玻璃体切割联合晶状体囊膜移植治疗难治性黄斑裂孔的效果和安全性

目的　回顾性分析玻璃体切割联合晶状体囊膜移植治疗难治性黄斑裂孔的效果和安全性。方法　收集2017年10月至2020年10月于武汉大学人民医院东院眼科行玻璃体切割联合晶状体囊膜移植治疗的难治性黄斑裂孔患者共15例（15眼）。使用OCT评估患者黄斑裂孔闭合情况，比较手术前后患者最佳矫正视力（BCVA），并记录术中、术后并发症情况。患者术后随访至少3个月。结果　15例患者中有13例患者黄斑裂孔完全愈合，2例患者黄斑裂孔未愈合。未愈合者均为高度近视黄斑裂孔伴视网膜脱离的患者。黄斑裂孔愈合的患者未见裂孔再开放，解剖愈合率为86.7%。晶状体囊膜移植术前患者BCVA（logMAR）为1.49±0.33，术后为1.27±0.39，差异有统计学意义（t=2.913，P=0.011），术后BCVA较术前提高。所有患者术中均未发生晶状体囊膜移植片移位，术后随访期间均未出现眼内炎、晶状体上皮细胞或Müller细胞过度增殖等并发症。结论　玻璃体切割联合晶状体囊膜移植能有效治疗难治性黄斑裂孔，提高黄斑裂孔愈合率，并能改善患者视力。

Clinical efficacy and safety of vitrectomy combined with lens capsular flap transplantation in the treatment of refractory macular holes

Objective To retrospectively analyze the clinical efficacy and safety of vitrectomy combined with lens capsular flap transplantation in the treatment of refractory macular holes.Methods A total of 15 patients(15 eyes)with refractory macular holes treated by vitrectomy combined with lens capsular flap transplantation in the Ophthalmology Department of the Renmin Hospital of Wuhan University from October 2017 to October 2020 were collected.The closure of macular holes was evaluated by optical coherence tomography(OCT).Preoperative and postoperative best corrected visual acuity(BCVA)was compared.Intraoperative and postoperative complications were recorded.The patients were followed up for at least 3 months.Results Macular holes were completely closed in 13 patients.The rest 2 patients with macular holes unclosed had high myopia and retinal detachment.The closed macular holes did not open again;thus,the anatomic success rate was 86.7%.The postoperative BCVA(logMAR)was 1.27±0.39,which improved significantly compared with the preoperative level(1.49±0.33)(t=2.913,P=0.011).No lens capsule displacement was found during surgery,and no postoperative complications such as endophthalmitis,excessive proliferation of lens epithelial cells and Müller cells were detected during the follow-up period.Conclusion Vitrectomy combined with lens capsular flap transplantation can effectively treat refractory macular holes.It can increase the closure of macular holes and improve the vision of patients.