41G超微针视网膜下注射平衡盐溶液治疗大直径黄斑裂孔的临床观察  

Clinical observation of 41G ultramicroneedle subretinal injection of balanced salt solution for large macular holes

作　　者：王霞[1] 李晓丽 武斌[1] 韩泉洪[1] 王莹[1] Wang Xia;Li Xiaoli;Wu Bin;Han Quanhong;Wang Ying(Tianjin Eye Hospital,Tianjin Key Laboratory of Ophthalmology and Visual Science,Tianjin Eye Institute,Clinical College of Ophthalmology,Tianjin Medical University,Tianjin 300020,China)

机构地区：[1]天津市眼科医院,天津市眼科学与视觉科学重点实验室,天津市眼科研究所天津医科大学眼科临床学院,天津300020

出　　处：《中华眼底病杂志》2024年第12期924-929,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察并评估41G超微针视网膜下注射平衡盐溶液(BSS)治疗大直径黄斑裂孔(MH)的疗效和安全性。方法前瞻性临床干预性研究。2024年3~6月于天津市眼科医院检查确诊的大直径全层MH患者22例22只眼纳入研究。患眼裂孔最小直径均>400μm。所有患眼均接受25G玻璃体切割联合内界膜剥除及41G超微针视网膜下注射BSS治疗。患眼手术前及手术后1、3个月均行最佳矫正视力(BCVA)、微视野、眼底自发荧光、光相干断层扫描(OCT)检查。BCVA检查采用标准对数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。采用OCT仪测量MH最小直径、基底直径。采用黄斑完整性评估仪行微视野检查,记录黄斑10°范围内黄斑整体指数(MII)、黄斑阈值(MT)。对比分析手术前后患眼BCVA、MI、MT变化以及裂孔闭合和并发症发生情况。同一连续性指标的手术前后比较,呈正态分布且方差齐采用Stutentt检验,非正态分布采用Mann-WhitneyU检验;不同指标之间的相关性采用Pearson相关性分析。结果果22例22只眼中,男性4例,女性18例;均为单眼发病;年龄66(60,71)岁;病程5(2.5,12.0)个月。患眼logMAR BCVA1.24土0.57,MII、MT分别为100.0(99.53,100.00)、19.0(13.23,21.78)dB。手术后1个月,所有患眼裂孔均闭合,其中1、Ⅱ型闭合分别为20(90.91%,20/22)、2(9.09%,2/22)只眼。末次随访时,患眼1ogMARBCVA0.62土0.58,MII、MT分别为99.9(59.45,100.00)、23.6(19.33,26.25)dB;与手术前比较,BCVA(t=3.579)、MII(Z=-2.374)、MT(Z=-2.997)明显改善,差异均有统计学意义(P<0.05)。相关性分析结果显示,手术后BCVA与手术前BCVA(r=0.41)、MH最小直径和基底直径(r=0.64、0.58)、病程(r=0.63)、年龄(r=0.50)均呈显著正相关(P<0.05)。随访期间所有患眼均未发生与手术相关的并发症。结论41G超微针视网膜下注射BSS短期内可有效提高大直径MH患眼的裂孔闭合率,改善视功能且安全性较好。Objective To evaluate the efficacy and safety of 41G ultramicroneedle subretinal injection of balanced salt solution(BSS)in the treatment of large diameter macular holes(MH).Methods A prospective clinical intervention study.A total of 22 eyes of 22 large-diameter full-layer MH patients diagnosed by examination in Tianjin Eye Hospital from March to June 2024 were included in the study.The minimum diameter of MH in the affected eyes was all greater than 400μm.The affected eyes received 25G pars plana vitrectomy combined with internal limiting membrane peeling and 41G ultramicroneedle subretinal injection of BSS.The affected eyes underwent best-corrected visual acuity(BCVA),microperimetry,fundus autofluorescence,and optical coherence tomography(OCT)examinations before and 1 and 3 months after surgery.BCVA was measured using the standard logarithmic visual acuity chart and converted to logarithm of the minimum angle of resolution(logMAR)visual acuity for statistical analysis.The minimum and base diameter of MH were measured using OCT.Microperimetry was performed using a macular integrity assessment device,recording the macular integrity index(MII)and macular threshold(MT)within 10o of the macular.The changes in BCVA,MII,MT,and the closure of MH and the occurrence of complications were compared and analyzed before and after surgery.For the comparison of the same continuous indicators before and after surgery,Student's t-test was used if the data were normally distributed and had equal variances,and the Mann-Whitney U test was used if the data were not normally distributed;the correlation between different indicators was analyzed using Pearson correlation analysis.Results Among the 22 cases(22 eyes),there were 4 males and 18 females;all were unilaterally affected.The age was 66(60,71)years.The duration of the disease was 5(2.5,12.0)months.The logMAR BCVA of the affected eyes was 1.24±0.57,and the MII and MT were 100.0(99.53,100.00)and 19.0(13.23,21.78)dB,respectively.One month after surgery,all MH were closed,with 20

关 键 词：玻璃体视网膜手术 黄斑裂孔 41G超微针 视网膜下注射 

分 类 号：R779.6[医药卫生—眼科]