摘要
目的探讨术中光学相干断层扫描(intraoperative optical coherence tomography,iOCT)在特发性黄斑裂孔(idiopathic macular holes,IMH)不同手术治疗方式中的应用价值。方法收集武汉市第一医院2021年1月至2021年12月间收治的因IMH行iOCT辅助下玻璃体切除的手术患者,进行回顾性研究。按照不同的手术方式(内界膜剥除术、内界膜翻转覆盖术、内界膜填塞术),将所有纳入的患者进行分组。所有患者均行iOCT检查,评估术中患眼黄斑区视网膜各层结构的形态变化,内界膜剥除的完整性,黄斑裂孔边缘的形态,以及术中黄斑区视网膜微损伤等情况。比较3种手术方式治疗后,患眼的裂孔闭合率、最佳矫正视力(best-corrected visual acuity,BCVA)变化以及术后并发症情况。结果经过筛选后共有72例患者纳入研究,男23例,女49例,平均年龄(57.88±7.21)岁,随访6个月。在所有手术患者中,完成内界膜剥除后,iOCT观察到有15只患眼黄斑裂孔边缘出现了形态学变化,有18(18/72,25%)只眼出现术中视网膜微损伤,其中12只眼出现神经纤维层的异常,如神经纤维层出血,另6只眼出现视网膜内层结构的轻度抬高。iOCT显示首次剥膜完成后,8(8/72,11.1%)只患眼仍可观察到前膜碎片,提示剥膜不完整,进行了2次剥除,其余64只眼则完全剥除。内界膜填塞组和内界膜翻转覆盖组均通过iOCT得到确认。内界膜剥除组,内界膜填塞组和内界膜翻转覆盖组3组患者眼术后1周、1个月和6个月的BCVA均高于术前,结果差异显著(均P<0.05)。内界膜剥除组、内界膜填塞组和内界膜翻转覆盖组3组裂孔闭合率分别为89.7%、91.3%、95.0%,组间无明显差异(均P>0.05)。三组手术患者术中及术后均未见与手术操作相关的严重并发症。结论内界膜剥除术、内界膜填塞术和内界膜翻转覆盖术都是治疗IMH的有效术式。iOCT能够在术中清晰地实时动态观察黄斑区视网膜的形态,尤其是黄斑裂孔的细微结构改变,有利于提升术者对手术区域的认识,指导手术操作,优化手术决策,改善手术后患者视力。
Objective To evaluate the application value of intraoperative optical coherence tomography(iOCT)in the treatment of idiopathic macular holes(IMH)using various surgical techniques.Methods A retrospective analysis was conducted on patients who underwent vitrectomy assisted by iOCT for IMH at Wuhan No.1 Hospital from January 2021 to December 2021.All the included patients were categorized based on the different surgical methods:internal limiting membrane(ILM)peeling,inverted ILM coverage,and ILM filling.All patients underwent iOCT examinations to assess morphological changes in the retinal layers of the macular region,the integrity of ILM peeling,the morphology of the macular hole edges,and any intraoperative retinal microdamage.The closure rates of macular holes,changes in best-corrected visual acuity(BCVA),and postoperative complications were compared among three surgical approaches.Results After selection,a total of 72 patients were included in the study,consisting of 23 males and 49 females,with an average age of(57.88±7.21)years and a follow-up period of 6 months.After completing ILM peeling,iOCT revealed morphological changes at the edges of the macular holes in 15 eyes,and intraoperative retinal microdamage occurred in 18 eyes(25%).Among these,12 eyes exhibited abnormalities in the nerve fiber layer,such as hemorrhage,while 6 showed mild elevation of the inner retinal structures.iOCT indicated that 8 eyes(11.1%)still had remnants of the anterior membrane after the initial peeling,suggesting incomplete peeling and a second peeling was performed.The remaining 64 eyes had complete peeling.BCVA significantly improved in the ILM peeling group,ILM filling group,and ILM inversion coverage group at 1 week,1 month,and 6 months post-surgery compared to preoperative values(P<0.05).The closure rates for the macular holes in the ILM peeling group,ILM filling group,and ILM inversion coverage group were 89.7%,91.3%,and 95.0%,respectively,with no significant differences among the groups(P>0.05).No severe complication related to the surgical procedure was observed in any of the three groups during or after surgery.Conclusion ILM peeling,ILM filling,and ILM inversion coverage are all effective surgical techniques for treating IMH.iOCT can clearly and dynamically observe the morphology of the retina in the macular area in real time during the operation,especially the subtle structural changes of the macular hole.It is beneficial to improve the surgeon's understanding of the surgical area,guide the operation,optimize the surgical decision,and improve the postoperative visual acuity of patients.
作者
李芳
罗艳
肖泽锋
Li Fang;Luo Yan;Xiao Zefeng(Department of Ophthalmology,Wuhan No.1 Hospital,Wuhan 430022,China)
出处
《华中科技大学学报(医学版)》
北大核心
2025年第1期112-116,共5页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
基金
武汉市卫生健康委员会医学科研项目(No.WX20B24)。
关键词
术中光学相干断层扫描
特发性黄斑裂孔
内界膜剥除术
内界膜翻转覆盖术
内界膜填塞术
intraoperative optical coherence tomography
idiopathic macular hole
internal limiting membrane peeling
inverted internal limiting membrane coverage
internal limiting membrane filling
