特发性黄斑裂孔手术前后矫正视力及多焦视网膜电图比较

目的 观察特发性黄斑裂孔(IMH)玻璃体切割手术(PPV)联合吲哚青绿(ICG)辅助内界膜剥除治疗前后的矫正视力及多焦视网膜电图(mfERG)的改变.方法 回顾分析我科接受PPV联合0.25%ICG辅助内界膜剥除治疗的特发性黄斑裂孔患者19例19只眼的临床资料.所有患眼手术前裂孔情况和手术后2个月裂孔闭合情况均以OCT检查为依据.采用VERIS Science 4.9视觉诱发反应图像系统观察手术前及手术后2、6、12个月患者mfERG6个环形视网膜区域mfERG的P1波振幅密度,同时分析比较手术前后最佳矫正视力的改变情况.结果 手术后2个月,OCT检查显示16例16只眼黄斑裂孔闭合,占84.21%;3例3只眼黄斑裂孔未闭合,占15.79%.手术后最佳矫正视力较手术前提高,其中以手术后2个月提高幅度最大(F=6.389,P=0.045).手术后2、6、12个月mfERG各环P1波振幅较手术前均明显降低,其差异均有统计学意义(t=6.140,P＜0.05).结论 IMH患者手术后最佳矫正视力提高;手术后P1波振幅较手术前降低.     

特发性黄斑裂孔的微视野检查

目的 探讨特发性黄斑裂孔(IMH)的微视野检查特征.方法 应用MP-1微视野仪(Nidek TeclnnoIogles Vigonza Italy-MP-1)检测了11例(19只眼)特发性黄斑裂孔患者,记录患眼的固视情况,以及中心20度的光敏感度.结果 特发性黄斑裂孔周围的四个象限的黄斑20度视网膜平均光敏感度(Meansensitivity,MS)明显下降,四个象限之间的差异具有显著性意义(P<0.05).结论 MP-1微视野计检查可以量化评价特发性黄斑裂孔的黄斑区MS,并为手术治疗提供了重要的辅助信息.     

特发性黄斑裂孔与外伤性黄斑裂孔玻璃体切割手术治疗预后差异比较

目的 观察玻璃体切割手术治疗特发性黄斑裂孔和外伤性黄斑裂孔的预后差异及其影响因素.方法 对特发性黄斑裂孔72例72只眼,外伤性黄斑裂孔55例55只眼的临床资料进行回顾性分析.所有患眼均接受相同方式的玻璃体切割手术治疗.观察两组患者手术后视力改变和黄斑裂孔闭合形式;对比分析黄斑裂孔直径、手术前视力＜0.1和≥0.1、病程＜4个月和≥4个月与手术后视力改变和黄斑裂孔闭合形式之间的相关性.结果 特发性黄斑裂孔72只眼中,闭合72只眼,占100.0%;外伤性黄斑裂孔 55只眼中,闭合47只眼,占85.5%;黄斑裂孔贴附8只眼,占14.5%.特发性黄斑裂孔的裂孔闭合高于外伤性黄斑裂孔的裂孔闭合,二者比较,差异有统计学意义(χ2=11.177,P=0.001).特发性黄斑裂孔和外伤性黄斑裂孔手术后视力与手术前视力比较,差异均有统计学意义(t=-6.841,-4.093;P值均=0.000).特发性黄斑裂孔和外伤性黄斑裂孔手术后视力提高者组间比较,差异无统计学意义(χ2=3.651,P=0.07).特发性黄斑裂孔手术前视力＜0.1和≥0.1的患眼手术后视力提高者之间比较,差异有统计学意义(x=12.04,P=0.001).外伤性黄斑裂孔手术前视力＜0.1和≥0.1的患眼手术后视力提高者之间比较,差异无统计学意义(χ2=0.371,P=0.486).特发性黄斑裂孔手术后视力提高者手术前黄斑裂孔直径小于手术后视力不提高者,差异有统计学意义(t=2.476,P=0.016).外伤性黄斑裂孔的裂孔闭合者手术前黄斑裂孔直径小于裂孔贴附者手术前黄斑裂孔直径,差异有统计学意义(t=-4.042,P＜0.001).外伤性黄斑裂孔病程＜4个月和≥4个月的患眼,手术后视力改变之间(χ2=0.704)、黄斑裂孔闭合形式之间(χ2=0.166)比较,差异无统计学意义(P=0.401,0.684).结论 特发性黄斑裂孔的裂孔闭合率优于外伤性黄斑裂孔的裂孔闭合率.黄斑裂孔直径和手术前视力是影响特发性黄斑裂孔视力预后的主要因素;而手术前视力和病程对外伤性黄斑裂孔的视力预后无显著影响.     

