前后联合手术处理黄斑裂孔视力相关因素分析

发布时间：2018-03-17 20:01

本文选题：黄斑裂孔　切入点：特发性黄斑裂孔　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨前后联合手术治疗特发性黄斑裂孔(idiopathic macular hole,IMH)、高度近视性黄斑裂孔(high myopicmacular hole.,HMMH)伴视网膜脱离以及不伴视网膜脱离三种类型的患者最佳矫正视力(best-corrected visual acuity,BCVA)相关因素的分析。方法从2015年1月至2015年12月在天津市眼科医院的43例黄斑裂孔患者(特发性黄斑裂孔25例、高度近视性黄斑裂孔伴视网膜脱离9例、高度近视性黄斑裂孔不伴视网膜脱离9例)行前后联合手术,术前眼部检查包括视力、眼内压(intraocular pressure,IOP)、裂隙灯、间接眼底镜、频域光学相干断层扫描(spectral-domain optical coherence tomography,SD-OCT)。所有患者全部行三通道平坦部玻璃体切割、吲哚青绿染色,同时行白内障超声乳化联合后房型人工晶体植入,行气液交换后,玻璃体腔注入0.3ml纯C3F8,术后2w、1m、3m、6m门诊复查,复查时进行最佳矫正视力、裂隙灯下前置镜观察眼底、眼压、IOL Master、黄斑区OCT检查,每个患者随访6个月后进行数据整理,记录术前术后最佳矫正视力、眼轴、黄斑裂孔愈合情况、验光结果及患者基本资料等指标,并进行统计学分析。结果三种类型黄斑裂孔术后结果表明特发性黄斑裂孔术后6个月观察期间中心凹外层视网膜不断发生形态学改变,25例全部可见外界膜愈合出现,92%集中在3-6个月出现外界膜愈合,外界膜愈合时间与术前视力呈负相关(r=-0.4047,p=0.0448),术前平均视力0.16±0.12,术后6m平均视力0.63±0.22。眼轴与视力呈负相关(P=0.0482),术前眼轴与术后2w、1m、3m、6m眼轴差异有统计学意义(P0.0001),术后2w、1m、3m、6m之间比较眼轴差异没有统计学意义。高度近视性黄斑裂孔伴视网膜脱离的术前平均视力0.05±0.07,术后6m平均视力视力0.39±0.29,眼轴与各时间点视力没有相关性(p=0.6718),术前术后眼轴没有统计学意义,术前视力是外界膜愈合的保护因素(χ~2=16.49 P0.0001)。高度近视性黄斑裂孔不伴视网膜脱离的术前平均视力0.13±0.09,术后6m平均视力视力0.42±0.26,年龄是外界膜愈合的危险因素(χ~2=8.35 p=0.0038),术前视力是外界膜愈合的保护因素(χ~2=4.12 p=0.0425),各个时间点的视力与眼轴呈负相关(p=0.0025),术前、术后眼轴各时间点的变化有统计学意义,术后各个时间点眼轴自身对比没有意义。结论1.黄斑裂孔术后外层视网膜超微结构和形态是不断发生变化的,而且与视功能有密切联系,术前视力越好,外界膜愈合的越早,而且外界膜的愈合多发生在3-6个月,外界膜出现越早,术后视力越好。年龄是外界膜的危险因素,术前视力是外界膜愈合的保护因素。2.眼轴的变化与视力有相关性,眼轴越短,视力越好。在黄斑裂孔术后眼轴的变化是没有统计学意义的。而与术前的变化可能是由于黄斑区视网膜组织的形态学改变和偏心注视造成的。
[Abstract]:Objective to investigate the factors associated with combined anterior and posterior surgery for the treatment of idiopathic macular hole macular, high myopicmacular HMMH with high myopic macular hole and retinal detachment and without retinal detachment. Methods from January 2015 to December 2015, 43 patients with macular hole (25 cases of idiopathic macular hole) in Tianjin Eye Hospital were analyzed. 9 cases of high myopic macular hole with retinal detachment and 9 cases of high myopic macular hole without retinal detachment) were performed combined anterior and posterior surgery. Preoperative eye examination included visual acuity, intraocular pressure, intraocular pressure IOP, slit lamp, indirect fundus lens. Frequency-domain optical coherence tomography (OCTA) optical coherence tomphography. All patients were treated with three-channel flat vitrectomy, indocyanine green staining, cataract phacoemulsification and posterior chamber intraocular lens implantation, and after gas-liquid exchange, all the patients underwent phacoemulsification and posterior chamber intraocular lens implantation. A total of 0.3 ml pure C3F8 was injected into the vitreous cavity. The outpatient examination was performed 2 weeks after operation. The best corrected visual acuity (BCVA), intraocular pressure (IOL) Masterboard, macular OCT were observed under slit lamp, and each patient was followed up for 6 months for data collation. The preoperative and postoperative best corrected visual acuity (BCVA), eye axis, macular hole healing, optometry and basic data of the patients were recorded. Results the postoperative results of three types of macular holes showed that there were continuous morphological changes in the outer retina of the central fovea during 6 months after the operation of idiopathic macular holes. All 25 cases had external membrane healing. At present, 92% of the patients had external membrane healing in 3-6 months. There was a negative correlation between the healing time of external membrane and preoperative visual acuity. The mean visual acuity was 0.16 卤0.12 before operation and 0.63 卤0.22 at 6 m after operation. There was a negative correlation between eye axis and visual acuity. There was significant difference between preoperative eye axis and postoperative visual acuity (P 0.0001). The mean preoperative visual acuity of high myopic macular hole with retinal detachment was 0.05 卤0.07, the average visual acuity of 6 m after operation was 0.39 卤0.29, and there was no correlation between eye axis and visual acuity at different time points. There was no statistical significance between preoperative and postoperative visual acuity. Preoperative visual acuity was the protective factor of external membrane healing (蠂 ~ 2 / 2 ~ (16.49) P _ (0.0001)). The mean preoperative visual acuity without retinal detachment was 0.13 卤0.09 in high myopic macular hole and 0.42 卤0.26 in 6 m postoperatively. Age was a risk factor for external membrane healing (蠂 ~ 2 / 2 ~ (8.35) p ~ (0.0038), preoperative visual acuity). It is a protective factor of external membrane healing (蠂 ~ 2 ~ 2 ~ 4. 12 p ~ (0.0425)). The visual acuity of each time point is negatively related to the axial axis of the eye. Before operation, there is a negative correlation between the visual acuity and the axial axis of the eye. There was statistical significance in the changes of the ocular axis at each time point after operation, but there was no significance in the contrast of the eye axis itself at each time point after operation. Conclusion 1. The ultrastructure and morphology of the outer retina after macular hole surgery are constantly changing. Moreover, there is a close relationship with visual function. The better the preoperative visual acuity, the earlier the external membrane is healed, and the more the external membrane healing occurs in 3-6 months, the earlier the external membrane appears, the better the postoperative visual acuity. Age is the risk factor of the external membrane. Preoperative visual acuity is the protective factor of external membrane healing. The visual acuity is better. There is no statistical significance in the change of eye axis after macular hole. The changes before operation may be caused by morphological changes of retinal tissue in macular area and eccentricity fixation.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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