玻璃體切除術(shù)聯(lián)合空氣填充治療特發(fā)性黃斑裂孔的療效觀察
發(fā)布時間：2018-07-22 19:57
【摘要】：研究背景黃斑裂孔最先于1869由Knapp提出并加以描述。但在此后相當(dāng)長的一段時間內(nèi),該病一直沒有有效的醫(yī)治方法。1991年Kelly等最初報道了玻璃體切除治療特發(fā)性黃斑裂孔,術(shù)后的裂孔的閉合率達58%。近年來,隨著手術(shù)的技巧的改進和設(shè)備的更新,黃斑裂孔的手術(shù)的閉合率高達90%以上。黃斑裂孔手術(shù)治療的思路得益于對黃斑裂孔形成的病理基礎(chǔ)的認識和提高。Gass經(jīng)過對玻璃體與黃斑相關(guān)的研究認為特發(fā)性黃斑裂孔的構(gòu)成主要是由黃斑區(qū)中心凹部位玻璃體皮質(zhì)收縮產(chǎn)生的切向牽引力以及環(huán)形及前后方向諸多生物力綜合作用的結(jié)果。此觀點后來得到了相關(guān)研究的證實。黃斑裂孔的主要手術(shù)步驟包括玻璃體切除誘導(dǎo)玻璃體后皮質(zhì)脫離、剝離黃斑前膜、剝離黃斑內(nèi)界膜、玻璃體腔填充和面向下位。玻璃體切除聯(lián)合內(nèi)界膜剝除眼內(nèi)填充物,眼內(nèi)填充物主要有SF6、C3F8、C2F6、空氣和硅油等。長效膨脹氣體已有很多報道,硅油填充的副作用及二次取出的風(fēng)險,大大限制了其臨床應(yīng)用,而空氣填充的相關(guān)文獻及報道相對較少。在以前手術(shù)的基礎(chǔ)上,我們通過玻璃體切除聯(lián)合內(nèi)界膜剝除及空氣填充探討空氣填充在特發(fā)性黃斑裂孔治療中的價值。目的及方法目的觀察玻璃體切除聯(lián)合內(nèi)界膜剝離治療特發(fā)性黃斑裂孔(IMH),術(shù)中填充空氣的療效。方法回顧性分析2014年9月至2016年10月在我組治療的IMH患者106例(112只眼),排除無法隨訪的病例,其中男31例,女75例,行玻璃體切除聯(lián)合內(nèi)界膜剝離術(shù),術(shù)中玻璃體腔內(nèi)空氣填充,所有手術(shù)均由同一操作熟練的醫(yī)師完成。術(shù)前所有患者行常規(guī)術(shù)前檢查,最佳矯正視力、眼壓、OCT、裂孔大小及閉合情況等。術(shù)后患者保持面向下位,當(dāng)氣體吸收能看清黃斑裂孔處視網(wǎng)膜時行OCT檢查,術(shù)后2周、1個月、3個月進行隨訪,按術(shù)前裂孔最小直徑分為4組:a組:直徑≤250μm,b組:250~400μm,c組:400~600μm,d組:直徑≥600μm,記錄各組最佳矯正視力、裂孔閉合時間、裂孔閉合率、氣體完全吸收時間、黃斑裂孔處視網(wǎng)膜暴露時間、面向下位時間及手術(shù)并發(fā)癥。統(tǒng)計學(xué)分析采用SPSS21.0統(tǒng)計學(xué)軟件對數(shù)據(jù)進行分析,計數(shù)資料的兩個率的比較采用卡方檢驗;計量資料兩樣本均數(shù)比較采用配對t檢驗;兩因素相關(guān)性分析采用Speaman等級相關(guān)分析。結(jié)果均以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果術(shù)后一周內(nèi)情況:術(shù)后裂孔閉合時間a組(1.56±0.39)天,b組(1.57±0.53)天,c組(1.619±0.34)天,d組(1.74±0.46)天。裂孔閉合率a組100%,b組100%,c組97.56%,d組95%,應(yīng)用卡方檢驗,各組間對比,P0.05,差異無統(tǒng)計學(xué)意義。術(shù)后2周內(nèi)空氣完全吸收時間a組(8.18±0.21)天,b組(8.10±0.35)天,c組(8.15±0.27)天,d組(8.23±0.41)天,各組之間兩兩相比,P0.05,差異無統(tǒng)計學(xué)意義。術(shù)后1周內(nèi)空氣填充術(shù)后在第1天露出黃斑裂孔處視網(wǎng)膜的患者有7只眼,術(shù)后第2天露出黃斑裂孔處視網(wǎng)膜的患者有43只眼,術(shù)后第3天露出黃斑裂孔處視網(wǎng)膜的患者有62只眼。術(shù)后2周內(nèi)患者面向下位的時間,2天6人,3天11人,4天37人,5天52人,黃斑裂孔處視網(wǎng)膜露出后,行OCT檢查,結(jié)果顯示裂孔閉合后則改為鼻側(cè)臥位�？諝馓畛浜�1周有6例眼壓升高(高于21mmHg低于45mmHg),占所有眼的4.35%,給予術(shù)眼降眼壓眼藥水控制正常,4d以內(nèi)眼壓均控制正常。術(shù)后1周2例患者裂孔未閉合,均因患者無法嚴格執(zhí)行面向下位所致,余未發(fā)生嚴重并發(fā)癥。術(shù)后1個月及3個月復(fù)診情況:各組裂孔及閉合率同一周時情況。各組術(shù)后最佳矯正視力較術(shù)前明顯高于術(shù)前,差異有統(tǒng)計學(xué)意義,無新的并發(fā)癥出現(xiàn)。隨著特發(fā)性黃斑裂孔分組裂孔直徑的增加,術(shù)后患者最佳矯正視力提高呈逐漸下降狀態(tài),經(jīng)Speaman等級相關(guān)分析,術(shù)后最佳矯正視力與各組之間呈負相關(guān)關(guān)系。結(jié)論1、對IMH患者而言,玻璃體切除聯(lián)合內(nèi)界膜剝離及空氣填充,裂孔閉合率高達98%。2、氣體吸收時間較長效氣體時間短,減少了患者面向下位的時間。3、大多數(shù)患眼術(shù)后的視力得到提高。
[Abstract]:Background macular holes were first proposed by Knapp and described by Knapp. But in a long period of time, the disease had no effective treatment for.1991 Kelly, etc. initially reported that vitrectomy was initially reported for the treatment of idiopathic macular holes. The closure rate after surgery was 58%. in recent years, with the improvement of the surgical skills and the improvement of the surgical techniques. The closure rate of the macular hole is up to 90%. The idea of the macular hole surgery is due to the understanding of the pathological basis of the macular hole and the improvement of the.Gass through the study of the vitreous and macula. It is believed that the formation of the macular hole is mainly composed of the vitreous cortex of the macular region. This view was later confirmed by the related research. The main operative steps of the macular hole include vitrectomy induced detachment of the posterior vitreous cortex, the exfoliation of the macular membrane, the exfoliation of the yellowish inner boundary membrane, the filling of the vitreous cavity and the lower position. Vitrectomy combined with internal boundary membrane removal of intraocular fillers, intraocular fillers are mainly SF6, C3F8, C2F6, air and silicone oil. Long effect