视网膜内界膜剥除对特发性黄斑裂孔患者术后裂孔愈合的影响

目的　探讨剥除视网膜内界膜对特发性黄斑裂孔患者术后裂孔愈合的影响。方法　对4 1例 (41只眼 )特发性黄斑裂孔患者进行手术治疗。A组 :单纯玻璃体切除 19只眼 ;B组 :玻璃体切除加视网膜内界膜剥除 2 2只眼。A组患者进行玻璃体切除、气体或液体交换及C3 F8眼内填充术 ;B组患者在A组术式的基础上 ,于术中增加黄斑区视网膜内界膜剥除。所有患者术后均保持面朝下体位10～ 14d。结果　 4 1只眼中 ,术后黄斑裂孔完全闭合 37只眼 ,相干光断层扫描显示黄斑裂孔已消失 ,总闭合率为 90 2 %。其中A组 19只眼中 ,有 15只眼黄斑裂孔闭合 ,闭合率为 78 9% ,视力略有提高 ;裂孔未闭 4只眼 ,相干光断层扫描仍见黄斑裂孔 ,视力无提高或降低。B组 2 2只眼经相干光断层扫描 ,证实黄斑裂孔已完全闭合 ,闭合率为 10 0 0 % ,视力明显提高。经Fisher精确概率检验 ,两组患者裂孔闭合率比较 ,差异有显著意义 (χ2 =4 86 5 ,P <0 0 5 ) ;视力改变比较 ,差异无显著意义(χ2 =0 0 0 0 ,P >0 0 5 ) ,但视力提高 2行以上者的差异有显著意义 (χ2 =4 385 ,P <0 0 5 )。结论　玻璃体手术是治疗黄斑裂孔患者的有效方法 ,而视网膜内界膜剥除有利于术后裂孔的闭合及其解剖结构的愈合

The effect of internal limiting membrane removal on healing of idiopathic macular hole

Objective To prospectively investigate the effect on macular hole healing after internal limiting membrane (ILM) removal during idiopathic macular hole (IMH) surgery Methods Forty one consecutive patients (forty one eyes) with idiopathic macular hole underwent pars plana vitrectomy (PPV) combined with surgical removal of the epiretinal membranes overlying the hole, gas/fluid exchange and C 3F 8 intraocular tamponade The patients were randomly divided into two groups, group A 19 patients in non ILM peeling group, group B 22 patients in ILM peeling group who underwent the removal of internal limiting membrane surrounding the hole Results Among the 41 cases, IMHs were completely closed in 37 eyes (90 2%) In the ILM removal group, IMHs were closed in 22 cases (22/22, 100%) In the non ILM removal group, IMHs were closed only in 15 eyes (15/19, 78 9%) There was a significant difference between the two groups ( P <0 05) Conclusion PPV is a valid treatment for IMH and the removal of ILM may help IMH close after surgery