玻璃体手术治疗特发性黄斑裂孔的疗效分析

目的：探讨玻璃体手术治疗特发性黄斑裂孔的疗效以及光学相干断层成像(optical coherence tomography，OCT)对黄斑裂孔手术疗效评价的价值。方法：回顾性分析经玻璃体手术治疗的特发性黄斑裂孔患者44例44只眼的临床资料。结果：经平均7．4个月的随访，黄斑裂孔闭合消失者14例，裂孔缩小晕轮消失者16例，裂孔大小未变而晕轮消失者9例，此39例(88．6％)孔缘神经上皮层间小囊腔消失、晕轮消失，属于解剖学愈合；27例手术中用自体血清封闭裂孔，17例未用，裂孔解剖学愈合的前者为21例(77．8％)，后者为15例(88．2％)；术后视物变形症状明显改善者38例，视力提高2行以上18例(40．9％)；术后短暂高眼压7只眼，晶状体混浊加重16只眼，医源性视网膜裂孔2只眼，视网膜脱离1只眼，黄斑前膜3只眼。经玻璃体手术治疗成功者OCT图像表现为裂孔周围神经上皮脱离的晕轮消失，裂孔边缘视网膜厚度恢复正常，神经上皮内小囊泡消失，裂孔明显变小甚至消失。结论：玻璃体手术是治疗特发性黄斑裂孔的安全有效方法，OCT是客观评价特发性黄斑裂孔手术疗效的有价值的方法。

Effect of vitrectomy on the treatment of idiopathic macular hole

Objective:To evaluate the effect of vitrectomy on the treatment of idiopathic macular hole and the value of OCT on the assessment of the surgical effect.Method:Clinical data of 44 patients(44 eyes) with idiopathic macular hole that was treated with vitrectomy were analysed retrospectively.Results:These patients were followed up for average 7.4 months,the macular hole was closed in 14 of 44 eyes,shrunk in 16 eyes and not changed in 9 eyes.Auto-serum was used in 27 eyes and not in the other 17 eyes.21 eyes(77.8%)of the 27 eyes obtained anatomic healing while 15 eyes(88.2%)in the latter group.Metamorphopsia was ameliorated in 38 eyes,and visual acuity was improved by 2 lines in 18 eyes(40.9%).Transient elevated intraocular pressure occurred in 7 eyes,opacity of lens increased in 16 eyes,retinal hole developed in 2 eyes,retinal detachment in 1 eye,and macular pre-membrane in 3 eyes.OCT in the patients with successful vitrectomy displayed disappearance of the ring detachment of the sensory retina,resumption of the normal thickness of the hole edge,extinction of the cyst in sensory retina and shrink or disappearance of the hole.Conclusion:Vitrectomy is a safe and effective treatment for idiopathic macular hole and OCT is an objective and valuable method for assessment of the surgical effect.