CAJ | 학술논문

目的观察玻璃体切割手术(PPV)治疗近视性牵引件黄斑病变(MTM)的疗效.方法回顾分析经时域光相干断层扫描(TD-OCT)及裂隙灯显微镜加前置镜检查确诊为MTM患者29例31只眼.将其分为MTM的较早期阶段组(1组)和MTM的最高级阶段组(2组),1组10例12只眼,2组19例19只眼.所有患眼均行标准三通道PPV,10%～15%惰性气体充填.手术后随访6～12个月,平均随访8个月,随访观察手术跟最佳矫正视力,黄斑结构恢复及视网膜复位情况.结果手术后6个月,1组患者视力全部改善,改善率100.0%;2组患者视力改善者占63.2%;手术后视力改善比较,1组显著优于2组,差异有统计学意义(Z=-5.477,P=0.000).黄斑裂孔消失且未见裸露的色素上皮者,1组12只眼,2组3只眼;黄斑中心仍有组织缺损但其周围视网膜复佗者,1组0只服,2组13只眼;黄斑裂孔存在伴视网膜脱离者,1组0只眼,2组3只眼;手术后黄斑结构恢复情况比较,1组显著优于2组,差异有统计学意义(Z=-4.318,P=0.000).结论早于黄斑裂孔视网膜脱离彤成进行手术十预可有效防治高度近视黄斑裂孔形成,最大限度保存视力.
목적 관찰파리체절할수술(PPV)치료근시성견인건황반병변(MTM)적료효.방법 회고분석경시역광상간단층소묘(TD-OCT)급렬극등현미경가전치경검사학진위MTM환자29례31지안.장기분위MTM적교조기계단조(1조)화MTM적최고급계단조(2조),1조10례12지안,2조19례19지안.소유환안균행표준삼통도PPV,10%～15%타성기체충전.수술후수방6～12개월,평균수방8개월,수방관찰수술근최가교정시력,황반결구회복급시망막복위정황.결과 수술후6개월,1조환자시력전부개선,개선솔100.0%;2조환자시력개선자점63.2%;수술후시력개선비교,1조현저우우2조,차이유통계학의의(Z=-5.477,P=0.000).황반렬공소실차미견라로적색소상피자,1조12지안,2조3지안;황반중심잉유조직결손단기주위시망막복타자,1조0지복,2조13지안;황반렬공존재반시망막탈리자,1조0지안,2조3지안;수술후황반결구회복정황비교,1조현저우우2조,차이유통계학의의(Z=-4.318,P=0.000).결론조우황반렬공시망막탈리동성진행수술십예가유효방치고도근시황반렬공형성,최대한도보존시력.
Objective To observe the therapeutic effect of pars plana vitrectomy (PPV) on myopic traction maculopathy (MTM). Methods The clinical data of 31 eyes of 29 patients with MTM diagnosed by time domain optical coherence tomography (TD-OCT) and slit-lamp ophthalmoscopy were retrospectively analyzed. The cases were divided into 2 groups according to the stage of MTM: 12 eyes of 10 patients at the early stage of MTM were in group 1 ; 19 eyes of patients at the most Advanced stage of MTM were in group 2. All of these eyes had undergone PPV with 10%-15% inert gas filling. The patients were followed post-operatively for 6 to 12 months with the average of 8 months, and the bes corrected visual acuity, reattachment of macular and retina was examined. Results The improvement rate of visual acuity after surgery for 6 months was 100% in group 1, and 63.2% in group 2 had (12/19); the visual acuity in group 1 was apparently better than that in group 2 (Z=-5. 477, P=0.000). The macular hole disappeared without exposure of the pigment epithelium in all eyes of Group 1, but only 3 eyes in Group 2. For Group 2 patients, 3 eyes had reattached retina with macular holes, and 3 eyes had detached retina with macular holes. The recovery of macular configuration in Group 1 was obviously better than that in Group 2 (Z= -4.318, P=0.000). Conclusion The surgical intervention of MTM before the formation of macular hole and retinal detachment may prevent the formation of macular holes.