玻璃体切除手术治疗特发性黄斑裂孔的效果分析

目的 探讨玻璃体切除手术治疗特发性黄斑裂孔的疗效及其影响因素.方法 回顾性系列病例研究.回顾性分析57例(58只眼)经玻璃体切除手术治疗的特发性黄斑裂孔患者的术前裂孔分期、裂孔面积、手术方式、术后裂孔闭合情况、视力改变等临床资料,分析手术效果及其可能的影响因素.采用SPSS 10.0统计学软件对数据进行处理.对两组间的正态分布连续变量资料,采用独立设计定量资料的t检验;对定性变量资料,采用R×C列联表分析;对有序变量资料,采用秩和检验.结果 57例(58只眼)特发性黄斑裂孔患者均进行了玻璃体切除手术联合10%C3F8填充.一次性手术后黄斑裂孔闭合44只眼(75.9%),术前裂孔面积0.01～0.85 mm2,平均0.20 mm2;裂孔未闭合14只眼(24.1%),术前裂孔面积0.08～3.16 mm2,平均0.69 mm2.术中联合视网膜内界膜(ILM)剥离36只眼,其中29只眼一次性手术后裂孔闭合(80.6%),26只眼术后视力提高或不变(72.2%);未联合ILM剥离22只眼,其中15只眼(68.2%)一次性手术后裂孔闭合,13只眼(59.1%)术后视力提高或不变.黄斑裂孔闭合眼与未闭合眼之间进行比较,裂孔面积(P=0.001)和最佳矫正视力改变(P=0.028)的差异均有统计学意义(P<0.05).其他因素并不能显著影响术后最佳矫正视力的改变.结论 玻璃体切除手术是治疗特发性黄斑裂孔的有效手段,术中联合ILM剥离并不能改善裂孔闭合率和视力预后,而裂孔面积却可能影响裂孔的闭合.     

黄斑裂孔手术前后固视、微视野和mERG的检测

目的用激光扫描眼底镜检测黄斑裂孔手术前后固视、微视野和多焦视网膜电图(mERG),比较这几种方法评价黄斑功能的可靠性.方法实验采集了因老年特发黄斑裂孔,行玻璃体切割术治疗后,黄斑裂孔闭合的12例患者,手术前后的固视、微视野、mERG的检测资料.用Rodenstock的激光扫描眼底镜(SLO)进行固视和微视野的检测.用Rodenstock的RETIscan 3.12系统进行mERG测定24°视野范围的一阶反应(first-order kernel).结果12例黄斑裂孔患者术后远视力提高6例,不变4例,下降2例;近视力提高9例,不变2例,下降1例.术前为非中心凹注视10例,术后注视改善7例,无改善3例;术前即为中心凹注视2例.术后光敏度较术前有明显提高,P＜O.05.mERG黄斑裂孔术前三维视觉山表现为火山口形状,术后黄斑裂孔闭合可观察到视觉山恢复的患者4例,术后视觉山形状无明显改善8例.mERG的中心1、2环的值手术前后无明显改变,P＞0.05.结论手术后的远近视力较术前均有所提高;固视和微视野对于检测黄斑功能的改变比较敏感,其中微视野改善更明显.mERG无明显改变,在检测黄斑功能方面受到变异性、固视等诸多因素影响.     

