特发性黄斑裂孔发病机制研究及内界膜剥离手术的临床疗效
发布时间：2018-11-06 16:02
【摘要】：特发性黄斑裂孔发病机制研究及内界膜剥离手术的临床疗效 目的 本研究旨在：(1)应用光学相干断层扫描(optical coherence tomography,OCT)探讨特发性黄斑裂孔(idiopathic macular hole,IMH)的发病机制；(2)观察玻璃体切割术(par plana vitrectomy, PPV)联合内界膜剥离术(internal limiting membrane peeling, ILMP)治疗IMH的临床疗效；(3)观察曲安奈德(triamcinolone acetonide,TA)、吲哚菁绿(indocyanine green, ICG)在IMH手术中的的染色效果。 方法 第一部分：收集IMH的患者39例43眼的OCT图像,依据Gass分期标准对裂孔进行分期,其中17眼(均为2-4期)接受了PPV联合ILMP手术,观察、对比、分析不同分期及术后OCT图像特点,探讨IMH的发病机制。第二部分：28例30眼行’TA、ICG双染色辅助PPV联合ILMP,观察术中TA、ICG染色情况、裂孔闭合率、及术前术后最佳矫正视力(best corrected visual acuity, BCVA),术中、术后并发症等,评价PPV联合ILMP治疗IMH的临床疗效及TA、ICG辅助染色的效果。 结果 1.1期裂孔中有4/5(80.0%)可观察到玻璃体后脱离(posterior vitreous detachment, PVD)对中心凹的牵拉,2期裂孔10/13(76.9%)可观察到PVD对中心凹的牵拉,3、4期裂孔玻璃体与中心凹粘连分离,3期11/16(68.7%)、4期7/9(77.8%)可观察到ILM增厚,反光增强。2-4期裂孔均有孔缘囊样病变、呈“鱼嘴样”翻卷上翘,并且裂孔形态几乎均为圆形,而PPV联合ILMP术后裂孔边缘囊样病变、“鱼嘴样”翻卷上翘均完全消失。 2.PPV联合ILMP 30眼术中玻璃体后皮质、内界膜染色效果好,TA.ICG辅助染色很大程度增加了手术能见度；术后随访5.00±1.62月,一次性手术裂孔闭合27眼,闭合率90%,22眼(73.33%)视力提高2行或2行以上 结论 1.IMH1期的主要发病机制是PVD对中心凹的前后方向牵拉；3、4期主要发病机制是ILM离心性张力和视网膜表面增殖膜收缩共同作用的结果；2期裂孔PVD中心凹牵拉、ILM离心性张力两种因素都存在 2.PPV联合ILMP是IMH安全、有效的治疗方法,能使大部分患者的裂孔闭合、视力改善。 3.PPV联合ILMP术中采用‘TA、ICG辅助染色可减小手术的难度,增加手术安全性。
[Abstract]:Study on the pathogenesis of idiopathic macular hole and the clinical curative effect of internal boundary membrane dissection objective: (1) to investigate the (idiopathic macular hole, of idiopathic macular hole by optical coherence tomography (optical coherence tomography,OCT) IMH); (2) to observe the clinical effect of vitrectomy with (par plana vitrectomy, PPV) combined with internal membrane dissection (internal limiting membrane peeling, ILMP) in the treatment of IMH; (3) to observe the staining effect of triamcinolone acetonide (triamcinolone acetonide,TA) and indocyanine green (indocyanine green, ICG) in IMH operation. Methods the first part was to collect the OCT images of 39 patients with IMH and 43 eyes. According to the standard of Gass staging, 17 eyes (2-4 stage) underwent PPV combined with ILMP operation. To investigate the pathogenesis of IMH by analyzing the features of different stages and postoperative OCT images. The second part: 28 cases (30 eyes) were observed by 'TA,ICG double staining and PPV combined with ILMP, to observe the intraoperative TA,ICG staining, the closure rate of the hole, the preoperative and postoperative best corrected visual acuity (best corrected visual acuity, BCVA), postoperative complications, and so on. To evaluate the clinical effect of PPV combined with ILMP in the treatment of IMH and the effect of TA,ICG auxiliary staining. Results 4 / 5 (80. 0%) of the 1. 1 phase hiatus could be observed to pull the fovea from the posterior vitreous detachment (posterior vitreous detachment, PVD), and 10 / 13 (76. 9%) of the second phase (10 / 13) could be observed by PVD to the fovea. In stage 3, 11 / 16 (68.7%) and 7 / 9 (77.8%) of ILM were observed. The shape of the fished-beak was almost round, but after PPV combined with ILMP, the saccular lesion of the rifts and the upturn of the "fish-beak" were completely disappeared. In 30 eyes of 2.PPV combined with ILMP, the intravitreous posterior cortex was stained well, and the operative visibility was greatly increased by TA.ICG auxiliary staining. The postoperative follow-up was 5.00 卤1.62months, 27 eyes were closed, the closure rate was 90%. The visual acuity of 22 eyes (73.33%) was improved by 2 or more lines. Conclusion the main pathogenesis of 1.IMH1 stage is the pulling of PVD to the fovea. 3The main pathogenesis of stage 4 is the effect of ILM centrifugal tension and the contraction of proliferative membrane on the surface of retina. 2.PPV combined with ILMP is a safe and effective treatment for PVD in stage 2, which can close the hole and improve the visual acuity of most of the patients. The use of 'TA,ICG auxiliary staining in 3.PPV combined with ILMP can reduce the difficulty of operation and increase the safety of operation.