expansive gases have been reported, the side effects of silicone oil filling and the risk of taking out two times have greatly limited the clinical application, and the related literature and reports of air filling are relatively small. In the previous operation basis On the basis of vitrectomy combined with internal boundary membrane exfoliation and air filling, we discuss the value of air filling in the treatment of idiopathic macular hole. Objective and methods objective and objective to observe the effect of vitrectomy combined with internal boundary membrane dissection in the treatment of idiopathic macular hole (IMH) and the effect of air filling during the operation. Methods Retrospective analysis from September 2014 to 2016 10. 106 cases (112 eyes) of IMH patients treated in our group were excluded, including 31 men and 75 women, with vitrectomy combined with internal boundary membrane dissection and intraocular air filling in the vitreous cavity. All the operations were performed by the same skilled physician. The preoperative examination, the best corrected visual acuity, intraocular pressure, and OCT were performed in the preoperative patients. The size and closure of the fracture. After the operation, the patients maintained the lower position. When the gas absorption could see the retina of the macular hole, the retina was examined by OCT, 2 weeks, 1 months and 3 months after the operation were followed up. According to the minimum diameter of the split hole, the diameter of the retina was divided into 4 groups: the a group: the diameter is less than 250 mu m, the B group: 250~400 mu m, the C group: 400~600 u m, the D group: the diameter of the 600 u m, the best correction of each group was recorded. The best correction of each group was recorded. Record the best correction of each group. The best correction of each group was recorded. Positive vision, hole closure time, split hole closure rate, gas complete absorption time, retinal exposure time at the macular hole, lower time and surgical complications. Statistical analysis was used to analyze the data by SPSS21.0 statistics software. The comparison of two rates of counting data was checked by chi square test; two samples were compared. Paired t test; two factor correlation analysis using Speaman level correlation analysis. Results all the results were statistically significant with P0.05. Results after one week of operation, postoperative split hole closure time in group A (1.56 + 0.39) days, B group (1.57 + 0.53) days, C group (1.619 + 0.34) days, D group (1.74 + 0.46) days, a group 100% of crack closure rate, B group 100%, C group 97.56%, D group 95%, with chi square test, there was no statistical difference between each group and P0.05. The total air absorption time in 2 weeks after operation was (8.18 + 0.21) days (8.18 + 0.21) days, B group (8.10 + 0.35) days, C group (8.15 + 0.27) days, D group (8.23 + 0.41) days, and there was no statistical difference between each group 22, P0.05. After postoperative 1 weeks, air filling revealed macula fissure. The patients in the retina of the hole had 7 eyes, 43 eyes were exposed to the retina at the macular hole second days after the operation, and 62 eyes were exposed to the retina at the macular hole third days after the operation. The patient had 62 eyes in the retina of the macular hole third days after the operation. The patient was facing the lower position in 2 weeks after the operation, 2 days 6 people, 11 people, 4 days 37, 5 day 52, and the retina exposed in the macular hole, and the result of OCT examination. 1 weeks after air filling, 6 cases had elevated intraocular pressure (higher than 21mmHg below 45mmHg), which accounted for 4.35% of all eyes. The intraocular pressure of eye drops was normal and the intraocular pressure within 4D was normal. 