23 G玻璃体切除术治疗特发性黄斑裂孔前后黄斑区视网膜厚度比较

目的：比较23G玻璃体切除术治疗特发性黄斑裂孔前后黄斑区视网膜厚度变化情况，定量分析手术前后黄斑区视网膜全层、视神经纤维层厚度。方法选取2013年6月至2015年4月我院收治的22例（23只眼）特发性黄斑裂孔患者为研究对象，所有患者术前1个月内行黄斑频域OCT检查，按ETDRS黄斑分区分别测量中心凹、黄斑内环、黄斑外环4个象限视网膜全层厚度，黄斑内环、黄斑外环4个象限视网膜神经纤维层厚度。所有患者由同一术者行23G玻璃体切除术，术后1个月时同样行黄斑频域OCT检查，测量术前相应区域视网膜全层、视神经纤维层厚度，术前术后相应位置指标行配对t检验。结果术后1个月OCT检查裂孔闭合率100％。术后1个月黄斑中心凹视网膜全层厚度（256．83±23．27）μm，与术前（361．39±62．14）μm相比明显减少，差异具有统计学意义（ P ＜0.01）；黄斑内环鼻侧、颞侧、上侧、下侧视网膜全层厚度分别为（299．26±28．51）μm、（271．43±15．56）μm、（286．61±19．20）μm、（282．30±24．71）μm，与术前（344．83±54．27）μm、（324．57±42．14）μm、（319．74±36.42）μm、（347．48±49．07）μm相比均明显减少，差异具有统计学意义（均为P ＜0.01）；黄斑外环鼻侧、颞侧、上侧、下侧视网膜全层厚度分别为（286．96±17．52）μm、（243．39±35．47）μm、（257．04±19．63）μm、（264．65±16.58）μm，与术前相比差异均无统计学意义（均为P ＞0.05）。黄斑内环鼻侧、下侧视网膜神经纤维层厚度分别为（20.70±9．30）μm、（21．87±12．07）μm，与术前（30.39±19．50）μm、（34．70±19．34）μm相比明显减少，差异具有统计学意义（均为P ＜0.05），颞侧、上侧分别为（18．13±11．10）μm、（28．43±11．05）μm，与术前相比差异无统计学意义（均为P ＞0.05）；黄斑外环鼻侧、颞侧、上侧、下侧视网膜神经纤维层厚度分别为（42．30±14．47）μm、（19.52±14．30）μm、（36．30±15．05）μm、（38．26±15．04）μm，与术前相比差异均无统计学意义（均为P ＞0.05）。结论23G玻璃体切除术治疗特发性黄斑裂孔能使裂孔有效闭合，术后能减轻黄斑中心凹、黄斑内环视网膜水肿，黄斑内环鼻侧、下侧视神经纤维层厚度亦有所减少，黄斑形态趋于正常。

Comparison of retinal thickness before and after 23-G vitrectomy for idiopathic macular hole

Objective To investigate the changes of macular retinal thickness and macular retinal nerve fiber layer thickness in eyes with idiopathic macular hole after 23-G pars plana vitrectomy.Methods Twenty-three eyes of 22 pa-tients with an idiopathic macular hole who underwent 23-G PPV with ILM peeling at the Tianjin Medical University Eye Hospital between June 2013 and April 2015 were studied.The macular was separated into nine areas and retinal thickness and retinal nerve fiber layer thickness were measured by SD-OCT before surgery and one month after vitrectomy.All data of the corresponding areas before and after vitrectomy were analyzed by paired t test.Results All macular holes were suc-cessfully closed one month after vitrectomy.Average foveal thickness reduced from 361.39 ±62.14 to 256.83 ±23.27μm with highly significant difference ( P <0.01).Nasal, temporal, superior, and inferior retinal thickness of macular inner ring also significantly reduced, while macular outer ring thickness were not significantly changed.Nasal and inferior RNFL thickness of macular inner ring significantly reduced as well.Conclusions 23-G PPV can make successful closure of a macular hole.Foveal edema and inner ring retina thickness significantly reduced and RNFL thickness of inner nasal and in-ferior also reduced, indicating restoration of normal macular anatomy.