA、MS、FAZ面积、PERIM、VLD、VPD分别为0.80±0.20、(22.20±4.60)dB、(0.18±0.10)mm^(2)、(1.83±0.80)mm、(9.54±2.88)mm^(-1)、(0.31±0.14)%;与手术前比较,差异均有统计学意义(P<0.05)。相关性分析结果显示,手术前BD与手术后6个月PERIM、VPD呈正相关(P<0.05);手术前MD与手术后6个月VLD呈负相关(P<0.05);手Objective To observe the effectiveness and safety of pars plana vitrectomy(PPV)combined with inner limiting membrane(ILM)removal and 41G microneedle subretinal injection of balanced salt solution(BSS)in the treatment of refractory macular hole.Methods A prospective clinical study.From January to June 2023,20 cases(20 eyes)of refractory macular hole patients diagnosed through examination at The Affiliated Eye Hospital of Nanchang University were included in the study.The basal diameter of the affected eye's basal diameter(BD)was>1000μm.Macular hole index(MHI)was<0.5.The affected eye received treatment with 23G PPV combined with ILM removal and 41G microneedle subretinal injection of BSS.Best corrected visual acuity(BCVA),microperimetry,and optical coherence tomography angiography(OCTA)were performed before and 1,2,3,and 6 months after surgery for the affected eye.BCVA examination was performed using standard logarithmic visual acuity chart,and convert it to logarithmic minimum resolution angle(logMAR)visual acuity for statistical purposes.MP-3 microperimetry was used for micro view examination,record the mean sensitivity(MS)of the retinal within a 12°range of the fovea.OCTA was used to measure the area of the avascular zone of the macula(FAZ),perimeter of the FAZ(PERIM),retinal vascular length density(VLD),and vascular perfusion density(VPD).The changes in BCVA,MS,FAZ area,PERIM,VLD,VPD before and after surgery were compared and analyzed.After the same time,the closure of macular hole and the occurrence of complications after surgery were observed.Single factor analysis of variance was used to compare the observation indicators at different times before and after surgery.The correlation between various observation indicators and preoperative minimum diameter(MD),BD,and hiatus height at 6 months after surgery were analyzed using Pearson correlation analysis.Results Among the 20 cases with 20 eyes,there were 2 males with 2 eyes and 18 females with 18 eyes.Age was(61.45±8.56)years old.The logMAR BCVA,MS,FAZ area,P

关 键 词：玻璃体切除术 超微针 视网膜下注射 难治性黄斑裂孔 

分 类 号：R774.1[医药卫生—眼科]