2 cases were not closed at 1 weeks after operation. All patients were unable to strictly carry out the lower position. Severe complications. 1 months and 3 months after operation: the fracture and closure rate of each group were the same week. The best corrected visual acuity after operation was significantly higher than that before the operation. There was no significant difference. There was no new complication. After Speaman grade correlation analysis, the best corrected visual acuity after operation was negatively correlated with each group. Conclusion 1, for IMH patients, vitrectomy combined with internal boundary membrane peeling and air filling, the rate of split hole closure is up to 98%.2, gas absorption time is shorter than long effective gas time, reducing the time of patients facing the lower.3, most of the time, mostly.3, most of the patients. Eyesight was improved after a number of eyes.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6
本文編號：2138402
[Abstract]:Background macular holes were first proposed by Knapp and described by Knapp. But in a long period of time, the disease had no effective treatment for.1991 Kelly, etc. initially reported that vitrectomy was initially reported for the treatment of idiopathic macular holes. The closure rate after surgery was 58%. in recent years, with the improvement of the surgical skills and the improvement of the surgical techniques. The closure rate of the macular hole is up to 90%. The idea of the macular hole surgery is due to the understanding of the pathological basis of the macular hole and the improvement of the.Gass through the study of the vitreous and macula. It is believed that the formation of the macular hole is mainly composed of the vitreous cortex of the macular region. This view was later confirmed by the related research. The main operative steps of the macular hole include vitrectomy induced detachment of the posterior vitreous cortex, the exfoliation of the macular membrane, the exfoliation of the yellowish inner boundary membrane, the filling of the vitreous cavity and the lower position. Vitrectomy combined with internal boundary membrane removal of intraocular fillers, intraocular fillers are mainly SF6, C3F8, C2F6, air and silicone oil. Long effect expansive gases have been reported, the side effects of silicone oil filling and the risk of taking out two times have greatly limited the clinical application, and the related literature and reports of air filling are relatively small. In the previous operation basis On the basis of vitrectomy combined with internal boundary membrane exfoliation and air filling, we discuss the value of air filling in the treatment of idiopathic macular hole. Objective and methods objective and objective to observe the effect of vitrectomy combined with internal boundary membrane dissection in the treatment of idiopathic macular hole (IMH) and the effect of air filling during the operation. Methods Retrospective analysis from September 2014 to 2016 10. 106 cases (112 eyes) of IMH patients treated in our group were excluded, including 31 men and 75 women, with vitrectomy combined with internal boundary membrane dissection and intraocular air filling in the vitreous cavity. All the operations were performed by the same skilled physician. The preoperative examination, the best corrected visual acuity, intraocular pressure, and OCT were performed in the preoperative patients. The size and closure of the fracture. After the operation, the patients maintained the lower position. When the gas absorption could see the retina of the