玻璃体切除术联合空气填充治疗特发性黄斑裂孔的疗效观察
发布时间：2018-07-22 19:57
【摘要】：研究背景黄斑裂孔最先于1869由Knapp提出并加以描述。但在此后相当长的一段时间内,该病一直没有有效的医治方法。1991年Kelly等最初报道了玻璃体切除治疗特发性黄斑裂孔,术后的裂孔的闭合率达58%。近年来,随着手术的技巧的改进和设备的更新,黄斑裂孔的手术的闭合率高达90%以上。黄斑裂孔手术治疗的思路得益于对黄斑裂孔形成的病理基础的认识和提高。Gass经过对玻璃体与黄斑相关的研究认为特发性黄斑裂孔的构成主要是由黄斑区中心凹部位玻璃体皮质收缩产生的切向牵引力以及环形及前后方向诸多生物力综合作用的结果。此观点后来得到了相关研究的证实。黄斑裂孔的主要手术步骤包括玻璃体切除诱导玻璃体后皮质脱离、剥离黄斑前膜、剥离黄斑内界膜、玻璃体腔填充和面向下位。玻璃体切除联合内界膜剥除眼内填充物,眼内填充物主要有SF6、C3F8、C2F6、空气和硅油等。长效膨胀气体已有很多报道,硅油填充的副作用及二次取出的风险,大大限制了其临床应用,而空气填充的相关文献及报道相对较少。在以前手术的基础上,我们通过玻璃体切除联合内界膜剥除及空气填充探讨空气填充在特发性黄斑裂孔治疗中的价值。目的及方法目的观察玻璃体切除联合内界膜剥离治疗特发性黄斑裂孔(IMH),术中填充空气的疗效。方法回顾性分析2014年9月至2016年10月在我组治疗的IMH患者106例(112只眼),排除无法随访的病例,其中男31例,女75例,行玻璃体切除联合内界膜剥离术,术中玻璃体腔内空气填充,所有手术均由同一操作熟练的医师完成。术前所有患者行常规术前检查,最佳矫正视力、眼压、OCT、裂孔大小及闭合情况等。术后患者保持面向下位,当气体吸收能看清黄斑裂孔处视网膜时行OCT检查,术后2周、1个月、3个月进行随访,按术前裂孔最小直径分为4组:a组:直径≤250μm,b组:250~400μm,c组:400~600μm,d组:直径≥600μm,记录各组最佳矫正视力、裂孔闭合时间、裂孔闭合率、气体完全吸收时间、黄斑裂孔处视网膜暴露时间、面向下位时间及手术并发症。统计学分析采用SPSS21.0统计学软件对数据进行分析,计数资料的两个率的比较采用卡方检验;计量资料两样本均数比较采用配对t检验;两因素相关性分析采用Speaman等级相关分析。结果均以P0.05为差异有统计学意义。结果术后一周内情况:术后裂孔闭合时间a组(1.56±0.39)天,b组(1.57±0.53)天,c组(1.619±0.34)天,d组(1.74±0.46)天。裂孔闭合率a组100%,b组100%,c组97.56%,d组95%,应用卡方检验,各组间对比,P0.05,差异无统计学意义。术后2周内空气完全吸收时间a组(8.18±0.21)天,b组(8.10±0.35)天,c组(8.15±0.27)天,d组(8.23±0.41)天,各组之间两两相比,P0.05,差异无统计学意义。术后1周内空气填充术后在第1天露出黄斑裂孔处视网膜的患者有7只眼,术后第2天露出黄斑裂孔处视网膜的患者有43只眼,术后第3天露出黄斑裂孔处视网膜的患者有62只眼。术后2周内患者面向下位的时间,2天6人,3天11人,4天37人,5天52人,黄斑裂孔处视网膜露出后,行OCT检查,结果显示裂孔闭合后则改为鼻侧卧位。空气填充后1周有6例眼压升高(高于21mmHg低于45mmHg),占所有眼的4.35%,给予术眼降眼压眼药水控制正常,4d以内眼压均控制正常。术后1周2例患者裂孔未闭合,均因患者无法严格执行面向下位所致,余未发生严重并发症。术后1个月及3个月复诊情况:各组裂孔及闭合率同一周时情况。各组术后最佳矫正视力较术前明显高于术前,差异有统计学意义,无新的并发症出现。随着特发性黄斑裂孔分组裂孔直径的增加,术后患者最佳矫正视力提高呈逐渐下降状态,经Speaman等级相关分析,术后最佳矫正视力与各组之间呈负相关关系。结论1、对IMH患者而言,玻璃体切除联合内界膜剥离及空气填充,裂孔闭合率高达98%。2、气体吸收时间较长效气体时间短,减少了患者面向下位的时间。3、大多数患眼术后的视力得到提高。
[Abstract]:Background macular holes were first proposed by Knapp and described by Knapp. But in a long period of time, the disease had no effective treatment for.1991 Kelly, etc. initially reported that vitrectomy was initially reported for the treatment of idiopathic macular holes. The closure rate after surgery was 58%. in recent years, with the improvement of the surgical skills and the improvement of the surgical techniques. The closure rate of the macular hole is up to 90%. The idea of the macular hole surgery is due to the understanding of the pathological basis of the macular hole and the improvement of the.Gass through the study of the vitreous and macula. It is believed that the formation of the macular hole is mainly composed of the vitreous cortex of the macular region. This view was later confirmed by the related research. The main operative steps of the macular hole include vitrectomy induced detachment of the posterior vitreous cortex, the exfoliation of the macular membrane, the exfoliation of the yellowish inner boundary membrane, the filling of the vitreous cavity and the lower position. Vitrectomy combined with internal boundary membrane removal of intraocular fillers, intraocular fillers are mainly SF6, C3F8, C2F6, air and silicone oil. Long effect expansive gases have been reported, the side effects of silicone oil filling and the risk of taking out two times have greatly limited the clinical application, and the related literature and reports of air filling are relatively small. In the previous operation basis On the basis of vitrectomy combined with internal boundary membrane exfoliation and air filling, we discuss the value of air filling in the treatment of idiopathic macular hole. Objective and methods objective and objective to observe the effect of vitrectomy combined with internal boundary membrane dissection in the treatment of idiopathic macular hole (IMH) and the effect of air filling during the operation. Methods Retrospective analysis from September 2014 to 2016 10. 106 cases (112 eyes) of IMH patients treated in our group were excluded, including 31 men and 75 women, with vitrectomy combined with internal boundary membrane dissection and intraocular air filling in the vitreous cavity. All the operations were performed by the same skilled physician. The preoperative examination, the best corrected visual acuity, intraocular pressure, and OCT were performed in the preoperative patients. The size and closure of the fracture. After the operation, the patients maintained the lower position. When the gas absorption could see the retina of the macular hole, the retina was examined by OCT, 2 weeks, 1 months and 3 months after the operation were followed up. According to the minimum diameter of the split hole, the diameter of the retina was divided into 4 groups: the a group: the diameter is less than 250 mu m, the B group: 250~400 mu m, the C group: 400~600 u m, the D group: the diameter