CAJ | 학술논문

目的评价曲安奈德(TA)辅助玻璃体后脱离(PVD)联合不染色剥除内界膜(ILM)治疗Ⅱ、Ⅲ期特发性黄斑裂孔(IMH)的解剖和视力预后.方法对Ⅱ、Ⅲ期IMH患者23例23只眼常规行最佳矫正视力(BCVA)、晶状体状态、光相干断层扫描(OCT)检查并进行黄斑裂孔分期.手术前BCVA为0.04～0.40,最小视角对数(logMAR)视力为0.398～1.398,平均0.846±0.310.患者均先在TA辅助下行人工PVD,然后在无染色条件下剥除黄斑区ILM.手术中联合白内障摘除手术5只眼.手术后随访时间6～16个月,平均随访时间9个月.统计分析黄斑裂孔解剖成功率、手术前后BCVA、手术并发症.结果手术后1个月OCT检查显示,黄斑裂孔闭合22只眼,占95.7%;黄斑裂孔未闭合1只眼,占4.3%,再行气液交换后黄斑裂孔成功闭合.至随访期末,均未见黄斑裂孔重新开放.手术后6个月BCVA为0.12～0.90,logMAR视力为0.046～0.921,平均视力为0.410±0.209,手术前后BCVA比较,差异有统计学意义(t=6.636,P＜0.000 1).视力提高21只眼,占91.3%;视力不变者2只眼,占8.7%;无视力下降者.剥除ILM 时视网膜表面出现1～3个点状自限性出血者5只眼.手术后未发生视网膜脱离或玻璃体积血等严重并发症.手术后晶状体核密度增加9只眼,一过性眼压升高6只眼.结论 TA辅助PVD联合不染色剥除ILM治疗Ⅱ、Ⅲ期IMH是一种安全有效的方法.
목적 평개곡안내덕(TA)보조파리체후탈리(PVD)연합불염색박제내계막(ILM)치료Ⅱ、Ⅲ기특발성황반렬공(IMH)적해부화시력예후.방법 대Ⅱ、Ⅲ기IMH환자23례23지안상규행최가교정시력(BCVA)、정상체상태、광상간단층소묘(OCT)검사병진행황반렬공분기.수술전BCVA위0.04～0.40,최소시각대수(logMAR)시력위0.398～1.398,평균0.846±0.310.환자균선재TA보조하행인공PVD,연후재무염색조건하박제황반구ILM.수술중연합백내장적제수술5지안.수술후수방시간6～16개월,평균수방시간9개월.통계분석황반렬공해부성공솔、수술전후BCVA、수술병발증.결과 수술후1개월OCT검사현시,황반렬공폐합22지안,점95.7%;황반렬공미폐합1지안,점4.3%,재행기액교환후황반렬공성공폐합.지수방기말,균미견황반렬공중신개방.수술후6개월BCVA위0.12～0.90,logMAR시력위0.046～0.921,평균시력위0.410±0.209,수술전후BCVA비교,차이유통계학의의(t=6.636,P＜0.000 1).시력제고21지안,점91.3%;시력불변자2지안,점8.7%;무시력하강자.박제ILM 시시망막표면출현1～3개점상자한성출혈자5지안.수술후미발생시망막탈리혹파리체적혈등엄중병발증.수술후정상체핵밀도증가9지안,일과성안압승고6지안.결론 TA보조PVD연합불염색박제ILM치료Ⅱ、Ⅲ기IMH시일충안전유효적방법.
Objective To evaluate the anatomic and visual outcomes of idiopathic macular holes treated with triamcinolone (TA)-assisted posterior vitreous detachment (PVD) and then internal limiting membrane (ILM) peeling without any dye. Methods Twenty-three patients (23 eyes) with stage Ⅱand Ⅲidiopathic macular holes were enrolled. The best-corrected visual acuity (BCVA), the lens, the duration,stage and size of the macular holes were measured before and after the surgery. The preoperative BCVA was 0.04 to 0.40; the logMAR was 0.398 to 1.398 with the mean of 0.846±0.310. All surgery involved TA-assisted PVD and then ILM peeling without any dye.Combined cataract extraction with vitrectomy was performed on 5 eyes.The follow-up ranged from 6 to 16 months with the mean of 9 months. Results Anatomic macular hole closure was achieved in 22 eyes (95.7%) at the first month after surgery and in 23eyes (100.0%) finally. At the 6th months after surgery, the BCVA was 0.12 to 0.90, logMAR was 0.046 to 0.921 with the mean of 0.410±0.209, compared with preoperative BCVA, the difference was statistically significant (t=6.636, P＜0.0001). BCVA increased in 21 eyes (91.3%) and kept unchanged in 2 eyes (8.7%). There are 1-3 spots self-limited bleeding on the retinal surface when the ILM was peeled in 5 eyes. Postoperative complications included progression of cataract in 9 patients and transient intraocular pressure elevation in 6 patients. Conclusions TA-assisted PVD and then ILM peeling without any dye is an effective and safe surgical technique in stage Ⅱ and Ⅲ idiopathic macular hole.