25G玻璃体切除联合空气填充治疗特发性黄斑裂孔

目的:观察对于特发性黄斑裂孔行25G玻璃体切除联合空气填充治疗后的解剖和视功能结果.方法:前瞻性干预性分析.27例(30眼)特发性黄斑裂孔患者接受25G经睫状体平坦部玻璃体切除术,同时行白内障超声乳化抽吸联合人工晶体置入和玻璃体腔无菌空气填充.所有患者在术前和术后3mo进行最佳矫正视力(logMAR视力)、视野检查和多焦视网膜电流图(multifocal electroretinography, mfERG)检查,使用OCT明确黄斑裂孔闭合情况.结果:首次手术后28眼的黄斑裂孔闭合,平均logMAR视力由术前的0.72±0.22提高到术后的0.29±0.18(P<0.001).中心10°视野检查中,平均偏差(mean deviation, MD)由术前的-3.59±1.83 dB减少到术后的-2.51±1.36 dB (P<0.001),平均模式标准差(pattern standard deviation, PSD)由术前的1.86±0.68 dB减少到术后的1.33±0.32 dB (P=0.001).MfERG中可见术后中心凹和旁中心凹区域的平均振幅明显升高,而4-6环区域的平均潜伏期明显延长(P<0.05).疾病病程长短(P<0.001)和1环区域的术前N1波振幅(P=0.001)对术后最佳矫正视力有预测作用.结论:特发性黄斑裂孔患者行25G玻璃体切除联合空气填充,术后保持1d的面向下体位,有很好的解剖成功率和视功能结果.     

亮蓝辅助内界膜剥离治疗特发性黄斑裂孔的临床观察

目的观察亮蓝(BBG)辅助视网膜内界膜(ILM)剥离治疗特发性黄斑裂孔的临床效果及影响因素。方法对2009年6月至2011年7月在我院就诊的一组III、IV期特发性黄斑裂孔患者行玻璃体切割亮蓝辅助内界膜剥离治疗的37例(37只眼)患者的临床资料进行回顾性分析,将术后黄斑裂孔I型闭合眼分为A组,黄斑裂孔II型闭合眼分为B组,所有病例术前均行常规最佳矫正视力(BCVA)、眼压、裂隙灯显微镜+90D前置镜眼底检查、B型超声、相干光断层扫描(OCT)检查。手术后随访6～16个月,观察患者手术后视力、裂孔闭合形式以及黄斑裂孔直径、厚度对术眼愈后的影响。结果 37例(37只眼)特发性黄斑裂孔均闭合,占100%,其中Ⅰ型闭合29只眼(A组),占78.4%,Ⅱ型闭合8只眼(B组),占21.6%,A、B两组手术后的视力较术前视力均提高,差异有统计学意义(P﹤0.01),且A组术后视力较B组好(P﹤0.05)。A组患眼手术前的黄斑裂孔直径小于B组,两者比较差异有统计学意义(P﹤0.01),A组患眼手术前的黄斑裂孔厚度小于B组,两者比较差异有统计学意义(P﹤0.05)。结论亮蓝辅助视网膜内界膜剥离治疗特发性黄斑裂孔是非常有效的手术方法,黄斑裂孔的直径和厚度是黄斑裂孔愈合的影响因素。     

亮蓝辅助内界膜剥离术治疗特发性黄斑裂孔的疗效

目的 探讨亮蓝染色下玻璃体切割注气联合内界膜剥离术治疗特发性黄斑裂孔患者的疗效.方法 对15例(15眼)特发性黄斑裂孔患者行玻璃体切割注气联合亮蓝辅助内界膜剥离术,观察术后黄斑裂孔闭合情况、视力、眼压及并发症等.结果 术中15眼患者内界膜染色效果均较好,剥离顺利.术后随访3个月,13眼黄斑裂孔闭合,闭合率为86.7%;2眼视力无变化.余视力均较术前有不同程度提高;未见由亮蓝注射导致的急性毒性反应和白内障、高眼压、医源性视网膜损伤等并发症.结论 亮蓝辅助内界膜剥离术治疗特发性黄斑裂孔是一种安全有效的方法.     

