本文選題：黃斑裂孔　切入點：特發(fā)性黃斑裂孔　出處：《天津醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的探討前后聯(lián)合手術治療特發(fā)性黃斑裂孔(idiopathic macular hole,IMH)、高度近視性黃斑裂孔(high myopicmacular hole.,HMMH)伴視網(wǎng)膜脫離以及不伴視網(wǎng)膜脫離三種類型的患者最佳矯正視力(best-corrected visual acuity,BCVA)相關因素的分析。方法從2015年1月至2015年12月在天津市眼科醫(yī)院的43例黃斑裂孔患者(特發(fā)性黃斑裂孔25例、高度近視性黃斑裂孔伴視網(wǎng)膜脫離9例、高度近視性黃斑裂孔不伴視網(wǎng)膜脫離9例)行前后聯(lián)合手術,術前眼部檢查包括視力、眼內壓(intraocular pressure,IOP)、裂隙燈、間接眼底鏡、頻域光學相干斷層掃描(spectral-domain optical coherence tomography,SD-OCT)。所有患者全部行三通道平坦部玻璃體切割、吲哚青綠染色,同時行白內障超聲乳化聯(lián)合后房型人工晶體植入,行氣液交換后,玻璃體腔注入0.3ml純C3F8,術后2w、1m、3m、6m門診復查,復查時進行最佳矯正視力、裂隙燈下前置鏡觀察眼底、眼壓、IOL Master、黃斑區(qū)OCT檢查,每個患者隨訪6個月后進行數(shù)據(jù)整理,記錄術前術后最佳矯正視力、眼軸、黃斑裂孔愈合情況、驗光結果及患者基本資料等指標,并進行統(tǒng)計學分析。結果三種類型黃斑裂孔術后結果表明特發(fā)性黃斑裂孔術后6個月觀察期間中心凹外層視網(wǎng)膜不斷發(fā)生形態(tài)學改變,25例全部可見外界膜愈合出現(xiàn),92%集中在3-6個月出現(xiàn)外界膜愈合,外界膜愈合時間與術前視力呈負相關(r=-0.4047,p=0.0448),術前平均視力0.16±0.12,術后6m平均視力0.63±0.22。眼軸與視力呈負相關(P=0.0482),術前眼軸與術后2w、1m、3m、6m眼軸差異有統(tǒng)計學意義(P0.0001),術后2w、1m、3m、6m之間比較眼軸差異沒有統(tǒng)計學意義。高度近視性黃斑裂孔伴視網(wǎng)膜脫離的術前平均視力0.05±0.07,術后6m平均視力視力0.39±0.29,眼軸與各時間點視力沒有相關性(p=0.6718),術前術后眼軸沒有統(tǒng)計學意義,術前視力是外界膜愈合的保護因素(χ~2=16.49 P0.0001)。高度近視性黃斑裂孔不伴視網(wǎng)膜脫離的術前平均視力0.13±0.09,術后6m平均視力視力0.42±0.26,年齡是外界膜愈合的危險因素(χ~2=8.35 p=0.0038),術前視力是外界膜愈合的保護因素(χ~2=4.12 p=0.0425),各個時間點的視力與眼軸呈負相關(p=0.0025),術前、術后眼軸各時間點的變化有統(tǒng)計學意義,術后各個時間點眼軸自身對比沒有意義。結論1.黃斑裂孔術后外層視網(wǎng)膜超微結構和形態(tài)是不斷發(fā)生變化的,而且與視功能有密切聯(lián)系,術前視力越好,外界膜愈合的越早,而且外界膜的愈合多發(fā)生在3-6個月,外界膜出現(xiàn)越早,術后視力越好。年齡是外界膜的危險因素,術前視力是外界膜愈合的保護因素。2.眼軸的變化與視力有相關性,眼軸越短,視力越好。在黃斑裂孔術后眼軸的變化是沒有統(tǒng)計學意義的。而與術前的變化可能是由于黃斑區(qū)視網(wǎng)膜組織的形態(tài)學改變和偏心注視造成的。
[Abstract]:Objective to investigate the factors associated with combined anterior and posterior surgery for the treatment of idiopathic macular hole macular, high myopicmacular HMMH with high myopic macular hole and retinal detachment and without retinal detachment. Methods from January 2015 to December 2015, 43 patients with macular hole (25 cases of idiopathic macular hole) in Tianjin Eye Hospital were analyzed. 9 cases of high myopic macular hole with retinal detachment and 9 cases of high myopic macular hole without retinal detachment) were performed combined anterior and posterior surgery. Preoperative eye examination included visual acuity, intraocular pressure, intraocular pressure IOP, slit lamp, indirect fundus lens. Frequency-domain optical coherence tomography (OCTA) optical coherence tomphography. All patients were treated with three-channel flat vitrectomy, indocyanine green staining, cataract phacoemulsification and posterior chamber intraocular lens implantation, and after gas-liquid exchange, all the patients underwent phacoemulsification and posterior chamber intraocular lens implantation. A total of 0.3 ml pure C3F8 was injected into the vitreous cavity. The outpatient examination was performed 2 weeks after operation. The best corrected visual acuity (BCVA), intraocular pressure (IOL) Masterboard, macular OCT were observed under slit lamp, and each patient was followed up for 6 months for