【学位授予单位】：辽宁医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6
本文编号：2314764
[Abstract]:Study on the pathogenesis of idiopathic macular hole and the clinical curative effect of internal boundary membrane dissection objective: (1) to investigate the (idiopathic macular hole, of idiopathic macular hole by optical coherence tomography (optical coherence tomography,OCT) IMH); (2) to observe the clinical effect of vitrectomy with (par plana vitrectomy, PPV) combined with internal membrane dissection (internal limiting membrane peeling, ILMP) in the treatment of IMH; (3) to observe the staining effect of triamcinolone acetonide (triamcinolone acetonide,TA) and indocyanine green (indocyanine green, ICG) in IMH operation. Methods the first part was to collect the OCT images of 39 patients with IMH and 43 eyes. According to the standard of Gass staging, 17 eyes (2-4 stage) underwent PPV combined with ILMP operation. To investigate the pathogenesis of IMH by analyzing the features of different stages and postoperative OCT images. The second part: 28 cases (30 eyes) were observed by 'TA,ICG double staining and PPV combined with ILMP, to observe the intraoperative TA,ICG staining, the closure rate of the hole, the preoperative and postoperative best corrected visual acuity (best corrected visual acuity, BCVA), postoperative complications, and so on. To evaluate the clinical effect of PPV combined with ILMP in the treatment of IMH and the effect of TA,ICG auxiliary staining. Results 4 / 5 (80. 0%) of the 1. 1 phase hiatus could be observed to pull the fovea from the posterior vitreous detachment (posterior vitreous detachment, PVD), and 10 / 13 (76. 9%) of the second phase (10 / 13) could be observed by PVD to the fovea. In stage 3, 11 / 16 (68.7%) and 7 / 9 (77.8%) of ILM were observed. The shape of the fished-beak was almost round, but after PPV combined with ILMP, the saccular lesion of the rifts and the upturn of the "fish-beak" were completely disappeared. In 30 eyes of 2.PPV combined with ILMP, the intravitreous posterior cortex was stained well, and the operative visibility was greatly increased by TA.ICG auxiliary staining. The postoperative follow-up was 5.00 卤1.62months, 27 eyes were closed, the closure rate was 90%. The visual acuity of 22 eyes (73.33%) was improved by 2 or more lines. Conclusion the main pathogenesis of 1.IMH1 stage is the pulling of PVD to the fovea. 3The main pathogenesis of stage 4 is the effect of ILM centrifugal tension and the contraction of proliferative membrane on the surface of retina. 2.PPV combined with ILMP is a safe and effective treatment for PVD in stage 2, which can close the hole and improve the visual acuity of most of the patients. The use of 'TA,ICG auxiliary staining in 3.PPV combined with ILMP can reduce the difficulty of operation and increase the safety of operation.
【学位授予单位】：辽宁医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6
【参考文献】
相关期刊论文 前1条
1 戴虹,卢颖毅,李永,师自安;特发性黄斑裂孔患者术后裂孔愈合形态与视功能恢复的研究[J];中华眼科杂志;2004年07期
，本文编号：2314764
本文链接：https://www.wllwen.com/yixuelunwen/yank/2314764.html
最近更新
教材专著
