【摘要】 目的比较经睫状体平坦部玻璃体切割术(PPV)联合内界膜翻转覆盖术与PPV联合游离内界膜移植术治疗大直径黄斑裂孔(MH)的临床疗效和安全性。方法将40例(40只眼)大直径MH(最小直径>400μm)患者按随机数字表法分为翻转组(n=20,20只眼)和移植组(n=20,20只眼)。翻转组采用PPV联合内界膜翻转覆盖术治疗,移植组采用PPV联合游离内界膜移植术治疗。观察2组术后2周裂孔闭合率,术前和术后2周和术后1、3、6个月最小视角对数视力表最佳矫正视力(log MAR BCVA)、眼压的水平及术后手术相关并发症、随访6个月的裂孔复发情况。频域光学相干断层成像(SD-OCT)的图像观察MH直径(测量MH最小直径及基底部最大直径)及MH是否闭合。结果术后2周翻转组裂孔闭合率为100.0%,移植组为95.0%。2组术后2周裂孔闭合率比较差异无统计学意义(P>0.05)。log MAR BCVA:翻转组术前为1.01±0.24,术后2周为0.82±0.32和术后1个月为0.72±0.45、术后3个月为0.52±0.25、术后6个月为0.53±0.42;移植组术前为1.09±0.32,术后2周为0.95±0.45和术后1个月为0.93±0.14、术后3个月为0.81±0.24、术后6个月为0.70±0.23。2组术后log MAR BCVA均较术前明显提高,差异有统计学意义(P<0.05);翻转组术后2周和术后1、3、6个月log MAR BCVA均较移植组明显提高,差异有统计学意义(P<0.05)。2组术后2周和术后1、3、6个月眼压与术前比较差异无统计学意义(P>0.05);2组术后均未出现手术相关并发症;2组均随访6个月,均无裂孔复发。结论 PPV联合内界膜翻转覆盖术治疗大直径MH效果与PPV联合游离内界膜移植术治疗相当,但翻转组术后log MAR BCVA优于移植组。更多还原

【Abstract】 Objective To compare the efficacy and safety of pars plana vitrectomy(PPV) combined with inverted internal limiting membrane(ILM) flap technique and PPV combined with ILM fragment transplantation in the treatment of large-diameter macular hole(MH).MethodsForty patients(40 eyes) with large-diameter MH(minimum diameter >400 μm) were randomly assigned to receive PPV combined with ILM flap inversion(inversion group,20 patients,20 eyes) or ILM fragment transplantation(transplantation group,20 patients,20 eyes).MH closure rate was observed 2 weeks after surgery.The logarithm of the minimal angle of resolution best corrected visual acuity(logMAR BCVA),intraocular pressure and surgery-related complications were determined before and 2 weeks,1 month,3 months and 6 months after surgery.The recurrence of MH was followed up for 6 months.Spectral-domain optical coherence tomography(SD-OCT) images were used to measure MH diameter(minimum MH diameter and maximum base diameter) and MH closure.Results The MH closure rate in inversion group(100.0%) was not significantly different from that in transplantation group(95.0%) at 2 weeks postoperatively(P>0.05).The logMAR BCVAs before and 2 weeks,1 month,3 months and 6 months after surgery were,respectively,1.01±0.24,0.82±0.32,0.72±0.45,0.52±0.25 and 0.53±0.42 in inversion group,and 1.09±0.32,0.95±0.45,0.93±0.14,0.81±0.24 and 0.70±0.23 in transplantation group.After operation,logMAR BCVAs significantly increased in both groups(P<0.05).Compared with transplantation group,logMAR BCVAs obviously increased in inversion group at 2 weeks,1 month,3 months and 6 months postoperatively(P<0.05).There was no significant difference between preoperative and postoperative intraocular pressure in both groups(P>0.05).No surgery-related complication and MH recurrence were found in both groups.Conclusion PPV combined with ILM flap inversion is equivalent to PPV combined with ILM fragment transplantation for treating large diameter MH.However,ILM flap inversion leads to a better postoperative logMAR BCVA than ILM fragment transplantation.更多还原