特發(fā)性黃斑裂孔發(fā)病機制研究及內(nèi)界膜剝離手術(shù)的臨床療效
發(fā)布時間：2018-11-06 16:02
【摘要】：特發(fā)性黃斑裂孔發(fā)病機制研究及內(nèi)界膜剝離手術(shù)的臨床療效 目的 本研究旨在：(1)應(yīng)用光學(xué)相干斷層掃描(optical coherence tomography,OCT)探討特發(fā)性黃斑裂孔(idiopathic macular hole,IMH)的發(fā)病機制；(2)觀察玻璃體切割術(shù)(par plana vitrectomy, PPV)聯(lián)合內(nèi)界膜剝離術(shù)(internal limiting membrane peeling, ILMP)治療IMH的臨床療效；(3)觀察曲安奈德(triamcinolone acetonide,TA)、吲哚菁綠(indocyanine green, ICG)在IMH手術(shù)中的的染色效果。 方法 第一部分：收集IMH的患者39例43眼的OCT圖像,依據(jù)Gass分期標(biāo)準(zhǔn)對裂孔進(jìn)行分期,其中17眼(均為2-4期)接受了PPV聯(lián)合ILMP手術(shù),觀察、對比、分析不同分期及術(shù)后OCT圖像特點,探討IMH的發(fā)病機制。第二部分：28例30眼行’TA、ICG雙染色輔助PPV聯(lián)合ILMP,觀察術(shù)中TA、ICG染色情況、裂孔閉合率、及術(shù)前術(shù)后最佳矯正視力(best corrected visual acuity, BCVA),術(shù)中、術(shù)后并發(fā)癥等,評價PPV聯(lián)合ILMP治療IMH的臨床療效及TA、ICG輔助染色的效果。 結(jié)果 1.1期裂孔中有4/5(80.0%)可觀察到玻璃體后脫離(posterior vitreous detachment, PVD)對中心凹的牽拉,2期裂孔10/13(76.9%)可觀察到PVD對中心凹的牽拉,3、4期裂孔玻璃體與中心凹粘連分離,3期11/16(68.7%)、4期7/9(77.8%)可觀察到ILM增厚,反光增強。2-4期裂孔均有孔緣囊樣病變、呈“魚嘴樣”翻卷上翹,并且裂孔形態(tài)幾乎均為圓形,而PPV聯(lián)合ILMP術(shù)后裂孔邊緣囊樣病變、“魚嘴樣”翻卷上翹均完全消失。 2.PPV聯(lián)合ILMP 30眼術(shù)中玻璃體后皮質(zhì)、內(nèi)界膜染色效果好,TA.ICG輔助染色很大程度增加了手術(shù)能見度；術(shù)后隨訪5.00±1.62月,一次性手術(shù)裂孔閉合27眼,閉合率90%,22眼(73.33%)視力提高2行或2行以上 結(jié)論 1.IMH1期的主要發(fā)病機制是PVD對中心凹的前后方向牽拉；3、4期主要發(fā)病機制是ILM離心性張力和視網(wǎng)膜表面增殖膜收縮共同作用的結(jié)果；2期裂孔PVD中心凹牽拉、ILM離心性張力兩種因素都存在 2.PPV聯(lián)合ILMP是IMH安全、有效的治療方法,能使大部分患者的裂孔閉合、視力改善。 3.PPV聯(lián)合ILMP術(shù)中采用‘TA、ICG輔助染色可減小手術(shù)的難度,增加手術(shù)安全性。
[Abstract]:Study on the pathogenesis of idiopathic macular hole and the clinical curative effect of internal boundary membrane dissection objective: (1) to investigate the (idiopathic macular hole, of idiopathic macular hole by optical coherence tomography (optical coherence tomography,OCT) IMH); (2) to observe the clinical effect of vitrectomy with (par plana vitrectomy, PPV) combined with internal membrane dissection (internal limiting membrane peeling, ILMP) in the treatment of IMH; (3) to observe the staining effect of triamcinolone acetonide (triamcinolone acetonide,TA) and indocyanine green (indocyanine green, ICG) in IMH operation. Methods the first part was to collect the OCT images of 39 patients with IMH and 43 eyes. According to the standard of Gass staging, 17 eyes (2-4 stage) underwent PPV combined with ILMP operation. To investigate the pathogenesis of IMH by analyzing the features of different stages and postoperative OCT images. The second part: 28 cases (30 eyes) were observed by 'TA,ICG double staining and PPV combined with ILMP, to observe the intraoperative TA,ICG staining, the closure rate of the hole, the preoperative and postoperative best corrected visual acuity (best corrected visual acuity, BCVA), postoperative complications, and so on. To evaluate the clinical effect of PPV combined with ILMP in the treatment of IMH and the effect of TA,ICG auxiliary staining. Results 4 / 5 (80. 0%) of the 1. 1 phase hiatus could be observed to pull the fovea from the posterior vitreous detachment (posterior vitreous detachment, PVD), and 10 / 13 (76. 9%) of the second phase (10 / 13) could be observed by PVD to the fovea. In stage 3, 11 / 16 (68.7%) and 7 / 9 (77.8%) of ILM were observed. The shape of the fished-beak was almost round, but after PPV combined with ILMP, the saccular lesion of the rifts and the upturn of the "fish-beak" were completely disappeared. In 30 eyes of 2.PPV combined with ILMP, the intravitreous posterior cortex was stained well, and the operative visibility was greatly increased by TA.ICG auxiliary staining. The postoperative follow-up was 5.00 鹵1.62months, 27 eyes were closed, the closure rate was 90%. The visual acuity of 22 eyes (73.33%) was improved by 2 or more lines. Conclusion the main pathogenesis of 1.IMH1 stage is the pulling of PVD to the fovea. 