内界膜剥离治疗特发性黄斑裂孔的早期愈合观察

目的：探讨玻璃体切除联合内界膜剥离治疗特发性黄斑裂孔的早期愈合情况。方法：回顾分析了2001年1月～2003年10月在我院行手术治疗的特发性黄斑裂孔25例(25只限),所有病人均采用经平坦部玻璃体切除联合黄斑前膜和(或)内界膜剥离,气-液交换和16％全氟丙烷(C3F8)充填。术后保持面朝下体位至少2周。采用裂隙灯、前置镜,光学相干断层扫描(OCT)检查观察手术后1个月内的黄斑裂孔的关闭情况。手术后第1周内每天检查,14、21和28d行常规裂隙灯前置镜检查;根据手术后玻璃体腔气体吸收的情况行OCT检查,当气体吸收超过50％,黄斑部露出时即行OCT检查。结果：25只眼中23只眼术中完整的撕除黄斑裂孔周围内界膜,2只眼未能完整撕除裂孔旁的内界膜。在手术后24—48h,23只眼裂隙灯及裂隙灯前置镜检查未发现黄斑裂孔的形态,1个月内的OCT检查证实23只眼黄斑裂孔均闭合．裂孔闭合率为92％,随访期间未发现裂孔再裂开现象。未闭合的2只眼均为手术中未能完整撕除内界膜眼,其中1只眼为3期黄斑裂孔,1只眼为4期黄斑裂孔,在随访期间未见裂孔关闭。术后早期黄斑裂孔关闭的23只眼的OCT形态主要表现为：正常的中心凹形态(简单闭合)15只眼(65,2％),桥样结构8只眼(34．8％)。结论：大部分特发性黄斑裂孔在手术后早期即已关闭,提示特发性黄斑裂孔在形成过程中不伴局部的视网膜组织缺损或缺损极少,手术解除玻璃体,特别是内界膜的机械牵拉后视网膜可复位,裂孔闭合。

Observation of Early Closure of Idiopathic Macular Hole after Vitrectomy Surgery with Internal Limiting Membrance Peeling

Purpose: To observe the early closure of idiopathic macular hole after vitrectomy surgery with internal limiting membrane (ILM) peeling. Methods ? Retrospectively, 25 eyes of idiopathic macular hole in 25 patients were performed vitrectomy surgery with ILM peeling from January of 2001 to October of 2003. All patients maintained the prone position at least 2 weeks after surgery.Slit-lamp examination and optical coherence topography (OCT) were performed to observe the closure of macular hole during 1 month post-operatively. Results: All but 2 eyes of the ILM around the macular hole were peeled successfully.Slit lamp examination showed the configurations of macular hole disappeared in 23 eyes in 24 -48 hours post-operatively and OCT confirmed the macular holes were closed in these eyes during 1 month after surgery. The anatomical closure rate was 92%. The repaired macular holes were classified by the OCT images as being of "simple closure" or "bridge shape". Conclusions : The majority of the idiopathic macular holes were closed in the early stage after surgery.It suggests that there are no or very little tissue loss in the process of idiopathic macular hole,after dismissing the mechanic traction caused by vitreous especially ILM, the hole could be closed.