内界膜剥离治疗特发性黄斑裂孔的早期愈合观察

目的：探讨玻璃体切除联合内界膜剥离治疗特发性黄斑裂孔的早期愈合情况。方法：回顾分析了2001年1月～2003年10月在我院行手术治疗的特发性黄斑裂孔25例(25只限),所有病人均采用经平坦部玻璃体切除联合黄斑前膜和(或)内界膜剥离,气-液交换和16％全氟丙烷(C3F8)充填。术后保持面朝下体位至少2周。采用裂隙灯、前置镜,光学相干断层扫描(OCT)检查观察手术后1个月内的黄斑裂孔的关闭情况。手术后第1周内每天检查,14、21和28d行常规裂隙灯前置镜检查;根据手术后玻璃体腔气体吸收的情况行OCT检查,当气体吸收超过50％,黄斑部露出时即行OCT检查。结果：25只眼中23只眼术中完整的撕除黄斑裂孔周围内界膜,2只眼未能完整撕除裂孔旁的内界膜。在手术后24—48h,23只眼裂隙灯及裂隙灯前置镜检查未发现黄斑裂孔的形态,1个月内的OCT检查证实23只眼黄斑裂孔均闭合．裂孔闭合率为92％,随访期间未发现裂孔再裂开现象。未闭合的2只眼均为手术中未能完整撕除内界膜眼,其中1只眼为3期黄斑裂孔,1只眼为4期黄斑裂孔,在随访期间未见裂孔关闭。术后早期黄斑裂孔关闭的23只眼的OCT形态主要表现为：正常的中心凹形态(简单闭合)15只眼(65,2％),桥样结构8只眼(34．8％)。结论：大部分特发性黄斑裂孔在手术后早期即已关闭,提示特发性黄斑裂孔在形成过程中不伴局部的视网膜组织缺损或缺损极少,手术解除玻璃体,特别是内界膜的机械牵拉后视网膜可复位,裂孔闭合。     

玻璃体切除联合自体浓缩血小板封闭 特发性黄斑裂孔疗效观察

目的探讨玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔的临床疗效。方法玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔手术１４例（１５只眼）,随访３～１６个月,对裂孔封闭情况及视力、视野中心阈值、Ａｍｓｌｅｒ方格表、荧光素眼底血管造影及手术并发症进行观察。结果８６．７％的手术眼裂孔完全闭合,视力增加２行以上者占８６．７％;Ａｍｓｌｅｒ方格表异常者术后视力全部改善;视野中心阈值手术前后差异无显著性（Ｐ＝０．３４）;荧光素眼底血管造影显示部分患眼术后黄斑孔处中央低荧光,其外围以窗样透见荧光环;术中主要并发症为视网膜裂孔,术后主要并发症为白内障加重。结论玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔可使大部分患眼裂孔闭合,视力改善,但尚需多中心、大样本研究及长期随诊后进一步加以验证     

Thickness of Retinal Nerve Fiber Layer Decreases after Vitreous Surgery for Idiopathic Macular Hole

Purpose: The alteration of the retinal nerve fiber thickness (NFLT) before and after vitreous surgery for a macular hole in cases with or without visual field defects was investigated.Methods: The NFLT of 23 eyes with idiopathic macular hole was measured with scanning laser polarimeter up to 12 months after surgery. The NFLT was divided into superior, inferior, nasal, and temporal quadrants. The mean NFLT of each quadrant was analyzed statistically and compared to the results of visual field tests.Results: In all cases, the NFLT decreased significantly up to 3 months after surgery, but increased gradually up to 12 months. In cases with visual field loss, the thickness of the nerve fiber layer that corresponds to the visual field defect diminished strongly, in contrast with other quadrants. Even in cases without visual field loss, the NFLT decreased significantly a month after surgery, especially in the nasal and inferior quadrants.Conclusion: This study demonstrates that the thickness of retinal nerve fiber layer decreases at least one month after surgery, even in cases without visual field defect. This may suggest the existence of a subclinical complication of vitreous surgery.     

Thickness of retinal nerve fiber layer decreases after vitreous surgery for idiopathic macular hole

PURPOSE: To investigate the alteration of the retinal nerve fiber thickness (NFLT) before and after vitreous surgery for a macular hole in cases with or without visual field defects. METHODS: The NFLT of 23 eyes with idiopathic macular hole was measured with scanning laser polarimeter upto 12 months after surgery. The NFLT was divided into superior, inferior, nasal, and temporal quadrants. The mean NFLT of each quadrant was analyzed statistically and compared to the results of visual field tests. RESULTS: In all cases, the NFLT decreased significantly upto 3 months after surgery, but increased gradually upto 12 months. In cases with visual field loss, the thickness of the nerve fiber layer that corresponds to the visual field defect diminished strongly, in contrast with other quadrants. Even in cases without visual field loss, the NFLT decreased significantly a month after surgery, especially in the nasal and inferior quadrants. CONCLUSION: This study demonstrates that the thickness of retinal nerve fiber layer decreases at least one month after surgery, even in cases without visual field defect. This fact may suggest the existence of a subclinical complication of vitreous surgery.     

