大直径特发性黄斑孔术后早期非面朝下体位和即时面朝下体位的疗效比较  

Comparison of clinical efficacy of early non-face-down body position and immediate face-down body position after large diameter idiopathic macular hole surgery

作　　者：李龙[1] 王文战[1] 马超 宋德弓 Li Long;Wang Wenzhan;Ma Chao;Song Degong(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科、河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2024年第5期360-364,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的比较大直径特发性黄斑孔患者术后早期(6h内)非面朝下体位和术后即时面朝下体位的疗效。方法回顾性病例对照研究。收集郑州大学第一附属医院2019年9月至2022年9月大直径(>400μm)特发性黄斑孔患者57例(59眼)的临床资料。所有患者黄斑孔的直径为(674.59±167.81)μm,均行23 G玻璃体切除术、内界膜剥除填塞联合空气填充术。根据术后体位的不同分为A、B两组。A组33例(34眼),术后6 h内非面朝下体位,6 h后严格俯卧位体位;B组24例(25眼),术后即时俯卧位。随访时间≥3个月。通过OCT检查黄斑孔闭合情况,观察术后最佳矫正视力(BCVA,logMAR)和并发症情况。结果A组和B组患者黄斑孔闭合率分别为64.71%(22/34)、88.00%(22/25),两组相比差异有统计学意义(χ^(2)=4.12,P=0.042);术后两组患者BCVA较术前改善明显,差异均有统计学意义(均P<0.05),且B组BCVA(0.50±0.21)优于A组(0.70±0.20),差异有统计学意义(t=2.95,P=0.004)。术后1周两组各有2眼出现高眼压,降眼压治疗后眼压均恢复正常。A组2眼术后1 d出现少量玻璃体积血,给予止血药物后积血吸收。其余术眼随访期间均未出现严重并发症。结论大直径特发性黄斑孔患者行玻璃体切除术、内界膜剥除填塞联合空气填充术后即时面朝下体位,与术后早期(6 h内)非面朝下体位相比,能提高大直径特发性黄斑孔的闭合率。ObjectiveTo compare the efficacy of early postoperative non-supine positioning(NSP)for the first 6 hours and immediate postoperative face down body position in the repair of large diameter idiopathic macular holes(IMH)(diameter>400μm).MethodsThis was a retrospective case-control study.The clinical data of 59 eyes of 57 IMH patients were collected in the First Affiliated Hospital of Zhengzhou University from Sep.2019 to Sep.2022,with macular holes of diameter(674.59±167.81)μm.All patients underwent 23-gauge vitrectomy,internal limiting membrane peeling and insertion combined with air tamponade.Based on different postural positions,they were divided into group A and group B.In group A,33 patients(34 eyes)were in non-face-down position within 6 h and strict prone position after 6 h.In group B,24 patients(25 eyes)were in prone position immediately after operation.The follow-up time was≥3 months.The macular hole closure were checked by optical coherence tomography.The best corrected visual acuity(BCVA,logMAR)after surgery and complications were observed.ResultsThe macular hole closure rates following a single operation were 64.71%(22/34)in group A,and 88.00%(22/25)in group B,and the difference was statistically significant(χ^(2)=4.12,P=0.042).Postoperative BCVA improved in both groups compared with that before operation,and the difference was statistically significant(all P<0.05),and it was better in group B(0.50±0.21)than in group A(0.70±0.20),with statistically significant difference(t=2.95,P=0.004).At 1 week after operation,2 eyes in each group experienced intraocular hypertension,and the intraocular pressure returned to normal after treatment.A small amount of vitreous hematoma appeared in 2 eyes of group A at 1 day after surgery,and hemorrhage was absorbed after treatment.No serious complications occurred in the rest of eyes during follow-up examinations.ConclusionCompared with early postoperative non-supine positioning for the first 6 hours,immediate postoperative face down body position for patients wit

关 键 词：玻璃体切除术 孔 特发性 黄斑 体位 面朝下 非 早期 体位 面朝下 

分 类 号：R779.6[医药卫生—眼科]