3The main pathogenesis of stage 4 is the effect of ILM centrifugal tension and the contraction of proliferative membrane on the surface of retina. 2.PPV combined with ILMP is a safe and effective treatment for PVD in stage 2, which can close the hole and improve the visual acuity of most of the patients. The use of 'TA,ICG auxiliary staining in 3.PPV combined with ILMP can reduce the difficulty of operation and increase the safety of operation.
【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.6
本文編號：2314764
[Abstract]:Study on the pathogenesis of idiopathic macular hole and the clinical curative effect of internal boundary membrane dissection objective: (1) to investigate the (idiopathic macular hole, of idiopathic macular hole by optical coherence tomography (optical coherence tomography,OCT) IMH); (2) to observe the clinical effect of vitrectomy with (par plana vitrectomy, PPV) combined with internal membrane dissection (internal limiting membrane peeling, ILMP) in the treatment of IMH; (3) to observe the staining effect of triamcinolone acetonide (triamcinolone acetonide,TA) and indocyanine green (indocyanine green, ICG) in IMH operation. Methods the first part was to collect the OCT images of 39 patients with IMH and 43 eyes. According to the standard of Gass staging, 17 eyes (2-4 stage) underwent PPV combined with ILMP operation. To investigate the pathogenesis of IMH by analyzing the features of different stages and postoperative OCT images. The second part: 28 cases (30 eyes) were observed by 'TA,ICG double staining and PPV combined with ILMP, to observe the intraoperative TA,ICG staining, the closure rate of the hole, the preoperative and postoperative best corrected visual acuity (best corrected visual acuity, BCVA), postoperative complications, and so on. To evaluate the clinical effect of PPV combined with ILMP in the treatment of IMH and the effect of TA,ICG auxiliary staining. Results 4 / 5 (80. 0%) of the 1. 1 phase hiatus could be observed to pull the fovea from the posterior vitreous detachment (posterior vitreous detachment, PVD), and 10 / 13 (76. 9%) of the second phase (10 / 13) could be observed by PVD to the fovea. In stage 3, 11 / 16 (68.7%) and 7 / 9 (77.8%) of ILM were observed. The shape of the fished-beak was almost round, but after PPV combined with ILMP, the saccular lesion of the rifts and the upturn of the "fish-beak" were completely disappeared. In 30 eyes of 2.PPV combined with ILMP, the intravitreous posterior cortex was stained well, and the operative visibility was greatly increased by TA.ICG auxiliary staining. The postoperative follow-up was 5.00 鹵1.62months, 27 eyes were closed, the closure rate was 90%. The visual acuity of 22 eyes (73.33%) was improved by 2 or more lines. Conclusion the main pathogenesis of 1.IMH1 stage is the pulling of PVD to the fovea. 3The main pathogenesis of stage 4 is the effect of ILM centrifugal tension and the contraction of proliferative membrane on the surface of retina. 2.PPV combined with ILMP is a safe and effective treatment for PVD in stage 2, which can close the hole and improve the visual acuity of most of the patients. The use of 'TA,ICG auxiliary staining in 3.PPV combined with ILMP can reduce the difficulty of operation and increase the safety of operation.
【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 戴虹,盧穎毅,李永,師自安;特發(fā)性黃斑裂孔患者術(shù)后裂孔愈合形態(tài)與視功能恢復(fù)的研究[J];中華眼科雜志;2004年07期
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