【摘要】：背景:黃斑裂孔(macular hole,MH)是指黃斑部視網(wǎng)膜神經(jīng)上皮層全層發(fā)生穿孔,是嚴(yán)重威脅人類視力的眼部疾病之一,特別是對于難治性黃斑裂孔,病變發(fā)生后治療難度大、視力下降明顯,預(yù)后較差。目前對難治性黃斑裂孔的治療以手術(shù)為主,但手術(shù)方式各有優(yōu)缺點(diǎn),特別是因各種原因臨床無法合規(guī)使用惰性氣體的情況下,如何進(jìn)行手.術(shù),有待臨床探索。目的:觀察難治性黃斑裂孔患者行內(nèi)界膜移植聯(lián)合顳側(cè)翻轉(zhuǎn)+空氣填充術(shù),與接受傳統(tǒng)的自體內(nèi)界膜移植+硅油填充術(shù),兩種手術(shù)方式術(shù)后閉孔率及視力改善有無差異,通過對手術(shù)方式的創(chuàng)新,改善難治性黃斑裂孔的預(yù)后。方法:收集2016年1月至2016年12月就診于山東大學(xué)齊魯醫(yī)院眼科的難治性黃斑裂孔患者25例25只眼,排除年齡相關(guān)性黃斑變性、中心性漿液性視網(wǎng)膜病變、青光眼、葡萄膜炎、眼部手術(shù)史及合并全身疾病眼部表現(xiàn)的患者,根據(jù)Gass分期標(biāo)準(zhǔn),Ⅲ-Ⅳ期特發(fā)性黃斑裂孔且孔徑700 μ m的患者、高度近視性黃斑裂孔的患者、較大孔徑外傷性黃斑裂孔的患者均可納入本研究。術(shù)前及術(shù)后對患者進(jìn)行最佳矯正視力(best-correeted visual acuity,BCVA)、眼壓(intraocular pressure,IOP、裂隙燈顯微鏡、間接眼底鏡及光學(xué)相干斷層成像(optical coherenece tomography,(OCT)檢查,25例患眼分為兩組,研究組:11例患眼行23(;標(biāo)準(zhǔn)二通道睫狀體平坦部玻璃體切割+鼻側(cè)內(nèi)界膜移植+顳側(cè)大瓣翻轉(zhuǎn)+空氣填充術(shù),術(shù)中創(chuàng)造性使用50%高滲糖輔助內(nèi)界膜瓣翻轉(zhuǎn),術(shù)后俯臥位至氣體完全吸收;對照組:14例患眼行23G標(biāo)準(zhǔn)三通道睫狀體平坦部玻璃體切割+內(nèi)界膜移植+硅油填充術(shù),術(shù)后嚴(yán)格俯臥位1-2周,密切隨訪3個(gè)月,分別在第1周、第2周、1個(gè)月、2個(gè)月、3個(gè)月時(shí)記錄患者的BCVA、裂孔閉合率等,進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.臨床資料:兩組患者的年齡、黃斑裂孔孔徑大小、術(shù)前BCVA及病程時(shí)間等無統(tǒng)計(jì)學(xué)差異(P0.05),符合試驗(yàn)的要求。2.術(shù)后相關(guān)資料:(1)術(shù)后BCVA:研究組患者術(shù)后BCVA(logMAR視力)為0.95±0.29,對照組患者術(shù)后BCVA(logMAR視力)為0.92±0.36,差異無統(tǒng)計(jì)學(xué)意義(t=0.199,p=0.844，，p0.05)。(2)術(shù)后黃斑裂孔閉合率:研究組術(shù)后裂孔閉合率為100%;對照組術(shù)后裂孔閉合率為92.9%,兩組差異無統(tǒng)計(jì)學(xué)意義(x2=0.818,p=0.366,p0.05)。結(jié)論:1、內(nèi)界膜移植聯(lián)合顳側(cè)翻轉(zhuǎn)+空氣填充治療難治性黃斑裂孔臨床效果確切。2、本術(shù)式中顳側(cè)內(nèi)界膜瓣的翻轉(zhuǎn)可以對移植的內(nèi)界膜起到保護(hù)作用,可有效防止術(shù)后移植內(nèi)界膜的脫位,在一定程度上起到"雙保險(xiǎn)"的作用,促進(jìn)黃斑裂孔的閉合。3、移植的內(nèi)界膜可以起到支架的作用,促進(jìn)術(shù)后黃斑裂孔處結(jié)構(gòu)的恢復(fù)。4、創(chuàng)造性的術(shù)中使用50%高滲糖輔助內(nèi)界膜翻轉(zhuǎn),可大大降低內(nèi)界膜瓣翻轉(zhuǎn)的難度,提高手術(shù)成功率。
[Abstract]:Background: macular hole (MH) refers to the perforation of the whole layer of the retinal nerve upper cortex in the macular region. It is one of the eye diseases that seriously threaten human visual acuity. Especially for the refractory macular hole, it is difficult to treat after the lesion, and the visual acuity is obviously decreased. The prognosis is poor. At present, the treatment of refractory macular hole is mainly surgery, but the operation has its own advantages and disadvantages, especially in the case of clinical inert gas can not be used for various reasons, how to carry out the operation. Surgery, need clinical exploration. Objective: to observe the difference of obturation rate and visual acuity between internal boundary membrane transplantation and temporal-flip air filling in patients with refractory macular hole. The prognosis of refractory macular hole was improved by the innovation of surgical method. Methods: from January 2016 to December 2016, 25 cases (25 eyes) of refractory macular hole were collected from Qilu Hospital, Shandong University, excluding age-related macular degeneration, central serous retinopathy, glaucoma and uveitis. According to Gass staging criteria, the patients with history of ocular surgery and ocular manifestations associated with systemic diseases had an aperture of 700 渭 m for stage 鈪

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