摘要
目的观察玻璃体切除联合内界膜剥除并内界膜翻瓣填塞治疗大直径特发黄斑裂孔的临床疗效。方法回顾性分析2016年10月至2018年7月在我院眼科行玻璃体切除联合内界膜剥除并内界膜翻瓣填塞治疗的大直径(最小直径>400μm)特发性黄斑裂孔26例(26只眼)。手术方法均采用标准经睫状体平坦部三通道23G玻璃体切除术。手术中清除玻璃体后皮质后,曲安奈德辅助标记黄斑区内界膜,约2个视盘直径处环形剥除内界膜,但黄斑裂孔边缘处不完全剥除,玻璃体剪对剥离内界膜进行修剪后,用玻璃体切割头将黄斑裂孔周围的内界膜瓣翻折后轻轻填塞到黄斑裂孔中,气液交换。俯卧位3~4 d。术后至少随访3个月,观察术后视力变化、中心暗点、黄斑裂孔闭合情况及术中、术后并发症情况。结果术后最佳矫正视力(BCVA)0.04~0.6,黄斑裂孔均闭合,其中1型闭合6只眼,视力0.04~0.1;2型闭合3只眼,视力0.08~0.25;3型闭合12只眼,视力0.15~0.3,4型闭合5只眼,视力为0.4~0.6。Amsler方格表检查24只眼中心暗点消失,但12只眼存在视物颜色改变。术中最常见的并发症少量点状出血,术后自诉闪光感6只眼。结论玻璃体切除联合内界膜剥除并内界膜翻瓣填塞治疗最小直径>400μm的特发性黄斑裂孔的临床疗效良好。
Objective To assess the clinical efficacy of vitrectomy combined with internal limiting membrane(ILM)peeling and inverted ILM flap technique in the treatment of large diameter idiopathic macular hole.Methods Data from 26 patients(26 eyes)with large diameter(minimum diameter>400μm)idiopathic macular hole from October 2016 to July 2018 were analyzed retrospectively.All patients received vitrectomy combined with ILM peeling and inverted ILM flap technique.Standard trans-ciliary planar three-channel 23 gauge vitrectomy was performed for all patients.In addition,after removal of the posterior vitreous cortex,triamcinolone acetonide was used to label the ILM in the macular area.The ILM was torn annularly at about 2 disc diameters from the macular,but not completely removed at the edge of the macular hole.The stripped ILM was further shaped using a vitreous scissor,and the ILM flaps around the macular hole were folded with a vitreous cutter and inverted into the macular hole.Gas-liquid exchange were performed subsequently.Patients were asked to remain in prone position for 3 to 4 days.The followed-up time was at least 3 months,and visual acuity,central scotoma,macular hole closure as well as intraoperative and postoperative complications were observed.Results The best corrected visual acuity ranged from 0.04 to 0.6.All macular holes were closed,including 6 eyes with type 1 closure and visual acuity of 0.04 to 0.1,3 eyes with type 2 closure and visual acuity of 0.08 to 0.25,12 eyes with type 3 closure and visual acuity of 0.15 to 0.3,and 5 eyes with type 4 closure and visual acuity of 0.4 to 0.6.The central dark spots disappeared in 24 eyes,but the color perception changed in 12 eyes.The most common intraoperative complication was minor punctate hemorrhage,and 6 cases reported flash sensation after the surgery.Conclusions Vitrectomy combined with ILM peeling and inverted ILM flap technique is effective in the treatment of idiopathic macular hole with minimum diameter>400μm.
作者
胥利平
周明
孟祥俊
沈健
刘豪杰
Xu Liping;Zhou Ming;Meng Xiangjun;Shen Jian;Liu Haojie(Department of Ophthalmology,the Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China)
出处
《临床眼科杂志》
2020年第1期22-24,共3页
Journal of Clinical Ophthalmology
关键词
黄斑裂孔
大直径
玻璃体切除
内界膜
内界膜剥除
内界膜翻瓣
Macular hole
Large diameter
Vitrectomy
Internal limiting membrane
Internal limiting membrane peeling
Internal limiting membrane inverted
