本文選題：原發(fā)性黃斑裂孔　切入點(diǎn)：玻璃體切割術(shù)　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:玻璃體切割術(shù)(pars plana vitrectomy,PPV)聯(lián)合內(nèi)界膜剝除術(shù)(internal limiting membrane peeling,ILMP)和眼內(nèi)氣體填充是目前公認(rèn)治療原發(fā)性黃斑裂孔(primary macular hole,PMH)的首選方法,本研究分析了PPV術(shù)后分別采用空氣或C3F8填充治療II~III期PMH的臨床資料,對比觀察兩種氣體填充對于PMH修復(fù)和視力預(yù)后的有效性及安全性,并探尋各術(shù)前因素與術(shù)后視力的相關(guān)性。方法:回顧性病例分析,收集2014年10月至2016年12月在重慶醫(yī)科大學(xué)附屬第一醫(yī)院眼科確診并接受手術(shù)治療的PMH患者39例39眼,均行標(biāo)準(zhǔn)三通道經(jīng)睫狀體平坦部23GPPV聯(lián)合ILMP,術(shù)中眼內(nèi)填充無菌空氣組20例20眼、眼內(nèi)注入10%C3F8組19例19眼,所有符合納入標(biāo)準(zhǔn)的患者均收集術(shù)前及術(shù)后1周、1月、3月最佳矯正視力(best corrected visual acuity,BCVA)、眼壓及光學(xué)相干斷層掃描(optical coherence tomography,OCT)。BCVA轉(zhuǎn)化為log MAR后利用SPSS19.0軟件行下列檢驗(yàn):(1)組內(nèi):空氣組或C3F8組各自組內(nèi),手術(shù)前后log MAR-BCVA的比較,采用配對t檢驗(yàn);(2)組間:兩組術(shù)前年齡、病程、術(shù)前l(fā)og MAR-BCVA、術(shù)前裂孔相關(guān)參數(shù),以及手術(shù)時(shí)長、術(shù)后log MAR-BCVA、術(shù)后1月和3月CRT的對比,行兩獨(dú)立樣本t檢驗(yàn);用Fisher確切概率法對裂孔閉合率、相關(guān)并發(fā)癥發(fā)生率進(jìn)行比較;(3)影響術(shù)后視力相關(guān)因素:將患者術(shù)前視力、年齡、病程以及PMH相關(guān)形態(tài)參數(shù)及計(jì)算值包括:PMH高度H(μm)、橢圓體帶(ellipsoid zone,EZ)破壞直徑A(μm)、基底直徑a(μm)、最小直徑b(μm)、邊徑之和c+d(μm)、術(shù)后黃斑中心凹視網(wǎng)膜厚度(central retinal thickness,CRT)(μm)、黃斑裂孔指數(shù)(macular hole index,MHI)、黃斑裂孔牽拉指數(shù)(tractional hole index,THI)、黃斑裂孔直徑指數(shù)(diametral hole index,DHI)、黃斑裂孔形成因子(hole form factor,HFF),與術(shù)后log MAR-BCVA行雙變量相關(guān)分析。以上統(tǒng)計(jì)分析,P0.05時(shí)認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:手術(shù)前,比較兩組間年齡(P=0.801)、病程(P=0.833)、術(shù)前視力(P=0.478)、H(P=0.370)、A(P=0.836)、a(P=0.533)、b(P=0.362)差異均無統(tǒng)計(jì)學(xué)意義(P0.05);空氣組或C3F8組各自組內(nèi),對手術(shù)前后log MAR-BCVA的比較,視力均較術(shù)前提高,空氣填充組(t=4.892,P=0.008)、C3F8填充組(t=5.780,P=0.000)差異有統(tǒng)計(jì)學(xué)意義(P0.05);空氣填充組與C3F8填充組比較手術(shù)時(shí)長(P=0.643)、術(shù)后log MAR-BCVA(P=0.913)、術(shù)后1月及3月的CRT(P=0.976、P=0.844),差異均無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后1月時(shí)兩組黃斑裂孔病例均完全閉合,術(shù)后1周時(shí),空氣填充組2例未完全閉合、C3F8填充組1例未閉合;術(shù)后1周內(nèi)空氣填充組出現(xiàn)高眼壓1例、C3F8組出現(xiàn)高眼壓3例,術(shù)后空氣填充組發(fā)現(xiàn)視網(wǎng)膜前出血1例、C3F8組未出現(xiàn)視網(wǎng)膜前出血,術(shù)后1周內(nèi)黃斑裂孔閉合率(P=1.000)及術(shù)后并發(fā)高眼壓發(fā)生率(P=0.342)、視網(wǎng)膜前出血的發(fā)生率(P=1.000)兩組比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后視力的相關(guān)性分析中,術(shù)前視力(r=0.479,P=0.025)、A(r=-0.450,P=0.035)、a(r=0.-0.438,P=0.039)與術(shù)后視力低度相關(guān),b(r=-0.657,P=0.012)、MHI(r=0.589,P=0.040)、THI(r=0.546,P=0.018)與術(shù)后視力中度相關(guān),差異有統(tǒng)計(jì)學(xué)意義(P0.05),而年齡(r=0.361,P=0.090)、病程(r=-0.292,P=0.203)、H(r=-0.235,P=0.314)、DHI(r=-0.231,P=0.316)、HFF(r=0.586,P=0.295)與術(shù)后視力的相關(guān)性差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:PPV聯(lián)合ILMP術(shù)中行空氣或C3F8填充治療PMH,療效相當(dāng),對于PMH的愈合和視力提高均安全有效;術(shù)前視力、裂孔最小直徑、基底直徑、EZ破壞直徑、MHI、THI與術(shù)后視力均具有相關(guān)性,故OCT對于PMH兼具診斷意義和預(yù)測術(shù)后視力的價(jià)值。
