玻璃体切割术治疗高度近视性黄斑劈裂及黄斑裂孔的疗效观察

发布时间：2018-04-06 03:13

  本文选题：高度近视　切入点：黄斑劈裂　出处：《眼科新进展》2014年06期

【摘要】：目的观察并分析高度近视黄斑劈裂及黄斑裂孔玻璃体切割术前、术后的光学相干断层扫描(optical coherence tomography,OCT)、视力及多焦视网膜电图(multifocal electroretinogram,mfERG)的变化特征,评估手术疗效,并探讨手术时机。方法收集2011年8月至2013年3月在我院行标准三通道经睫状体平坦部玻璃体切割术联合内界膜剥离术治疗高度近视性黄斑劈裂及黄斑裂孔不伴视网膜脱离患者38例(44眼),并将其分成两组,即黄斑劈裂组(24眼)和黄斑裂孔组(20眼),术后随访6个月,观察患眼术前及术后视力、OCT及mfERG情况。结果两组患者术后视力较术前均有提高(均为P0.05),黄斑劈裂组患者术后视力提高幅度大于黄斑裂孔组(P0.05)。视力进步者黄斑劈裂组为91.7%,黄斑裂孔组为50.0%,两组相比差异有统计学意义(P0.05)。OCT示黄斑劈裂组24眼中22眼(91.7%)黄斑区完全愈合,2眼(8.3%)好转;黄斑裂孔组20眼中8眼(40.0%)完全愈合,6眼(30.0%)好转,6眼(30.0%)未愈合;两组黄斑区完全愈合率相比,差异有统计学意义(P0.01)。mfERG示术后6个月时,黄斑劈裂组1环P1波潜伏期为(37.50±3.62)ms,与术前的(44.23±4.35)ms相比明显缩短(P0.05),而黄斑裂孔组为(38.54±4.75)ms,与术前的(40.31±2.80)ms相比差异无统计学意义(P0.05)。两组患者P1波振幅密度在术后2个月、3个月、6个月时均逐渐提高,但仍略低于术前(均为P0.05)。术前mfERG的三维地形图表现为中央峰缺如或低平,旁中心凹区域有多处不规则低反应区。术后愈合患者mfERG的三维地形图的中央峰逐渐恢复,旁中心凹区域不规则反应区减少或消失。两组术中未见医源性裂孔形成,术后无眼内出血或眼内炎等严重并发症发生。结论玻璃体切割联合内界膜剥离术是治疗高度近视性黄斑劈裂及黄斑裂孔安全有效的手术方法。在高度近视黄斑劈裂形成伴有视力受损之后、裂孔形成之前及时行玻璃体切割术治疗可有效保存视功能,提高患者的视力。
[Abstract]:Objective To observe and analyze the myopic foveoschisis with macular hole and vitreous body cutting before operation, after operation of optical coherence tomography (optical coherence tomography, OCT), visual acuity and multifocal electroretinogram (multifocal electroretinogram, mfERG) change characteristic, evaluation of the efficacy of surgery, and to investigate the timing of surgery. Methods from August 2011 to March 2013 in our hospital three channel standard pars plana vitrectomy combined with vitreous body peefing for treatment of high myopia macular retinoschisis and macular hole without retinal detachment in 38 patients (44 eyes), and divided into two groups, namely retinoschisis group (24 eyes) and macular the hole group (20 eyes), after 6 months of follow-up, visual acuity were observed before and after the operation, OCT and mfERG. The results of two groups of patients with postoperative visual acuity was improved (P0.05), macular retinoschisis group of patients with postoperative visual acuity was greater than 榛勬枒瑁傚瓟缁，

本文编号：1717710