玻璃体切割术治疗高度近视性黄斑劈裂及黄斑裂孔的临床疗效观察

发布时间：2018-06-27 22:46

本文选题：高度近视 + 黄斑劈裂　；参考：《中南大学》2011年硕士论文

【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手术前后的视力、多焦视网膜电图(Multifocal electroretinogram, mfERG)及光学相干断层扫描(optical coherence tomography, OCT)的变化特征,评估手术疗效,并探讨手术时机。方法：收集2008年4月～2011年5月在我院行标准三通道经睫状体平坦部玻璃体切割术(Pars Plana Vitrectomy, PPV)联合内界膜剥离术(Internal Limiting Membrane Peeling, ILMP)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19例(22只眼),并将其分成两组即黄斑劈裂组(12眼)和黄斑裂孔组(10眼),分别在手术前和手术后2、3、6个月时,对患者行视力、mfERG及OCT检查。并将两组的检查结果进行统计学分析和比较。结果： 1.视力：两组患者术后视力较术前均有提高(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91.7%,黄斑裂孔组50%,且视力改善具有统计学差异(P0.05)。 2.mfERG:手术后6个月时,高度近视黄斑劈裂组,P1波1环(黄斑中心凹区)术后潜伏期较术前缩短(P0.05),而高度近视黄斑裂孔组较术前无明显差异、(P0.05)；且黄斑劈裂组1环P1波潜伏期改善程度大于黄斑裂孔组(P0.05)。两组患者1环P1波振幅密度在手术后2、3、6个月时逐渐提高,但仍略低于术前,2环(旁中心凹区)P1波振幅密度较术前无明显提高(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低反应区减少或消失。 3.OCT：高度近视黄斑劈裂组,12眼中有11眼(91.7%)黄斑区解剖结构恢复,1眼(8.3%)好转。高度近视黄斑裂孔组,10眼中有4眼(40%)裂孔闭合,3眼(30%)好转,3眼(30%)未愈合。高度近视黄斑劈裂组黄斑区形态学恢复优于黄斑裂孔组(P0.01)。 4.手术并发症：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产生结论： 1.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。 2.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 changes of visual acuity, multifocal electroretinogram (mfERG) and optical coherence tomography (optical coherence tomography,) before and after vitrectomy of macular split and macular hole in high myopia, and to evaluate the curative effect of the operation. The time of operation was also discussed. Methods: standard three-channel transciliary vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) was performed in our hospital from April 2008 to May 2011 for the treatment of high myopic macular splitting and macular hole failure. 19 patients (22 eyes) with retinal detachment were divided into two groups: macular split group (12 eyes) and macular hole group (10 eyes). The visual acuity was examined by mfERG and Oct. The results of the two groups were statistically analyzed and compared. Results: 1. Visual acuity: the postoperative visual acuity was improved in both groups (P0.05), and the postoperative visual acuity in macular split group was higher than that in macular hole group (P0.05). In the macular split group (91.7%) and macular hole group (50%), the visual acuity improved significantly (P0.05). 2. MfERG: at 6 months after operation, In high myopic macular splitting group, the latency of P1 wave 1 ring (macular fovea) was shorter than that of preoperative group (P0.05), but there was no significant difference between high myopic macular hole group and preoperative group (P0.05), and the improvement degree of P1 wave latency in macular split group was greater than that in macular hole group (P0.05). The amplitude density of P1 wave in both groups increased gradually at 2 and 6 months after operation, but it was still slightly lower than that in the second ring (paracentric fovea) before operation (P0.05). The 3D topography of mfERG showed that the central peak was absent or low, and there were many irregular low response areas in the paracentric fovea. The central peak of 3D topographic map of mfERG was gradually recovered. 3. In high myopia macular split group, 11 eyes (91.7%) had macular anatomic structure recovery and 1 eye (8.3%) had improved in high myopia macular split group. In high myopia group, 4 eyes (40%) in 10 eyes of macular hole had closed hole, 3 eyes (30%) had improved and 3 eyes (30%) had not healed. The morphological recovery of macular area in high myopia macular split group was better than that in macular hole group (P0.01). Operative complications: no iatrogenic hole formation, no intraocular hemorrhage or endophthalmitis and other serious complications: conclusion: 1. Vitrectomy combined with internal membrane dissection is a safe and effective method for the treatment of macular split and macular hole in high myopia. 2. Vitrectomy can effectively preserve visual function and improve visual acuity after macular split formation and visual impairment in high myopia.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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