Causes of visual field defects after vitrectomy]

PURPOSE: An inferotemporal visual field defect sometimes occurs following vitreous surgery for idiopathic macular hole. There is a possibility that this visual field defect is due to damage to the superonasal retina by fluid or air irrigation through an inferonasal infusion port. We tested this hypothesis by placing the infusion port in the inferonasal sector during vitreous surgery. CASES AND METHOD: We performed vitreous surgery on 31 eyes with idiopathic macular hole. The infusion port was placed in the inferonasal sector. The vitreous cavity was replanced either by 20% SF6 or 12% C3F8. We did not abrade the retinal pigment epithelium within the hole. The visual field was assessed before and 1 month after surgery using a Goldmann perimeter. FINDINGS: Three eyes developed a wedge-shaped visual field defect in the inferonasal sector. No visual field defect developed in the other 28 eyes. CONCLUSION: The findings show that visual field defect following surgery for idiopathic macular hole is dependent upon the site of the infusion port. We presume that the visual field defect is consequent to retinal damage caused by the flow of air or fluid during surgery.     

Macular Hole Surgery-Associated Peripheral Visual Field Loss

To examine in more detail the peripheral visual field loss after macular hole surgery, we reviewed a series of 38 consecutive patients (44 eyes) with idiopathic macular hole who underwent vitrectomy and fluid–gas exchange. Ten (22.7%) eyes of 9 patients developed peripheral visual field loss shortly after successful surgery. This complication was characterized by mild to moderate wedge-shaped visual field loss that predominantly affected the inferotemporal periphery. Of these 9 patients, 2 complained of peripheral visual field loss, and the 7 others remained asymptomatic. The peripheral visual field loss remained unchanged for a mean follow-up of 18.5 months, except in one case of complete recovery. The thickness of the retinal nerve fiber layer was measured postoperatively to determine whether any damage to the optic nerve head had occurred during surgery. The information obtained in this study did not provide conclusive evidence for the understanding of the pathomechanism of the macular hole surgery-associated visual field loss. Peripheral visual field defect after otherwise uneventful surgery for idiopathic macular hole is probably not uncommon. This complication is variable in its severity and is usually permanent. Whether it is caused by any surgical trauma to the optic nerve head remains to be elucidated.     

Results of macular hole surgery in patients over 80 years of age

PURPOSE: To evaluate the results of macular hole surgery in patients over 80 years of age to determine if surgery is beneficial in an elderly patient population. METHODS: Twenty consecutive patients over age 80 with idiopathic macular holes and 20 nonconsecutive controls younger than 80 years treated for idiopathic macular holes were compared in a retrospective, consecutive case-control series. RESULTS: The macular hole was closed 3 months after surgery in 19/20 eyes (95%) of patients over age 80 years and 17/20 eyes (85%) of patients under 80 years. The mean preoperative visual acuity was 20/160 in patients over 80 years and 20/160-1 in patients under 80 years. The mean visual acuity at 3 months was 20/63 in eyes of patients over 80 years and 20/80 in eyes of patients under 80 years (P = 0.3). The mean visual acuity was 20/50-2 in eyes of patients over 80 years and 20/63-2 in eyes of patients under 80 years at the final examination (P = 0.403). CONCLUSIONS: Macular hole surgery is beneficial in patients over 80 years of age, with very similar results to those of patients younger than 80 years of age. Age should not be the primary criterion for recommending macular hole surgery.     

