本文選題：高度近視　切入點：黃斑劈裂　出處：《眼科新進展》2014年06期

【摘要】：目的觀察并分析高度近視黃斑劈裂及黃斑裂孔玻璃體切割術(shù)前、術(shù)后的光學相干斷層掃描(optical coherence tomography,OCT)、視力及多焦視網(wǎng)膜電圖(multifocal electroretinogram,mfERG)的變化特征,評估手術(shù)療效,并探討手術(shù)時機。方法收集2011年8月至2013年3月在我院行標準三通道經(jīng)睫狀體平坦部玻璃體切割術(shù)聯(lián)合內(nèi)界膜剝離術(shù)治療高度近視性黃斑劈裂及黃斑裂孔不伴視網(wǎng)膜脫離患者38例(44眼),并將其分成兩組,即黃斑劈裂組(24眼)和黃斑裂孔組(20眼),術(shù)后隨訪6個月,觀察患眼術(shù)前及術(shù)后視力、OCT及mfERG情況。結(jié)果兩組患者術(shù)后視力較術(shù)前均有提高(均為P0.05),黃斑劈裂組患者術(shù)后視力提高幅度大于黃斑裂孔組(P0.05)。視力進步者黃斑劈裂組為91.7%,黃斑裂孔組為50.0%,兩組相比差異有統(tǒng)計學意義(P0.05)。OCT示黃斑劈裂組24眼中22眼(91.7%)黃斑區(qū)完全愈合,2眼(8.3%)好轉(zhuǎn);黃斑裂孔組20眼中8眼(40.0%)完全愈合,6眼(30.0%)好轉(zhuǎn),6眼(30.0%)未愈合;兩組黃斑區(qū)完全愈合率相比,差異有統(tǒng)計學意義(P0.01)。mfERG示術(shù)后6個月時,黃斑劈裂組1環(huán)P1波潛伏期為(37.50±3.62)ms,與術(shù)前的(44.23±4.35)ms相比明顯縮短(P0.05),而黃斑裂孔組為(38.54±4.75)ms,與術(shù)前的(40.31±2.80)ms相比差異無統(tǒng)計學意義(P0.05)。兩組患者P1波振幅密度在術(shù)后2個月、3個月、6個月時均逐漸提高,但仍略低于術(shù)前(均為P0.05)。術(shù)前mfERG的三維地形圖表現(xiàn)為中央峰缺如或低平,旁中心凹區(qū)域有多處不規(guī)則低反應區(qū)。術(shù)后愈合患者mfERG的三維地形圖的中央峰逐漸恢復,旁中心凹區(qū)域不規(guī)則反應區(qū)減少或消失。兩組術(shù)中未見醫(yī)源性裂孔形成,術(shù)后無眼內(nèi)出血或眼內(nèi)炎等嚴重并發(fā)癥發(fā)生。結(jié)論玻璃體切割聯(lián)合內(nèi)界膜剝離術(shù)是治療高度近視性黃斑劈裂及黃斑裂孔安全有效的手術(shù)方法。在高度近視黃斑劈裂形成伴有視力受損之后、裂孔形成之前及時行玻璃體切割術(shù)治療可有效保存視功能,提高患者的視力。
[Abstract]:Objective To observe and analyze the myopic foveoschisis with macular hole and vitreous body cutting before operation, after operation of optical coherence tomography (optical coherence tomography, OCT), visual acuity and multifocal electroretinogram (multifocal electroretinogram, mfERG) change characteristic, evaluation of the efficacy of surgery, and to investigate the timing of surgery. Methods from August 2011 to March 2013 in our hospital three channel standard pars plana vitrectomy combined with vitreous body peefing for treatment of high myopia macular retinoschisis and macular hole without retinal detachment in 38 patients (44 eyes), and divided into two groups, namely retinoschisis group (24 eyes) and macular the hole group (20 eyes), after 6 months of follow-up, visual acuity were observed before and after the operation, OCT and mfERG. The results of two groups of patients with postoperative visual acuity was improved (P0.05), macular retinoschisis group of patients with postoperative visual acuity was greater than 榛勬枒瑁傚瓟緇，

本文編號：1717710