比较玻璃体切除联合内界膜填塞术中空气填充与硅油填充治疗大型IMH的效果  

Comparison of efficacy of air tamponade and silicone oil tamponade in vitrectomy combined with internal limiting membrane packing in the treatment of large idiopathic macular holes

作　　者：赵晓华[1] 袁超峰[1] 马成霞[1] Zhao Xiaohua;Yuan Chaofeng;Ma Chengxia(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Henan Ophthalmic Hospital,Zhengzhou 450002,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450002

出　　处：《中华眼外伤职业眼病杂志》2024年第12期887-893,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的比较玻璃体切除联合内界膜(ILM)填塞术中空气填充与硅油填充治疗大型特发性黄斑孔(IMH)的效果。方法回顾性队列研究。纳入2021年5月至2022年6月于郑州大学第一附属医院诊治的62例(62只眼)大型IMH患者作为研究对象,按照手术方法不同分为两组,A组34例(34只眼)行玻璃体切除联合ILM填塞及空气填充术治疗,B组28例(28只眼)行玻璃体切除联合ILM填塞及硅油填充术治疗。术后随访12个月,比较两组患眼最佳矫正视力(BCVA,logMAR)、黄斑中心区视网膜厚度(CMT)、光感受器内段/外段(IS/OS)缺损范围、黄斑孔闭合率及并发症情况。结果A组术后1、3、6、12个月的BCVA分别为1.08±0.35、0.84±0.23、0.63±0.15、0.51±0.11,均较术前(1.52±0.63)改善(t=4.37、7.67、9.23、10.35,均P<0.001);术后12个月的CMT(147.03±12.53)μm较术前1个月(237.41±28.52)μm、术后3个月(174.02±21.96)μm及术后6个月(162.85±15.28)μm降低(t=23.97、8.03、8.09,均P<0.001);术后1、3、6、12个月的IS/OS缺损范围分别为(859.42±82.65)、(632.17±52.58)、(431.85±41.09)、(328.96±34.25)μm,均较术前(1105.74±122.56)μm下降(t=15.19、29.09、38.02、42.82,均P<0.001)。B组术后1、3、6、12个月的患眼BCVA分别为1.07±0.32、0.86±0.25、0.65±0.17、0.53±0.13,均较术前(1.49±0.65)改善(t=3.70、5.64、7.38、8.33,均P<0.05);术后12个月的CMT(146.96±12.43)μm较术前1个月(238.03±28.49)μm、术后3个月(173.85±22.04)μm及术后6个月(161.36±16.78)μm均降低(t=20.90、7.10、4.07,均P<0.001);术后1、3、6、12个月的IS/OS缺损范围分别为(860.05±83.74)、(629.78±53.47)、(432.05±41.14)、(328.98±34.17)μm,均较术前(1107.52±122.49)μm下降(t=12.79、26.48、33.47、41.73,均P<0.001)。两组术后1、3、6、12个月的患眼BCVA、CMT、IS/OS缺损范围及黄斑孔闭合率比较,差异均无统计学意义(均P>0.05)。A组的并发症发生率[2.94%(1/34)]低于B组[21.43%(6/28)](χ^(2)=5.24,P=0.022)。结论玻�Objective To compare the efficacy of air tamponade and silicone oil tamponade in vitrectomy combined with internal limiting membrane(ILM)in the treatment of large idiopathic macular hole(IMH).Methods This was a retrospective cohort study.Sixty-two eyes of 62 patients with large IMH treated in the First Affiliated Hospital of Zhengzhou University from May 2021 to Jun.2022 were selected as the study subjects,and they were divided into two groups based on different surgical methods.In group A,34 cases(34 eyes)underwent vitrectomy combined with ILM packing and air tamponade,and in group B,28 cases(28 eyes)underwent vitrectomy combined with ILM packing and silicone oil tamponade.All patients were followed up for 12 months.Best corrected visual acuity(BCVA,logMAR),retinal thickness in macular central area(CMT),inner segment/outer segment(IS/OS),macular hole closure rate,and complications were compared between the two groups.Results BCVA was 1.08±0.35,0.84±0.23,0.63±0.15,and 0.51±0.11 in group A at 1,3,6,and 12 months after operation,respectively,which all improved compared with the 1.52±0.63 before operation(t=4.37,7.67,9.23,10.35;all P<0.001).CMT decreased at 12 months after surgery[(147.03±12.53)μm]compared with the(237.41±28.52)μm at 1 month before surgery,(174.02±21.96)μm at 3 months after surgery,and(162.85±15.28)μm at 6 months after surgery(t=23.97,8.03,8.09;all P<0.001);IS/OS defect range was(859.42±82.65),(632.17±52.58),(431.85±41.09),and(328.96±34.25)μm at 1,3,6,and 12 months after surgery,which decreased compared with the(1105.74±122.56)μm before surgery(t=15.19,29.09,38.02,42.82,all P<0.001).BCVA was 1.07±0.32,0.86±0.25,0.65±0.17,and 0.53±0.13 in group B at 1,3,6,and 12 months after operation,which improved compared with the 1.49±0.65 before operation(t=3.70,5.64,7.38,8.33;all P<0.05);CMT at 12 months after surgery was(146.96±12.43)μm,which was lower than the(238.03±28.49),(173.85±22.04),and(161.36±16.78)μm at 1 month before surgery,3 months after surgery,and 6 months after sur

关 键 词：玻璃体切除术 填塞术 空气 黄斑孔 特发性 大型 厚度 视网膜 黄斑区 

分 类 号：R73[医药卫生—肿瘤]