發(fā)布時間：2018-06-27 22:46

  本文選題：高度近視 + 黃斑劈裂��； 參考：《中南大學(xué)》2011年碩士論文

【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手術(shù)前后的視力、多焦視網(wǎng)膜電圖(Multifocal electroretinogram, mfERG)及光學(xué)相干斷層掃描(optical coherence tomography, OCT)的變化特征,評估手術(shù)療效,并探討手術(shù)時機(jī)。 方法：收集2008年4月～2011年5月在我院行標(biāo)準(zhǔn)三通道經(jīng)睫狀體平坦部玻璃體切割術(shù)(Pars Plana Vitrectomy, PPV)聯(lián)合內(nèi)界膜剝離術(shù)(Internal Limiting Membrane Peeling, ILMP)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19例(22只眼),并將其分成兩組即黃斑劈裂組(12眼)和黃斑裂孔組(10眼),分別在手術(shù)前和手術(shù)后2、3、6個月時,對患者行視力、mfERG及OCT檢查。并將兩組的檢查結(jié)果進(jìn)行統(tǒng)計學(xué)分析和比較。 結(jié)果： 1.視力：兩組患者術(shù)后視力較術(shù)前均有提高(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(jìn)步者黃斑劈裂組91.7%,黃斑裂孔組50%,且視力改善具有統(tǒng)計學(xué)差異(P0.05)。 2.mfERG:手術(shù)后6個月時,高度近視黃斑劈裂組,P1波1環(huán)(黃斑中心凹區(qū))術(shù)后潛伏期較術(shù)前縮短(P0.05),而高度近視黃斑裂孔組較術(shù)前無明顯差異、(P0.05)；且黃斑劈裂組1環(huán)P1波潛伏期改善程度大于黃斑裂孔組(P0.05)。兩組患者1環(huán)P1波振幅密度在手術(shù)后2、3、6個月時逐漸提高,但仍略低于術(shù)前,2環(huán)(旁中心凹區(qū))P1波振幅密度較術(shù)前無明顯提高(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(yīng)區(qū)。術(shù)后愈合患者mfERG的三維地形圖的中央峰逐漸恢復(fù),旁中心凹區(qū)域不規(guī)則低反應(yīng)區(qū)減少或消失。 3.OCT：高度近視黃斑劈裂組,12眼中有11眼(91.7%)黃斑區(qū)解剖結(jié)構(gòu)恢復(fù),1眼(8.3%)好轉(zhuǎn)。高度近視黃斑裂孔組,10眼中有4眼(40%)裂孔閉合,3眼(30%)好轉(zhuǎn),3眼(30%)未愈合。高度近視黃斑劈裂組黃斑區(qū)形態(tài)學(xué)恢復(fù)優(yōu)于黃斑裂孔組(P0.01)。 4.手術(shù)并發(fā)癥：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(yán)重并發(fā)癥產(chǎn)生 結(jié)論： 1.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。 2.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 changes of visual acuity, multifocal electroretinogram (mfERG) and optical coherence tomography (optical coherence tomography,) before and after vitrectomy of macular split and macular hole in high myopia, and to evaluate the curative effect of the operation. The time of operation was also discussed. Methods: standard three-channel transciliary vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) was performed in our hospital from April 2008 to May 2011 for the treatment of high myopic macular splitting and macular hole failure. 19 patients (22 eyes) with retinal detachment were divided into two groups: macular split group (12 eyes) and macular hole group (10 eyes). The visual acuity was examined by mfERG and Oct. The results of the two groups were statistically analyzed and compared. Results: 1. Visual acuity: the postoperative visual acuity was improved in both groups (P0.05), and the postoperative visual acuity in macular split group was higher than that in macular hole group (P0.05). In the macular split group (91.7%) and macular hole group (50%), the visual acuity improved significantly (P0.05). 2. MfERG: at 6 months after operation, In high myopic macular splitting group, the latency of P1 wave 1 ring (macular fovea) was shorter than that of preoperative group (P0.05), but there was no significant difference between high myopic macular hole group and preoperative group (P0.05), and the improvement degree of P1 wave latency in macular split group was greater than that in macular hole group (P0.05). The amplitude density of P1 wave in both groups increased gradually at 2 and 6 months after operation, but it was still slightly lower than that in the second ring (paracentric fovea) before operation (P0.05). The 3D topography of mfERG showed that the central peak was absent or low, and there were many irregular low response areas in the paracentric fovea. The central peak of 3D topographic map of mfERG was gradually recovered. 3. In high myopia macular split group, 11 eyes (91.7%) had macular anatomic structure recovery and 1 eye (8.3%) had improved in high myopia macular split group. In high myopia group, 4 eyes (40%) in 10 eyes of macular hole had closed hole, 3 eyes (30%) had improved and 3 eyes (30%) had not healed. The morphological recovery of macular area in high myopia macular split group was better than that in macular hole group (P0.01). Operative complications: no iatrogenic hole formation, no intraocular hemorrhage or endophthalmitis and other serious complications: conclusion: 1. Vitrectomy combined with internal membrane dissection is a safe and effective method for the treatment of macular split and macular hole in high myopia. 2. Vitrectomy can effectively preserve visual function and improve visual acuity after macular split formation and visual impairment in high myopia.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.6

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