CAJ | 학술논문

目的观察玻璃体手术治疗视网膜中央静脉阻塞(CRVO)伴黄斑水肿的临床疗效.方法取临床诊断为缺血性CRVO伴黄斑水肿的连续病例36例(36眼).根据手术时间先后分为放射状视神经切开术(RON)组和玻璃体切除与周边视网膜光凝术(PPV/PE)组,随访(28.6±6.3)个月.对比观察各个时段的视力、视野、黄斑中心凹厚度及眼底改变情况.结果 1个月内RON组4只眼视力提高,PPV/PE组6只眼视力提高.1年以上追踪观察RON组8只眼视力提高,4只眼视力不变,2只眼视力下降,PPV/PE组12只眼视力提高.8只眼视力不变,4只眼视力下降,两组最好矫正视力均无≥0.5,≥0.1者占50%.两组1个月及一年时段视力提高≥0.1者对比差异无统计学意义(P>0.05),两组对黄斑中心凹的视网膜厚度经OCT测量均有持续明显的减轻.RON组4只眼视神经切开部位萎缩.结论对于缺血性CRVO伴黄斑水肿的玻璃体手术的治疗,从视力改变及黄斑水肿减轻的角度出发,RON组和PPV/PE组无明显区别,且RON存在着视神经萎缩的并发症.临床应首选简单易行的PPV/PE手术.
목적 관찰파리체수술치료시망막중앙정맥조새(CRVO)반황반수종적림상료효.방법 취림상진단위결혈성CRVO반황반수종적련속병례36례(36안).근거수술시간선후분위방사상시신경절개술(RON)조화파리체절제여주변시망막광응술(PPV/PE)조,수방(28.6±6.3)개월.대비관찰각개시단적시력、시야、황반중심요후도급안저개변정황.결과 1개월내RON조4지안시력제고,PPV/PE조6지안시력제고.1년이상추종관찰RON조8지안시력제고,4지안시력불변,2지안시력하강,PPV/PE조12지안시력제고.8지안시력불변,4지안시력하강,량조최호교정시력균무≥0.5,≥0.1자점50%.량조1개월급일년시단시력제고≥0.1자대비차이무통계학의의(P>0.05),량조대황반중심요적시망막후도경OCT측량균유지속명현적감경.RON조4지안시신경절개부위위축.결론 대우결혈성CRVO반황반수종적파리체수술적치료,종시력개변급황반수종감경적각도출발,RON조화PPV/PE조무명현구별,차RON존재착시신경위축적병발증.림상응수선간단역행적PPV/PE수술.
Objective To observe the clinical therapeutic effects of vitrectomy and radial optic neurotomy (RON) for macular edema secondary to central retinal vein occlusion (CRVO). Methods Thirty-six consecutive patients (36 eyes) were identified duration of macular edema secondary to ischemic CRVO. According to the time of surgery, these patients divided into two groups, the radial optic neurotomy (RON) group, the Pars Planna Vitrectomy/Panretianl Endophotocoagulation (PPV/PE) group. The average follow-up periods were 28.6± 6.3 months. The changes in visual acuity (VA), foveal thickness, visual fiPEd and the case of optic disc were observed and compared. Results The visual acuity (VA) of 4 eyes in the radial optic neurotomy (RON) group and 6 eyes in the Pars Planna Vitrectomy /Panretiani Endopbotocoagulation (PPV/PE) group improved at the first 1 month. Then clinical observation and follow-up more than 1 year, in the radial optic neurotomy (RON) group: visual acuity (VA) had improvement in 8 eyes, 4 remained the same, whereas 2 became worse. The Pars Planna Vitrectomy/Panretianl Endopbotocoagulation (PPV/PE) group: visual acuity (VA) had improvement in 12 eyes, 8 remained the same, whereas 4 became worse. None of both the groups were≥0.5 in BCVA, and 50% were ≥0.1. It was not statistically significant between the two groups which eyes were≥ 0.1 in BCVA at 1 month and 1 year of follow-up (P >0.05 ). OCT showed that all patients were improved at their last follow-up when compared with preoperative foveal thickness. However,4 eyes had optic atrophy in RON group. Conclusions The improvement in visual acuity and macular edema between RON group and PPV/PE group has no statistically significant differences. However, optic atrophy is a major postoperative complication in the RON group. It's better to choose PPV/PE first.