data collation. The preoperative and postoperative best corrected visual acuity (BCVA), eye axis, macular hole healing, optometry and basic data of the patients were recorded. Results the postoperative results of three types of macular holes showed that there were continuous morphological changes in the outer retina of the central fovea during 6 months after the operation of idiopathic macular holes. All 25 cases had external membrane healing. At present, 92% of the patients had external membrane healing in 3-6 months. There was a negative correlation between the healing time of external membrane and preoperative visual acuity. The mean visual acuity was 0.16 鹵0.12 before operation and 0.63 鹵0.22 at 6 m after operation. There was a negative correlation between eye axis and visual acuity. There was significant difference between preoperative eye axis and postoperative visual acuity (P 0.0001). The mean preoperative visual acuity of high myopic macular hole with retinal detachment was 0.05 鹵0.07, the average visual acuity of 6 m after operation was 0.39 鹵0.29, and there was no correlation between eye axis and visual acuity at different time points. There was no statistical significance between preoperative and postoperative visual acuity. Preoperative visual acuity was the protective factor of external membrane healing (蠂 ~ 2 / 2 ~ (16.49) P _ (0.0001)). The mean preoperative visual acuity without retinal detachment was 0.13 鹵0.09 in high myopic macular hole and 0.42 鹵0.26 in 6 m postoperatively. Age was a risk factor for external membrane healing (蠂 ~ 2 / 2 ~ (8.35) p ~ (0.0038), preoperative visual acuity). It is a protective factor of external membrane healing (蠂 ~ 2 ~ 2 ~ 4. 12 p ~ (0.0425)). The visual acuity of each time point is negatively related to the axial axis of the eye. Before operation, there is a negative correlation between the visual acuity and the axial axis of the eye. There was statistical significance in the changes of the ocular axis at each time point after operation, but there was no significance in the contrast of the eye axis itself at each time point after operation. Conclusion 1. The ultrastructure and morphology of the outer retina after macular hole surgery are constantly changing. Moreover, there is a close relationship with visual function. The better the preoperative visual acuity, the earlier the external membrane is healed, and the more the external membrane healing occurs in 3-6 months, the earlier the external membrane appears, the better the postoperative visual acuity. Age is the risk factor of the external membrane. Preoperative visual acuity is the protective factor of external membrane healing. The visual acuity is better. There is no statistical significance in the change of eye axis after macular hole. The changes before operation may be caused by morphological changes of retinal tissue in macular area and eccentricity fixation.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R779.6

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