黄斑前增生性病变的玻璃体手术治疗

目的：探讨黄斑区内表面增生性病变玻璃体手术治疗效果帮并发症的防治,方法,对各种原因所致的黄斑区牵引和皱褶共41例（41只眼）行玻璃体手术治疗。包括特发性黄斑前膜12例,黄斑裂孔合并黄斑前膜形成10例,外伤或视网膜脱离复位术后黄斑皱褶19例（不包括 病性眼底病变或视网膜脱离患者）。术哪找前膜与视网膜之间的潜在性间隙（桥底）或粘连薄弱部位,应用笛形针、视网膜钩、铲、镊等眼内器械,将增生膜和玻璃体后界膜剥离干净。结果：41例术中均顺利剥除黄斑区的视网膜前膜、恢复黄斑区的解部形态,除4例术中,术后发生少量视网膜浅层出血外,未见视网膜撕裂、脱离等并发症。术后视力提高者共38例,3例视力保持原有水平,所有患者视物变形均有明显改善甚视力提高,症状缓解,并发症得到有效控制,术前、术后应用光学相干断层成像术检查,有助于了解黄斑区及增生膜的情况,并进行疗效的客观评价。

Vitreous surgery for proliferative maculopathy

Objective To explore the indication of vitrectomy for the treatment of pre macular proliferative disease, the surgical technique, results and the prevention and treatment of complications. Methods Forty one eyes of 41 cases with different kinds of macular traction or macular pucker, including 12 cases of idiopathic epimacular membrane, 10 cases of macular hole complicated with epimacular membrane and 19 cases of macular pucker after reattachment surgery (no diabetic retinopathy or retinal detachment) were treated with vitreous surgery. The issue of this operation is to find out underlying fissures (an under bridge) or weakly adherent sites between a membrane and the retina. Using flute needle, intraocular pick, spade and vitreoretinal forceps, we can separate and peel the proliferative membrane and the posterior cortical vitreous from the retinal surface completely. Results In 41 cases, epimacular membrane was peeled successfully, and the normal anatomic structure of the macula was restored. Four cases had small amount of hemorrhage in the superficial layer of the retina in and after the operation, and all the other cases did not have any complications, such as retinal tear or detachment. Thirty eight cases obtained higher visual acuity, and in 3 cases the visual acuity maintained at their pre operative level. Metamorphopsia was significantly improved, even disappeared. The follow up period was 3 months to 4 years. Conclusions The therapeutic effects of vitreous surgery for treatment of various kinds of proliferative maculopathy are reliable. After the surgery, the visual acuity can be elevated, the symptoms can be ameliorated and the complications can be effectively controlled.