【摘要】 目的比较内界膜剥除孔周按摩术与内界膜填塞术治疗较大孔径特发性黄斑裂孔(IMH)患者的临床疗效。方法回顾性分析2018年9月至2020年6月于本院收治的IMH患者49例(50眼),裂孔直径为405～698(536.98±73.93)μm; 24例(25眼)患者行玻璃体切割联合内界膜剥除孔周按摩术(A组);25例(25眼)患者行玻璃体切割联合内界膜填塞术(B组)。术后1周、1个月、3个月、6个月定期复查,观察并比较两组患者术眼视力、不同光学相干断层扫描(OCT)分型黄斑裂孔恢复情况、微视野及术后并发症情况。结果术后1周,A组23眼、B组24眼黄斑裂孔闭合,裂孔闭合率分别为92%、96%,两组差异无统计学意义(χ~2=0.355,P=0.552)。术后6个月OCT分型黄斑裂孔愈合形态:A组18眼(72%)、B组11眼(44%)为Ⅰ型愈合,两组差异有统计学意义(χ~2=4.023,P=0.04)。术后1周、1个月、3个月、6个月,两组患者视力均较术前改善,差异均有统计学意义(均为P<0.01);两组患者间比较,术后1周视力差异无统计学意义(t=-1.092,P>0.05),术后1个月、3个月、6个月视力差异均有统计学意义(均为P<0.05),A组患者视力恢复优于B组。两组患者黄斑8°视网膜平均光敏感度和黄斑中心凹2°固视率术后均较术前改善,差异均有统计学意义(均为P<0.01);术后1个月、3个月、6个月,两组患者间差异均有统计学意义(均为P<0.05)。A组1眼术后1周出现高眼压,抗炎及降眼压治疗后恢复;其余术眼随访期间均未出现严重并发症。结论孔径400～700μm的IMH行内界膜剥除孔周按摩术的治疗效果优于内界膜填塞术,值得在临床上推广应用。更多还原

【Abstract】 Objective To compare the clinical efficacy of internal limiting membrane peeling combined with parafoveal retinal massage and internal limiting membrane transposition to treat idiopathic macular holes(IMH) with larger diameter. Methods This study was a retrospective study. A total of 49 IMH patients(50 eyes) with macular holes of 405-698(536.98±73.93) μm admitted in the hospital from September 2018 to June 2020 were selected. Among them, 24 patients(25 eyes) underwent vitrectomy combined with internal limiting membrane peeling and parafoveal retinal massage(group A), and 25 patients(25 eyes) underwent vitrectomy combined with internal limiting membrane transposition(group B). Regular follow-up examinations were performed at 1 week, 1 month, 3 months, and 6 months after surgery to compare the visual acuity, the recovery of macular holes by optical coherence tomography(OCT), the microscopic field, and the postoperative complications. Results One week after surgery, the macular hole was closed in 23 eyes in group A and 24 eyes in group B. The hole closure rate was 92% and 96%, respectively, without statistically significant difference between the two groups(χ~2=0.355, P=0.552). Six months after surgery, type I closure appeared in 18 eyes(72%) in group A and 11 eyes(44%) in group B based on OCT, and the difference between the two groups was statistically significant(χ~2=4.023, P=0.04). Postoperative visual acuity improved in both groups compared with preoperative value, and the differences were statistically significant(all P<0.01). Except at 1 week(t=-1.092, P>0.05), the two groups showed statistically significant differences in visual acuity at 1 month, 3 months and 6 months after surgery(all P<0.05), and vision recovery in group A was better than that in group B. The retinal mean sensitivity(RMS) at 8° of the macula and the fixation rate at 2° of the macular fovea improved in both groups after surgery, and the differences were statistically significant(all P<0.01). Upon comparison between the two groups, there were statistically significant differences in RMS and fixation rate at 1 month, 3 months, and 6 months after surgery(all P<0.05). Ocular hypertension appeared in 1 eye in group A at 1 week after surgery and recovered by anti-inflammatory and intraocular pressure-reducing therapy. No serious complications occurred in the rest of eyes during follow-up examinations. Conclusion For 400-700 μm IMH, internal limiting membrane peeling combined with parafoveal retinal massage is more effective than internal limiting membrane transposition and can be widely used in clinical practice.更多还原