PPV联合ILMP术中行空气或C3F8填充治疗PMH的疗效观察

发布时间：2018-04-09 13:00

  本文选题：原发性黄斑裂孔　切入点：玻璃体切割术　出处：《重庆医科大学》2017年硕士论文

【摘要】：目的:玻璃体切割术(pars plana vitrectomy,PPV)联合内界膜剥除术(internal limiting membrane peeling,ILMP)和眼内气体填充是目前公认治疗原发性黄斑裂孔(primary macular hole,PMH)的首选方法,本研究分析了PPV术后分别采用空气或C3F8填充治疗II~III期PMH的临床资料,对比观察两种气体填充对于PMH修复和视力预后的有效性及安全性,并探寻各术前因素与术后视力的相关性。方法:回顾性病例分析,收集2014年10月至2016年12月在重庆医科大学附属第一医院眼科确诊并接受手术治疗的PMH患者39例39眼,均行标准三通道经睫状体平坦部23GPPV联合ILMP,术中眼内填充无菌空气组20例20眼、眼内注入10%C3F8组19例19眼,所有符合纳入标准的患者均收集术前及术后1周、1月、3月最佳矫正视力(best corrected visual acuity,BCVA)、眼压及光学相干断层扫描(optical coherence tomography,OCT)。BCVA转化为log MAR后利用SPSS19.0软件行下列检验:(1)组内:空气组或C3F8组各自组内,手术前后log MAR-BCVA的比较,采用配对t检验;(2)组间:两组术前年龄、病程、术前log MAR-BCVA、术前裂孔相关参数,以及手术时长、术后log MAR-BCVA、术后1月和3月CRT的对比,行两独立样本t检验;用Fisher确切概率法对裂孔闭合率、相关并发症发生率进行比较;(3)影响术后视力相关因素:将患者术前视力、年龄、病程以及PMH相关形态参数及计算值包括:PMH高度H(μm)、椭圆体带(ellipsoid zone,EZ)破坏直径A(μm)、基底直径a(μm)、最小直径b(μm)、边径之和c+d(μm)、术后黄斑中心凹视网膜厚度(central retinal thickness,CRT)(μm)、黄斑裂孔指数(macular hole index,MHI)、黄斑裂孔牵拉指数(tractional hole index,THI)、黄斑裂孔直径指数(diametral hole index,DHI)、黄斑裂孔形成因子(hole form factor,HFF),与术后log MAR-BCVA行双变量相关分析。以上统计分析,P0.05时认为差异有统计学意义。结果:手术前,比较两组间年龄(P=0.801)、病程(P=0.833)、术前视力(P=0.478)、H(P=0.370)、A(P=0.836)、a(P=0.533)、b(P=0.362)差异均无统计学意义(P0.05);空气组或C3F8组各自组内,对手术前后log MAR-BCVA的比较,视力均较术前提高,空气填充组(t=4.892,P=0.008)、C3F8填充组(t=5.780,P=0.000)差异有统计学意义(P0.05);空气填充组与C3F8填充组比较手术时长(P=0.643)、术后log MAR-BCVA(P=0.913)、术后1月及3月的CRT(P=0.976、P=0.844),差异均无统计学意义(P0.05);术后1月时两组黄斑裂孔病例均完全闭合,术后1周时,空气填充组2例未完全闭合、C3F8填充组1例未闭合;术后1周内空气填充组出现高眼压1例、C3F8组出现高眼压3例,术后空气填充组发现视网膜前出血1例、C3F8组未出现视网膜前出血,术后1周内黄斑裂孔闭合率(P=1.000)及术后并发高眼压发生率(P=0.342)、视网膜前出血的发生率(P=1.000)两组比较差异均无统计学意义(P0.05);术后视力的相关性分析中,术前视力(r=0.479,P=0.025)、A(r=-0.450,P=0.035)、a(r=0.-0.438,P=0.039)与术后视力低度相关,b(r=-0.657,P=0.012)、MHI(r=0.589,P=0.040)、THI(r=0.546,P=0.018)与术后视力中度相关,差异有统计学意义(P0.05),而年龄(r=0.361,P=0.090)、病程(r=-0.292,P=0.203)、H(r=-0.235,P=0.314)、DHI(r=-0.231,P=0.316)、HFF(r=0.586,P=0.295)与术后视力的相关性差异均无统计学意义(P0.05)。结论:PPV联合ILMP术中行空气或C3F8填充治疗PMH,疗效相当,对于PMH的愈合和视力提高均安全有效;术前视力、裂孔最小直径、基底直径、EZ破坏直径、MHI、THI与术后视力均具有相关性,故OCT对于PMH兼具诊断意义和预测术后视力的价值。
[Abstract]:Objective: vitreous body incision (pars plana vitrectomy, PPV) combined with internal limiting membrane peeling (internal limiting membrane peeling, ILMP) and intraocular gas tamponade is currently recognized as treatment of idiopathic macular hole (primary macular, hole, PMH) the preferred method, this study analyzes the PPV after operation respectively by air or C3F8 fill the clinical data for the treatment of stage II~III PMH, comparative observation of two kinds of gas filling for the efficacy and safety of PMH repair and visual prognosis, and explore the correlation between the preoperative visual acuity and postoperative factors. Methods: a retrospective analysis from October 2014 to December 2016 and received surgical treatment in First Affiliated Hospital of Chongqing Medical University diagnosed PMH and 39 cases 39 eyes underwent a standard three channel pars plana combined with 23GPPV ILMP, intraocular filling aseptic air group 20 cases 20 eyes, intraocular injection 10% C3F8 group and 19 cases of 19 eyes, the With 1 weeks, the inclusion criteria of patients were collected before and after the operation in January March, the best corrected visual acuity (best corrected visual acuity, BCVA), and optical coherence tomography (optical coherence intraocular pressure tomography, OCT) log MAR after using SPSS19.0 software for the test for the conversion of.BCVA: (1): air group group or C3F8 group in each group, log MAR-BCVA was compared before and after surgery, using the paired t test; (2) between the two groups: the two groups preoperative age, course of disease, preoperative log MAR-BCVA, preoperative macular hole and related parameters, operation time, postoperative log MAR-BCVA, compared to January and March CRT after operation two, independent samples t test; Fisher exact method for macular hole closure rate and complication rate were compared; (3) effects of related factors of postoperative visual acuity: preoperative visual acuity, age, course of disease and PMH related morphological parameters and calculation values include: PMH height H (M), ellipse with ellips ( oid zone,EZ)鐮村潖鐩村緞A(渭m),鍩哄簳鐩村緞a(渭m),鏈，

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