玻璃体切除联合非翻瓣内界膜转位手术治疗大直径黄斑裂孔

摘要

目的:观察玻璃体切除联合带蒂的非翻瓣内界膜(ILM)转位手术治疗大直径黄斑裂孔(macular hole,MH)的效果.方法:前瞻性研究.2016-12/2017-02于江苏省人民医院收治的9例10眼经频域光学相干断层扫描(SD-OCT)确诊为大直径MH患者(MH>400μm),进行玻璃体切除联合ILM转位术.术前、术后1d,1wk,1、3、6mo随访SD-OCT、最佳矫正视力(best corrected visual acuity,BCVA)及微视野检查.结果:患者裂孔闭合率为100%;术前 BCVA(LogMAR) 1.19±0.54,术后视力提高显著,末次随访0.70±0.50(P=0.005);黄斑8°平均视网膜光敏感度(MS)值术前3.14 ± 4.52dB、术后末次随访8.91 ±5.53dB(P=0.008);黄斑2° MS值术前1.46 ± 2.94dB、术后末次随访6.33 ± 4.90dB (P=0.008).术前固视不稳定8眼,术后末次随访固视不稳定1眼.结论:玻璃体切除联合内界膜转位手术可以有效治疗大直径MH,具有较高的裂孔闭合率,术后视功能改善显著.%·AIM:To explore the effectiveness of a new non-inverted pedicle internal limiting membrane ( ILM ) flap transposition technique in the treatment of large macular holes (MH). ·METHODS: This was a prospective pilot study which included 9 patients with 10 eyes in Jiangsu Province People's Hospital from December 2016 to February 2017. All patients was diagnosed with large MH (size >400μ m) by the spectra- domain optical coherence tomography (SD-OCT) and underwent the non-inverted pedicle ILM flap transposition surgery. Best-corrected visual acuity (BCVA), SD-OCT images, and MP-1 microperimetry tests were performed pre-operation, 1d, 1wk, 1, 3, and 6mo post-operation. ·RESULTS:The macular hole closure rate after 6mo was 100%. The averaged BCVA improved from 1. 19 ± 0. 54 (LogMAR) pre-operation to 0.70 ± 0.50 (LogMAR) post-operation (P=0.005). The mean retinal sensitivity within 8° and 2° improved from 3.14±4.52dB to 8.91±5.53dB(P=0.008), and 1.46 ± 2.94dB to 6.33 ± 4.90dB (P=0.008) respectively. Preoperative unstable fixation in seven eyes resolved at the last postoperative follow-up.·CONCLUSION: Our non-inverted pedicle internal ILM flap transposition technique shows effectiveness in the treatment of large macular holes with high MH closure rate and improving visual function.