曲安奈德辅助玻璃体后脱离联合不染色剥除内界膜治疗Ⅱ、Ⅲ期特发性黄斑裂孔的临床观察

目的 评价曲安奈德(TA)辅助玻璃体后脱离(PVD)联合不染色剥除内界膜(ILM)治疗Ⅱ、Ⅲ期特发性黄斑裂孔(IMH)的解剖和视力预后.方法 对Ⅱ、Ⅲ期IMH患者23例23只眼常规行最佳矫正视力(BCVA)、晶状体状态、光相干断层扫描(OCT)检查并进行黄斑裂孔分期.手术前BCVA为0.04～0.40,最小视角对数(logMAR)视力为0.398～1.398,平均0.846±0.310.患者均先在TA辅助下行人工PVD,然后在无染色条件下剥除黄斑区ILM.手术中联合白内障摘除手术5只眼.手术后随访时间6～16个月,平均随访时间9个月.统计分析黄斑裂孔解剖成功率、手术前后BCVA、手术并发症.结果 手术后1个月OCT检查显示,黄斑裂孔闭合22只眼,占95.7%;黄斑裂孔未闭合1只眼,占4.3%,再行气液交换后黄斑裂孔成功闭合.至随访期末,均未见黄斑裂孔重新开放.手术后6个月BCVA为0.12～0.90,logMAR视力为0.046～0.921,平均视力为0.410±0.209,手术前后BCVA比较,差异有统计学意义(t=6.636,P＜0.000 1).视力提高21只眼,占91.3%;视力不变者2只眼,占8.7%;无视力下降者.剥除ILM 时视网膜表面出现1～3个点状自限性出血者5只眼.手术后未发生视网膜脱离或玻璃体积血等严重并发症.手术后晶状体核密度增加9只眼,一过性眼压升高6只眼.结论 TA辅助PVD联合不染色剥除ILM治疗Ⅱ、Ⅲ期IMH是一种安全有效的方法.

Abstract：

Objective To evaluate the anatomic and visual outcomes of idiopathic macular holes treated with triamcinolone (TA)-assisted posterior vitreous detachment (PVD) and then internal limiting membrane (ILM) peeling without any dye. Methods Twenty-three patients (23 eyes) with stage Ⅱand Ⅲidiopathic macular holes were enrolled. The best-corrected visual acuity (BCVA), the lens, the duration,stage and size of the macular holes were measured before and after the surgery. The preoperative BCVA was 0.04 to 0.40; the logMAR was 0.398 to 1.398 with the mean of 0.846±0.310. All surgery involved TA-assisted PVD and then ILM peeling without any dye.Combined cataract extraction with vitrectomy was performed on 5 eyes.The follow-up ranged from 6 to 16 months with the mean of 9 months. Results Anatomic macular hole closure was achieved in 22 eyes (95.7%) at the first month after surgery and in 23eyes (100.0%) finally. At the 6th months after surgery, the BCVA was 0.12 to 0.90, logMAR was 0.046 to 0.921 with the mean of 0.410±0.209, compared with preoperative BCVA, the difference was statistically significant (t=6.636, P＜0.0001). BCVA increased in 21 eyes (91.3%) and kept unchanged in 2 eyes (8.7%). There are 1-3 spots self-limited bleeding on the retinal surface when the ILM was peeled in 5 eyes. Postoperative complications included progression of cataract in 9 patients and transient intraocular pressure elevation in 6 patients. Conclusions TA-assisted PVD and then ILM peeling without any dye is an effective and safe surgical technique in stage Ⅱ and Ⅲ idiopathic macular hole.     

特发性黄斑裂孔手术治疗前后的视功能

目的 探讨特发性黄斑裂孔手术治疗前后患者的视功能。方法 19例(19只眼)特发性黄斑裂孔患者,其中2期3只眼,3期10只眼,4期6只眼。采用玻璃体视网膜手术治疗黄斑裂孔。术前和术后均进行国际标准视力、激光视网膜视力、明视强度反应ERG和Humphrey　30-2程序视野测定。 结果 (1)国际标准视力：术前视力0.01至0.1,术后视力0.04至0.4,术前术后视力改变差异无显著性的意义(p＞0.05)。(2)激光视网膜视力：术前激光视网膜视力0.12至0.4,术后激光视网膜视力 从0.2至0.63。术前和术后激光视网膜视力改变差异有显著性的意义(P＜0.05)。(3)ERG明视强度反应曲线：术前和术后b波最大振幅Rmax(μV)和代表曲线斜率的n值的改变差异均无显著性的意义(P＞0.05)。术后半饱合光刺激强度K(cd·sec/m2)的对数单位Log值,较术前降低,差异有显著性的意义(P＜0.05)。(4)Humphrey视野：术后 0～10° 较术前光阈值提高,差异 有显著性的意义(P＜0.05)。术前和术后15～30°光阈值差异无显著性的意义(P＞0.05)。 结论 手术治疗IMH能提高视网膜黄斑部视锥细胞功能。（中华眼底病杂志,2000,16：213-284）     

