残留曲安奈德对特发性黄斑裂孔的愈合及组织水肿消退的研究

目的：探讨残留曲安奈德对特发性黄斑裂孔(IMH)愈合及组织水肿消退的临床作用。

方法：患者32例32眼实施闭合玻璃体切割术。试验组16例16眼术中应用曲安奈德(TA)辅助剥除内界膜，并残留少许曲安奈德于黄斑裂孔底部。对照组16例16眼未用辅助剂剥除内界膜。术后随访6～12mo，比较两组黄斑裂孔解剖复位、术后最佳矫正视力(BCVA)与黄斑裂孔指数情况。对结果进行统计学分析。

结果：术后所有的黄斑裂孔均达到解剖复位，闭合率100%。两组术后BCVA均较术前有所提高(P=0.000)。两组之间的视力改善无统计学意义(P>0.05)。两组术后BCVA与黄斑裂孔指数(MHI)呈正相关，与裂孔高度无相关性。试验组手术时间较对照组明显缩短。两组均无严重并发症发生。

结论：术中应用曲安奈德有助于内界膜剥除。残留曲安奈德不影响特发性黄斑裂孔的愈合及组织水肿的消退； MHI计算简便，可作为临床预后的指标。未见与TA有关的副作用。

Clinical study on residual triamcinolone acetonide in the treatment of idiopathic macular hole and lessening of tissue edema

AIM: To evaluate the clinical effects of residual triamcinolone acetonide(TA)on the treatment of idiopathic macular hole(IMH)and lessening of tissue edema.

METHODS: A total of 32 patients(32 eyes)underwent closed vitrectomy. During the operation, TA was applied to 16 eyes of experimental group to assist internal limiting membrane peeling. A small amount of TA was left at the bottom of the macular hole. The others eyes of control group didn't use TA to assist internal limiting membrane peeling. Anatomical reduction, postoperative BCVA and macular hole index(MHI)were recorded and the statistical analysis was made.

RESULTS:All the macular holes reached the anatomical reduction after operation, the closing rate was 100%. Postoperative BCVA of the two groups were improved(P=0.000). The visual improvement between the two groups had no statistical significance(P>0.05). There is a positive correlation between postoperative BCVA and MHI, and there is no correlation between postoperative BCVA and the hole degree. The operation time in experimental group was shorter than in control group. No serious complications occurred in both groups.

CONCLUSION:Intraoperative application of TA was helpful for peeling off internal limiting membrane. Residual TA has no influence on the treatment of idiopathic macular hole or lessening of tissue edema. The MHI can be easily calculated to be used as a clinical index for visual acuity. It is an effective technique with no serious side effects.