特发性黄斑裂孔术中填充物的探讨

目的:探讨如何选择特发性黄斑裂孔术中的填充物.方法:回顾性分析特发性黄斑裂孔手术患者46例46眼的临床资料.A组(23眼)行经睫状体平坦部的三切口玻璃体切除+内界膜剥除+硅油注入术,B组(23眼)行经睫状体平坦部的三切口玻璃体切除+内界膜剥除+C2F6(20％)注入术,术前应用频域光学相干断层扫描及其深度增强成像技术(EDI-OCT)测量黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)以明确分组.对手术前后最佳矫正视力(best corrected visual acuity,BCVA)、裂孔闭合率、IS/OS破坏直径及手术并发症等进行临床观察.结果:术后随访至少12mo.随访期末A组术后BCVA与术前相比,差异有统计学意义(t=7.659,P＜0.05).B组术后BCVA与术前相比,差异有统计学意义(t=11.648,P＜0.05).A组裂孔闭合率100％,B组裂孔闭合率为95.2％.A组术后IS/OS破坏直径与术前相比差异有统计学意义(t=12.252,P＜0.05),B组术后IS/OS破坏直径与术前相比差异有统计学意义(t=13.257,P＜0.05).并发症:A组术后4眼发生高眼压,B组术后1眼裂孔未闭合继发视网膜脱离,再次行硅油注入术后裂孔闭合.B组术后2眼出现玻璃体积血,1眼吸收,1眼再次行玻璃体腔灌洗术.结论:两种手术方式均可有效治疗特发性黄斑裂孔.A组手术方式可以更持久顶压黄斑区视网膜,利于黄斑裂孔闭合,但是需俯卧较长时间及再次手术取出硅油,增加患者身心和经济负担.B组手术方式无需再次手术取出填充物,但是存在黄斑裂孔不闭合需再次手术的风险.我们将黄斑中心凹下脉络膜厚度作为术前合理选择手术方案的标准,为患者提供个性化的治疗方案.

Investigation of the filler for the treatment of idiopathic macular hole

AIM: To choose the filler for the treatment of idiopathic macular hole(IMH).

METHODS: Clinical data of 46 eyes of 46 cases with IMH who underwent surgical treatment were retrospectively analyzed. Patients in Group A(23 eyes)underwent pars plana vitrectomy + membrane peeling + Silicone oil injection and patients in Group B(23 eyes)underwent pars plana vitrectomy + membrane peeling + C2F6(20%)gas liquid injection. EDI-OCT was used to measure the subfoveal choroidal thickness(SFCT)before the surgery. Changes in best corrected visual acuity(BCVA), the closure rate of hole, the damage diameter of IS/OS and the complications after the surgery were observed.

RESULTS: The follow-up time was 12mo at least. In Group A, the post-operative BCVA improved compared with preoperative one and the difference was statistically significant(t=7.659, P<0.05). In Group B, the post-operative BCVA improved compared with preoperative one and the difference was statistically significant(t=11.648, P<0.05). In Group A, the closure rate of hole is 100%. In Group B, the closure rate of hole is 95.2%. In Group A, the post-operative damage diameter of IS/OS improved compared with preoperative one and the difference was statistically significant(t=12.252, P<0.05). In group B, the post-operative damage diameter of IS/OS improved compared with preoperative one and the difference was statistically significant(t=13.257, P<0.05). Complications: In Group A, high intraocular pressure occurred in 4 eye after the surgery. In group B, retinal detachment with the hole not closed occurred in 1 eye, and the hole was closed after the silicone oil injection again. In Group B, vitreous hemorrhage occurred in 2 eyes after surgery, one eye was absorbed naturally, and one eye needed surgery again.

CONCLUSION: The two kinds of operation can cure IMH effectively. The surgical method of Group A can press the retina persistently, increase the chance of the macular hole closing. But patients needed lie prone for a long time, and needed surgery again to get the silicone oil out, increase the burden of the patients. The surgical method of Group B needn''t surgery again to get the fillers out, but needed surgery again when the macular hole fails to close. We used the SFCT as the guidelines to design the surgical method. We provided personalized treatment for patients.