Improvement of visual acuity one-year after vitreous surgery in eyes with residual triamcinolone acetonide at the macular hole

PURPOSE: To investigate whether triamcinolone acetonide in the macular hole after surgery interferes with anatomic macular hole repair or visual acuity improvement. DESIGN: Prospective, interventional case series with historical comparison. METHODS: Pars plana vitrectomy and triamcinolone acetonide-assisted internal limiting membrane peeling were performed in 26 eyes (24 patients) with stage 3 or 4 idiopathic macular hole. The visual acuities one-year after surgery were compared between eyes with and without residual triamcinolone acetonide after surgery. RESULTS: The macular holes were closed successfully in all 26 eyes. Nine eyes (35%) had residual triamcinolone acetonide in the macular hole at the end of the surgery and in the fovea on day 3 after surgery. The mean preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity +/- standard deviation was 0.73 +/- 0.36 and improved significantly to 0.20 +/- 0.29 one-year after surgery (P = .010). In the nine eyes with residual triamcinolone acetonide, the preoperative mean logMAR triamcinolone acetonide was 0.81 +/- 0.33, which improved to 0.20 +/- 0.19 one-year after surgery (P = .013). In the remaining 17 eyes, the mean visual acuity also improved from 0.71 +/- 0.38 before surgery to 0.21 +/- 0.28 after surgery (P = .001). No significant difference was found between the groups in preoperative and postoperative logMAR visual acuities. CONCLUSIONS: Residual triamcinolone acetonide in the macular hole does not interfere with anatomic or visual improvement.     

内界膜剥除孔周按摩术与内界膜填塞术治疗较大孔径特发性黄斑裂孔的对比研究

目的　比较内界膜剥除孔周按摩术与内界膜填塞术治疗较大孔径特发性黄斑裂孔（IMH）患者的临床疗效。方法　回顾性分析2018年9月至2020年6月于本院收治的IMH患者49例（50眼）,裂孔直径为405～698（536.98±73.93）μm;24例（25眼）患者行玻璃体切割联合内界膜剥除孔周按摩术（A组）;25例（25眼）患者行玻璃体切割联合内界膜填塞术（B组）。术后1周、1 个月、3个月、6个月定期复查,观察并比较两组患者术眼视力、不同光学相干断层扫描（OCT）分型黄斑裂孔恢复情况、微视野及术后并发症情况。结果　术后1周,A组23眼、B组24眼黄斑裂孔闭合,裂孔闭合率分别为92%、96%,两组差异无统计学意义（χ²=0.355,P=0.552）。术后6个月OCT分型黄斑裂孔愈合形态:A组18眼（72%）、B组11眼（44%）为Ⅰ型愈合,两组差异有统计学意义（χ²=4.023,P=0.04）。术后1周、1个月、3个月、6个月,两组患者视力均较术前改善,差异均有统计学意义（均为P<0.01）;两组患者间比较,术后1周视力差异无统计学意义（t=-1.092,P>0.05）,术后1个月、3个月、6个月视力差异均有统计学意义（均为P<0.05）,A组患者视力恢复优于B组。两组患者黄斑8°视网膜平均光敏感度和黄斑中心凹2°固视率术后均较术前改善,差异均有统计学意义（均为P<0.01）;术后1个月、3个月、6个月,两组患者间差异均有统计学意义（均为P<0.05）。A组1眼术后1周出现高眼压,抗炎及降眼压治疗后恢复;其余术眼随访期间均未出现严重并发症。结论　孔径400~700 μm的IMH行内界膜剥除孔周按摩术的治疗效果优于内界膜填塞术,值得在临床上推广应用。