空气填充内界膜移植联合颞侧翻转治疗难治性黄斑裂孔的临床观察

发布时间：2018-08-22 12:23

【摘要】：背景:黄斑裂孔(macular hole,MH)是指黄斑部视网膜神经上皮层全层发生穿孔,是严重威胁人类视力的眼部疾病之一,特别是对于难治性黄斑裂孔,病变发生后治疗难度大、视力下降明显,预后较差。目前对难治性黄斑裂孔的治疗以手术为主,但手术方式各有优缺点,特别是因各种原因临床无法合规使用惰性气体的情况下,如何进行手.术,有待临床探索。目的:观察难治性黄斑裂孔患者行内界膜移植联合颞侧翻转+空气填充术,与接受传统的自体内界膜移植+硅油填充术,两种手术方式术后闭孔率及视力改善有无差异,通过对手术方式的创新,改善难治性黄斑裂孔的预后。方法:收集2016年1月至2016年12月就诊于山东大学齐鲁医院眼科的难治性黄斑裂孔患者25例25只眼,排除年龄相关性黄斑变性、中心性浆液性视网膜病变、青光眼、葡萄膜炎、眼部手术史及合并全身疾病眼部表现的患者,根据Gass分期标准,Ⅲ-Ⅳ期特发性黄斑裂孔且孔径700 μ m的患者、高度近视性黄斑裂孔的患者、较大孔径外伤性黄斑裂孔的患者均可纳入本研究。术前及术后对患者进行最佳矫正视力(best-correeted visual acuity,BCVA)、眼压(intraocular pressure,IOP、裂隙灯显微镜、间接眼底镜及光学相干断层成像(optical coherenece tomography,(OCT)检查,25例患眼分为两组,研究组:11例患眼行23(;标准二通道睫状体平坦部玻璃体切割+鼻侧内界膜移植+颞侧大瓣翻转+空气填充术,术中创造性使用50%高渗糖辅助内界膜瓣翻转,术后俯卧位至气体完全吸收;对照组:14例患眼行23G标准三通道睫状体平坦部玻璃体切割+内界膜移植+硅油填充术,术后严格俯卧位1-2周,密切随访3个月,分别在第1周、第2周、1个月、2个月、3个月时记录患者的BCVA、裂孔闭合率等,进行统计学分析。结果:1.临床资料:两组患者的年龄、黄斑裂孔孔径大小、术前BCVA及病程时间等无统计学差异(P0.05),符合试验的要求。2.术后相关资料:(1)术后BCVA:研究组患者术后BCVA(logMAR视力)为0.95±0.29,对照组患者术后BCVA(logMAR视力)为0.92±0.36,差异无统计学意义(t=0.199,p=0.844，，p0.05)。(2)术后黄斑裂孔闭合率:研究组术后裂孔闭合率为100%;对照组术后裂孔闭合率为92.9%,两组差异无统计学意义(x2=0.818,p=0.366,p0.05)。结论:1、内界膜移植联合颞侧翻转+空气填充治疗难治性黄斑裂孔临床效果确切。2、本术式中颞侧内界膜瓣的翻转可以对移植的内界膜起到保护作用,可有效防止术后移植内界膜的脱位,在一定程度上起到"双保险"的作用,促进黄斑裂孔的闭合。3、移植的内界膜可以起到支架的作用,促进术后黄斑裂孔处结构的恢复。4、创造性的术中使用50%高渗糖辅助内界膜翻转,可大大降低内界膜瓣翻转的难度,提高手术成功率。
[Abstract]:Background: macular hole (MH) refers to the perforation of the whole layer of the retinal nerve upper cortex in the macular region. It is one of the eye diseases that seriously threaten human visual acuity. Especially for the refractory macular hole, it is difficult to treat after the lesion, and the visual acuity is obviously decreased. The prognosis is poor. At present, the treatment of refractory macular hole is mainly surgery, but the operation has its own advantages and disadvantages, especially in the case of clinical inert gas can not be used for various reasons, how to carry out the operation. Surgery, need clinical exploration. Objective: to observe the difference of obturation rate and visual acuity between internal boundary membrane transplantation and temporal-flip air filling in patients with refractory macular hole. The prognosis of refractory macular hole was improved by the innovation of surgical method. Methods: from January 2016 to December 2016, 25 cases (25 eyes) of refractory macular hole were collected from Qilu Hospital, Shandong University, excluding age-related macular degeneration, central serous retinopathy, glaucoma and uveitis. According to Gass staging criteria, the patients with history of ocular surgery and ocular manifestations associated with systemic diseases had an aperture of 700 渭 m for stage 鈪

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