[Abstract]:Objective: vitreous body incision (pars plana vitrectomy, PPV) combined with internal limiting membrane peeling (internal limiting membrane peeling, ILMP) and intraocular gas tamponade is currently recognized as treatment of idiopathic macular hole (primary macular, hole, PMH) the preferred method, this study analyzes the PPV after operation respectively by air or C3F8 fill the clinical data for the treatment of stage II~III PMH, comparative observation of two kinds of gas filling for the efficacy and safety of PMH repair and visual prognosis, and explore the correlation between the preoperative visual acuity and postoperative factors. Methods: a retrospective analysis from October 2014 to December 2016 and received surgical treatment in First Affiliated Hospital of Chongqing Medical University diagnosed PMH and 39 cases 39 eyes underwent a standard three channel pars plana combined with 23GPPV ILMP, intraocular filling aseptic air group 20 cases 20 eyes, intraocular injection 10% C3F8 group and 19 cases of 19 eyes, the With 1 weeks, the inclusion criteria of patients were collected before and after the operation in January March, the best corrected visual acuity (best corrected visual acuity, BCVA), and optical coherence tomography (optical coherence intraocular pressure tomography, OCT) log MAR after using SPSS19.0 software for the test for the conversion of.BCVA: (1): air group group or C3F8 group in each group, log MAR-BCVA was compared before and after surgery, using the paired t test; (2) between the two groups: the two groups preoperative age, course of disease, preoperative log MAR-BCVA, preoperative macular hole and related parameters, operation time, postoperative log MAR-BCVA, compared to January and March CRT after operation two, independent samples t test; Fisher exact method for macular hole closure rate and complication rate were compared; (3) effects of related factors of postoperative visual acuity: preoperative visual acuity, age, course of disease and PMH related morphological parameters and calculation values include: PMH height H (M), ellipse with ellips ( oid zone,EZ)鐮村潖鐩村緞A(渭m),鍩哄簳鐩村緞a(渭m),鏈，

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