玻璃体切除手术治疗特发性黄斑裂孔的效果分析

目的 探讨玻璃体切除手术治疗特发性黄斑裂孔的疗效及其影响因素.方法 回顾性系列病例研究.回顾性分析57例(58只眼)经玻璃体切除手术治疗的特发性黄斑裂孔患者的术前裂孔分期、裂孔面积、手术方式、术后裂孔闭合情况、视力改变等临床资料,分析手术效果及其可能的影响因素.采用SPSS 10.0统计学软件对数据进行处理.对两组间的正态分布连续变量资料,采用独立设计定量资料的t检验;对定性变量资料,采用R×C列联表分析;对有序变量资料,采用秩和检验.结果 57例(58只眼)特发性黄斑裂孔患者均进行了玻璃体切除手术联合10%C3F8填充.一次性手术后黄斑裂孔闭合44只眼(75.9%),术前裂孔面积0.01～0.85 mm2,平均0.20 mm2;裂孔未闭合14只眼(24.1%),术前裂孔面积0.08～3.16 mm2,平均0.69 mm2.术中联合视网膜内界膜(ILM)剥离36只眼,其中29只眼一次性手术后裂孔闭合(80.6%),26只眼术后视力提高或不变(72.2%);未联合ILM剥离22只眼,其中15只眼(68.2%)一次性手术后裂孔闭合,13只眼(59.1%)术后视力提高或不变.黄斑裂孔闭合眼与未闭合眼之间进行比较,裂孔面积(P=0.001)和最佳矫正视力改变(P=0.028)的差异均有统计学意义(P<0.05).其他因素并不能显著影响术后最佳矫正视力的改变.结论 玻璃体切除手术是治疗特发性黄斑裂孔的有效手段,术中联合ILM剥离并不能改善裂孔闭合率和视力预后,而裂孔面积却可能影响裂孔的闭合.

Outcome of pars plans vitrectomy on idiopathic macular hole

Objective To assess the efficacy in patients undergoing pars plans vitrectomy for the treatment of idiopathic macular hole (IMH). Methods Retrospective observational case series. Retrospective analysis of vitrectomy for IMH patients treated between January 2001 and January 2008 was performed. The statistical software SPSS10. 0 were used to analyze the data such as surgical technique, closure rate, BCVA, hole size and stage etc. The variables in normal distribution were compared by independent sample t-tests, the qualitative data were compared by R × C table, and the ordered data were compared by nonpuramatric tests. Results Fifty eight eyes of 57 patients underwent vitrectomy with gas (10% C3F8) injection. Primary closure was achieved in 44 eyes (75.9%) with an average hole size of 0. 20 mm2 (0. 01-0. 85 mm2 ), whereas the size in the remaining 14 eyes was 0. 69 mm2 (0. 08-3. 16 mm2 ). The closure rate of the 36 eyes treated with ILM peeling was 80. 6% (29/36), and decreased visual acuity was not observed in 72. 2% of them (26/36). The closure rate of the 22 eyes without ILM peeling was 68. 2% (15/22), and decreased visual acuity was not observed in 59. 1% of them (13/22). There was a significant difference in the size and the change of BCVA between the closed cases and the unclosed cases, and no other factors had significant effect on the BCVA. Conclusions Vitrectomy was evaluated as an useful treatment for IMH. ILM peeling in vitrectomy could not improve the closure rate and the visual outcomes. Preoperative hole size may be a sensitive predictor for postoperative closure.