CAJ | 학술논문

目的：观察玻璃体切割、内界膜剥除联合玻璃体腔气体填充治疗特发性黄斑裂孔的手术疗效及影响因素。 　　方法：对特发性黄斑裂孔患者22例23眼的临床资料进行回顾分析。患眼术前术后除常规检查外最后由光学相干断层扫描（ OCT）确诊及测量黄斑裂孔形态。所有患眼均行玻璃体切割、内界膜剥除联合玻璃体腔气体（空气或惰性气体）填充术。观察患者术后视力和黄斑裂孔闭合率及手术并发症的发生情况。用SPSS 13．0统计软件分析患者年龄、病程、术前最佳矫正视力（ BCVA ）、黄斑裂孔直径、玻璃体腔填充气体种类与术后BCVA和黄斑裂孔闭合率的相关性。 　　结果：术后 OCT 检查结果显示患者黄斑裂孔闭合率100％。其中术中使用空气进行玻璃体腔填充的14眼，一期黄斑裂孔闭合11眼（79％）；术中使用惰性气体（100 mL/L C3 F8）进行玻璃体腔填充的9眼，一期黄斑裂孔全部闭合，闭合率100％，二者比较，差异无统计学意义（χ2＝2．1214，P＞0．05）。术后平均矫正视力0．23±0．12，与术前平均矫正视力0．11±0．05相比较，差异有统计学意义（t＝4．023，P＜0．05）。术后视力提高者术前黄斑裂孔直径小于术后视力不提高者，差异有统计学意义（t＝3．92，P＜0．05）。术后BCVA与患者年龄（r＝-0．415，P＝0．256）、病程（ r＝0．193， P＝0．498）、术前 BCVA （ r＝0.152，P＝0．673）无相关性。 　　结论：玻璃体切割、内界膜剥除联合玻璃体腔气体填充术治疗特发性黄斑裂孔疗效确切；黄斑裂孔直径是影响特发性黄斑裂孔术后闭合和视力预后的主要因素；而术前视力、年龄、病程对特发性黄斑裂孔术后闭合和视力预后的影响无相关性。
목적：관찰파리체절할、내계막박제연합파리체강기체전충치료특발성황반렬공적수술료효급영향인소。 　　방법：대특발성황반렬공환자22례23안적림상자료진행회고분석。환안술전술후제상규검사외최후유광학상간단층소묘（ OCT）학진급측량황반렬공형태。소유환안균행파리체절할、내계막박제연합파리체강기체（공기혹타성기체）전충술。관찰환자술후시력화황반렬공폐합솔급수술병발증적발생정황。용SPSS 13．0통계연건분석환자년령、병정、술전최가교정시력（ BCVA ）、황반렬공직경、파리체강전충기체충류여술후BCVA화황반렬공폐합솔적상관성。 　　결과：술후 OCT 검사결과현시환자황반렬공폐합솔100％。기중술중사용공기진행파리체강전충적14안，일기황반렬공폐합11안（79％）；술중사용타성기체（100 mL/L C3 F8）진행파리체강전충적9안，일기황반렬공전부폐합，폐합솔100％，이자비교，차이무통계학의의（χ2＝2．1214，P＞0．05）。술후평균교정시력0．23±0．12，여술전평균교정시력0．11±0．05상비교，차이유통계학의의（t＝4．023，P＜0．05）。술후시력제고자술전황반렬공직경소우술후시력불제고자，차이유통계학의의（t＝3．92，P＜0．05）。술후BCVA여환자년령（r＝-0．415，P＝0．256）、병정（ r＝0．193， P＝0．498）、술전 BCVA （ r＝0.152，P＝0．673）무상관성。 　　결론：파리체절할、내계막박제연합파리체강기체전충술치료특발성황반렬공료효학절；황반렬공직경시영향특발성황반렬공술후폐합화시력예후적주요인소；이술전시력、년령、병정대특발성황반렬공술후폐합화시력예후적영향무상관성。
AIM: To observe the surgical effect and influential factors of idiopathic macular hole ( IMH ) treated with vitrectomy and internal limiting membrane peeling combined with intravitreal gas tamponade. METHODS: The clinical data of 22 IMH patients ( 23 eyes ) were retrospectively analyzed. All the patients were diagnosed with IMH by optical coherence tomography ( OCT) and their macular hole patterns were measured before and after surgery by OCT in addition to the routine examinations.All patients were treated with vitrectomy, internal limiting membrane peeling combined with gas injection ( air or inert gas ) . The postoperative visual acuity, macular hole closure rate and the incidence of surgical complications were observed.The correlation between the patients'age, course of disease, preoperative best corrected visual acuity ( BCVA ) , macular hole diameter, the type of vitreous cavity filling gas, the postoperative BCVA, and the macular hole closure rate was analyzed with SPSS 13.0 statistical software. RESULTS: Postoperative OCT examination results showed that the macular hole closure rate was 100%. The macular hole closure rate was 79% ( 11 eyes of 14 eyes) after the first intravitreal air injection and 100% (9 eyes) after fist intravitreal inert gas injection ( 100mL/L C3 F8 ) .There was no significant difference between the air injection and inert gas injection (χ2=2.1214, P>0.05). The mean preoperational BCVA was 0.11 ±0.05 and the mean postoperative BCVA 0.23 ±0.12; there was a statistically significant difference between them ( t =4.023,P<0.05).Compared with the patients without visual acuity improvement after surgery, the diameters of the hole were smaller in the patients whose postoperative visual acuity got improved ( t=3.92, P<0.05).There was a significant difference in the visual acuity before and after the surgery(P<0.05).The age of the patients (r=-0.415, P=0.256), duration of disease (r=0.193, P=0.498), preoperative VA (r=0.152, P=0.673) had no significant influence on IMH visual outcomes. CONCLUSION: The vitrectomy combined with internal limiting membrane peeling and intravitreal gas tamponade is an effective treatment for IMH; the macular hole diameter is the major influence factor in the postoperative closure and visual prognosis of IMH;while the preoperative visual acuity, age, duration and the type of gas filled in the visual cavity have no effects on the postoperative closure and visual prognosis in IMH.