玻璃体切割手术后继发黄斑裂孔的临床研究

目的研究玻璃体切割手术后继发黄斑裂孔(MH)的相关因素.方法对2007年3月至2011年2月收治的玻璃体切割手术后继发 MH 患者7例(7只眼)进行回顾性分析.结果7例继发性 MH 与一期玻璃体手术之间平均间隔7.4个月(2~15个月).按原发疾病分为视网膜脱离3例,增生性糖尿病视网膜病变4例.所有病例均于局麻下行玻璃体切割联合内界膜剥离手术,术后平均随访10.8个月(3~14个月).单次手术裂孔闭合率为71.4%(5只眼),2例未闭合患者均放弃继续治疗. MH 术前最佳矫正视力为0.02~0.2,平均0.13,术后最佳矫正视力为0.08~0.4,平均0.18.视力提高眼4只眼(57.1%),视力不变2只眼(28.6%),视力下降1只眼(14.3%).结论玻璃体切割手术后继发黄斑裂孔发病率较低,通过玻璃体切割联合内界膜玻璃体手术治疗可以取得令人满意的疗效.

Development of macular holes after vitrectomy

Objective To access the factors associated with the development of a macular hole after vitrectomy.Methods 7 eyes that developed macular holes after vitrectomy between March 2007 and Feb 2011 in our hospital were reviewed.Results The mean interval between the vitrectomy and onset of a macular hole was 7.4 months with a range from 2 to 15 months.The initial vitrectomy was performed on 3 eyes with rhegmatogenous retinal detachment and 4 eyes with proliferative diabetic retinopathy.All cases underwent vitrectomy with removal of the internal limiting membrane,and the mean follow-up time after surgery was 10.8 months with a range from 3 to 14 months.Single operation macular hole closure rate was 71.4%(5 eyes).Preoperative best corrected visual acuity ranged from 0.02 to 0.2,with a mean of 0.13.Postoperative best corrected visual acuity ranged from 0.08 to 0.4,with a mean of 0.18.Visual acuity had improved in 4 eyes(57.1%),unchanged in 2 eyes(28.6%),and declined in 1 eye.Conclusion The incidence of macular hole after vitrectomy is very rare,and these cases can be repaired by vitrectomy with removal of the internal limiting membrane.The pathogenesis of the formation of these holes remains unclear.