of the 600 u m, the best correction of each group was recorded. The best correction of each group was recorded. Record the best correction of each group. The best correction of each group was recorded. Positive vision, hole closure time, split hole closure rate, gas complete absorption time, retinal exposure time at the macular hole, lower time and surgical complications. Statistical analysis was used to analyze the data by SPSS21.0 statistics software. The comparison of two rates of counting data was checked by chi square test; two samples were compared. Paired t test; two factor correlation analysis using Speaman level correlation analysis. Results all the results were statistically significant with P0.05. Results after one week of operation, postoperative split hole closure time in group A (1.56 + 0.39) days, B group (1.57 + 0.53) days, C group (1.619 + 0.34) days, D group (1.74 + 0.46) days, a group 100% of crack closure rate, B group 100%, C group 97.56%, D group 95%, with chi square test, there was no statistical difference between each group and P0.05. The total air absorption time in 2 weeks after operation was (8.18 + 0.21) days (8.18 + 0.21) days, B group (8.10 + 0.35) days, C group (8.15 + 0.27) days, D group (8.23 + 0.41) days, and there was no statistical difference between each group 22, P0.05. After postoperative 1 weeks, air filling revealed macula fissure. The patients in the retina of the hole had 7 eyes, 43 eyes were exposed to the retina at the macular hole second days after the operation, and 62 eyes were exposed to the retina at the macular hole third days after the operation. The patient had 62 eyes in the retina of the macular hole third days after the operation. The patient was facing the lower position in 2 weeks after the operation, 2 days 6 people, 11 people, 4 days 37, 5 day 52, and the retina exposed in the macular hole, and the result of OCT examination. 1 weeks after air filling, 6 cases had elevated intraocular pressure (higher than 21mmHg below 45mmHg), which accounted for 4.35% of all eyes. The intraocular pressure of eye drops was normal and the intraocular pressure within 4D was normal. 2 cases were not closed at 1 weeks after operation. All patients were unable to strictly carry out the lower position. Severe complications. 1 months and 3 months after operation: the fracture and closure rate of each group were the same week. The best corrected visual acuity after operation was significantly higher than that before the operation. There was no significant difference. There was no new complication. After Speaman grade correlation analysis, the best corrected visual acuity after operation was negatively correlated with each group. Conclusion 1, for IMH patients, vitrectomy combined with internal boundary membrane peeling and air filling, the rate of split hole closure is up to 98%.2, gas absorption time is shorter than long effective gas time, reducing the time of patients facing the lower.3, most of the time, mostly.3, most of the patients. Eyesight was improved after a number of eyes.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
本文编号：2138402
[Abstract]:Background macular holes were first proposed by Knapp and described by Knapp. But in a long period of time, the disease had no effective treatment for.1991 Kelly, etc. initially reported that vitrectomy was initially reported for the treatment of idiopathic macular holes. The closure rate after surgery was 58%. in recent years, with the improvement of the surgical skills and the improvement of the surgical techniques. The closure rate of the macular hole is up to 90%. The idea of the macular hole surgery is due to the understanding of the pathological basis of the macular hole and the improvement of the.Gass through the study of the vitreous and macula. It is believed that the formation of the macular hole is mainly composed of the vitreous cortex of the macular region. This view was later confirmed by the related research. The main operative steps of the macular hole include vitrectomy induced detachment of the posterior vitreous cortex, the exfoliation of the macular membrane, the exfoliation of the yellowish inner boundary membrane, the filling of the vitreous cavity and the lower position. Vitrectomy combined with internal boundary membrane removal of intraocular fillers, intraocular fillers are mainly SF6, C3F8, C2F6, air and silicone oil. Long effect expansive gases have been reported, the side effects of silicone oil filling and the risk of taking out two times have greatly limited the clinical application, and the related literature and reports of air filling are relatively small. In the previous operation basis On the basis of vitrectomy combined with internal boundary membrane exfoliation and air filling, we discuss the value of air filling in the treatment of idiopathic macular hole. Objective and methods objective and objective to observe the effect of vitrectomy combined with internal boundary membrane dissection in the treatment of idiopathic macular hole (IMH) and the effect of air filling during the operation. Methods Retrospective analysis from September 2014 to 2016 10. 