macular hole, the retina was examined by OCT, 2 weeks, 1 months and 3 months after the operation were followed up. According to the minimum diameter of the split hole, the diameter of the retina was divided into 4 groups: the a group: the diameter is less than 250 mu m, the B group: 250~400 mu m, the C group: 400~600 u m, the D group: the diameter of the 600 u m, the best correction of each group was recorded. The best correction of each group was recorded. Record the best correction of each group. The best correction of each group was recorded. Positive vision, hole closure time, split hole closure rate, gas complete absorption time, retinal exposure time at the macular hole, lower time and surgical complications. Statistical analysis was used to analyze the data by SPSS21.0 statistics software. The comparison of two rates of counting data was checked by chi square test; two samples were compared. Paired t test; two factor correlation analysis using Speaman level correlation analysis. Results all the results were statistically significant with P0.05. Results after one week of operation, postoperative split hole closure time in group A (1.56 + 0.39) days, B group (1.57 + 0.53) days, C group (1.619 + 0.34) days, D group (1.74 + 0.46) days, a group 100% of crack closure rate, B group 100%, C group 97.56%, D group 95%, with chi square test, there was no statistical difference between each group and P0.05. The total air absorption time in 2 weeks after operation was (8.18 + 0.21) days (8.18 + 0.21) days, B group (8.10 + 0.35) days, C group (8.15 + 0.27) days, D group (8.23 + 0.41) days, and there was no statistical difference between each group 22, P0.05. After postoperative 1 weeks, air filling revealed macula fissure. The patients in the retina of the hole had 7 eyes, 43 eyes were exposed to the retina at the macular hole second days after the operation, and 62 eyes were exposed to the retina at the macular hole third days after the operation. The patient had 62 eyes in the retina of the macular hole third days after the operation. The patient was facing the lower position in 2 weeks after the operation, 2 days 6 people, 11 people, 4 days 37, 5 day 52, and the retina exposed in the macular hole, and the result of OCT examination. 1 weeks after air filling, 6 cases had elevated intraocular pressure (higher than 21mmHg below 45mmHg), which accounted for 4.35% of all eyes. The intraocular pressure of eye drops was normal and the intraocular pressure within 4D was normal. 2 cases were not closed at 1 weeks after operation. All patients were unable to strictly carry out the lower position. Severe complications. 1 months and 3 months after operation: the fracture and closure rate of each group were the same week. The best corrected visual acuity after operation was significantly higher than that before the operation. There was no significant difference. There was no new complication. After Speaman grade correlation analysis, the best corrected visual acuity after operation was negatively correlated with each group. Conclusion 1, for IMH patients, vitrectomy combined with internal boundary membrane peeling and air filling, the rate of split hole closure is up to 98%.2, gas absorption time is shorter than long effective gas time, reducing the time of patients facing the lower.3, most of the time, mostly.3, most of the patients. Eyesight was improved after a number of eyes.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6
【參考文獻】
相關(guān)期刊論文 前2條
1 陶明;李艷;張文芳;;特發(fā)性黃斑裂孔玻璃體切除手術(shù)聯(lián)合空氣填充的臨床觀察[J];國際眼科雜志;2015年11期
2 張貴森;姚毅;鞏慧;任鳳梅;劉曉琳;崔巍;;25G玻璃體切除聯(lián)合惰性氣體填充和空氣填充治療特發(fā)性黃斑裂孔的療效觀察[J];臨床眼科雜志;2015年05期
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