摘要
目的 比较黄斑裂孔患者玻璃体切除术后行内界膜翻瓣术与内界膜剥离术治疗黄斑裂孔的效果.方法 选取驻马店市第一人民医院2016年3月至2018年3月收治的黄斑裂孔患者40例(40眼),按照随机数字表法分为两组,每组20例.研究组实施玻璃体切除+内界膜翻瓣术,对照组实施玻璃体切除+内界膜剥离术,术后随访6个月.对比两组术后黄斑裂孔闭合率、椭圆体区闭合率、黄斑裂孔闭合类型、黄斑裂孔闭合时间、椭圆体区闭合时间、恢复最佳矫正视力(BVCA)时间;分别于术前及术后5、12、24周检测并比较两组BVCA(logMAR),记录两组术后并发症发生情况.结果 研究组黄斑裂孔闭合率、椭圆体区闭合率分别为100%(20/20)、30%(6/20),高于对照组的70%(14/20)、0%(0/20),P均<0.05.研究组黄斑裂孔闭合类型以U型为主,占50%,对照组以V型为主,占45%,组间比较差异有统计学意义(Z=-2.062,P=0.039).术后5、12、24周,两组BVCA(logMAR)较术前均呈上升趋势,且研究组上升速度高于对照组,差异有统计学意义(P<0.05).研究组黄斑裂孔闭合时间、椭圆体区闭合时间、达到正常BCVA时间分别为(14.21±3.51)、(12.14±2.69)、(30.74±11.24)d,均短于对照组的(21.12±4.67)、(17.32±3.13)、(46.79±12.41)d,P均<0.05.术后1~7 d,研究组出现眼压升高1例,对照组出现眼压升高2例,给予局部降眼压药物治疗后恢复正常;随访6个月,两组均未见其他严重并发症发生.结论 玻璃体切除术后行内界膜翻瓣术治疗黄斑裂孔效果优于内界膜剥离术,患者术后裂孔闭合率高,且多为U型闭合,椭圆体区术后闭合理想,患者视力明显改善,并发症少,是一种安全有效的黄斑裂孔治疗手段.
Objective To compare the therapeutic effects of inverted internal limiting membrane flap technique and internal limiting membrane peeling technique on macular hole after vitrectomy.Methods Forty patients(40 eyes)with macular hole admitted to the First People’s Hospital of Zhumadian from March 2016 to March 2018 were selected,and they were divided into research group and control group according to random number table method,with 20 cases(20 eyes)in each group.All the patients received vitrectomy.In addition,research group was given inverted internal limiting membrane flap technique,while control group was treated by internal limiting membrane peeling technique.And they were given postoperative 6-month follow-up.The closure rate of postoperative macular hole,closure rate of ellipsoid area,closure types of macular hole,closure time of macular hole,closure time of ellipsoid area,time of best corrected visual acuity(BCVA)were compared between the two groups.BVCA(logMAR)was detected before operation and 5,12 and 24 weeks after operation,and the complications of the two groups were recorded.Results The closure rate of macular hole and closure rate of ellipsoid area in research group were 100%(20/20)and 30%(6/20),higher than 70%(14/20)and 0%(0/20)in control group(P<0.05).The closure type of macular hole closure in research group was mainly U-shape(50%),and it was mainly V-type(45%)in control group,and the difference between the two groups was statistically significant(Z=-2.062,P=0.039).At 5,12 and 24 weeks after operation,BVCA(logMAR)in the two groups showed the increased trend,compared with preoperative value,the increased speed of research group was higher than that of control group(P<0.05).The closure time of macular hole,closure time of ellipsoid area,time to normal BCVA in research group were(14.21±3.51)d,(12.14±2.69)d,(30.74±11.24)d,shorter than(21.12±4.67)d,(17.32±3.13)d,(46.79±12.41)d in control group(all P<0.05).After surgery for 1-7 d,1 case of increased intraocular pressure was found in research group and 2 cases of increased intraocular pressure in control group.However,they returned to normal level after locally using intraocular pressure-lowering drugs.During 6-month follow-up,there were no severe complications in neither group.Conclusions Inverted limiting membrane flap technique in the treatment of macular hole after vitrectomy has better therapeutic effects than internal limiting membrane peeling technique.The closure rate of postoperative macular hole is higher,and most of them are U-shape.The inverted internal limiting membrane flap technique can achieve ideal postoperative closure of ellipsoid area,improve patients’visual acuity with less complications,which is a safe and effective treatment method for macular hole.
作者
李辉
王伟献
刘金梅
胡汝平
杨顺
Li Hui;Wang Weixian;Liu Jinmei;Hu Ruping;Yang Shun(The First People’s Hospital of Zhumadian,Zhumadian 463000,China)
出处
《中国实用医刊》
2020年第1期61-65,共5页
Chinese Journal of Practical Medicine
关键词
黄斑裂孔
玻璃体切除术
内界膜翻瓣术
内界膜剥离术
Retinal perforations
Vitrectomy
Inverted internal limiting membrane flap technique
Internal limiting membrane peeling technique