106 cases (112 eyes) of IMH patients treated in our group were excluded, including 31 men and 75 women, with vitrectomy combined with internal boundary membrane dissection and intraocular air filling in the vitreous cavity. All the operations were performed by the same skilled physician. The preoperative examination, the best corrected visual acuity, intraocular pressure, and OCT were performed in the preoperative patients. The size and closure of the fracture. After the operation, the patients maintained the lower position. When the gas absorption could see the retina of the macular hole, the retina was examined by OCT, 2 weeks, 1 months and 3 months after the operation were followed up. According to the minimum diameter of the split hole, the diameter of the retina was divided into 4 groups: the a group: the diameter is less than 250 mu m, the B group: 250~400 mu m, the C group: 400~600 u m, the D group: the diameter of the 600 u m, the best correction of each group was recorded. The best correction of each group was recorded. Record the best correction of each group. The best correction of each group was recorded. Positive vision, hole closure time, split hole closure rate, gas complete absorption time, retinal exposure time at the macular hole, lower time and surgical complications. Statistical analysis was used to analyze the data by SPSS21.0 statistics software. The comparison of two rates of counting data was checked by chi square test; two samples were compared. Paired t test; two factor correlation analysis using Speaman level correlation analysis. Results all the results were statistically significant with P0.05. Results after one week of operation, postoperative split hole closure time in group A (1.56 + 0.39) days, B group (1.57 + 0.53) days, C group (1.619 + 0.34) days, D group (1.74 + 0.46) days, a group 100% of crack closure rate, B group 100%, C group 97.56%, D group 95%, with chi square test, there was no statistical difference between each group and P0.05. The total air absorption time in 2 weeks after operation was (8.18 + 0.21) days (8.18 + 0.21) days, B group (8.10 + 0.35) days, C group (8.15 + 0.27) days, D group (8.23 + 0.41) days, and there was no statistical difference between each group 22, P0.05. After postoperative 1 weeks, air filling revealed macula fissure. The patients in the retina of the hole had 7 eyes, 43 eyes were exposed to the retina at the macular hole second days after the operation, and 62 eyes were exposed to the retina at the macular hole third days after the operation. The patient had 62 eyes in the retina of the macular hole third days after the operation. The patient was facing the lower position in 2 weeks after the operation, 2 days 6 people, 11 people, 4 days 37, 5 day 52, and the retina exposed in the macular hole, and the result of OCT examination. 1 weeks after air filling, 6 cases had elevated intraocular pressure (higher than 21mmHg below 45mmHg), which accounted for 4.35% of all eyes. The intraocular pressure of eye drops was normal and the intraocular pressure within 4D was normal. 2 cases were not closed at 1 weeks after operation. All patients were unable to strictly carry out the lower position. Severe complications. 1 months and 3 months after operation: the fracture and closure rate of each group were the same week. The best corrected visual acuity after operation was significantly higher than that before the operation. There was no significant difference. There was no new complication. After Speaman grade correlation analysis, the best corrected visual acuity after operation was negatively correlated with each group. Conclusion 1, for IMH patients, vitrectomy combined with internal boundary membrane peeling and air filling, the rate of split hole closure is up to 98%.2, gas absorption time is shorter than long effective gas time, reducing the time of patients facing the lower.3, most of the time, mostly.3, most of the patients. Eyesight was improved after a number of eyes.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
【参考文献】
相关期刊论文 前2条
1 陶明;李艳;张文芳;;特发性黄斑裂孔玻璃体切除手术联合空气填充的临床观察[J];国际眼科杂志;2015年11期
2 张贵森;姚毅;巩慧;任凤梅;刘晓琳;崔巍;;25G玻璃体切除联合惰性气体填充和空气填充治疗特发性黄斑裂孔的疗效观察[J];临床眼科杂志;2015年05期
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