| 玻璃体切割联合内界膜剥离及消毒空气注入术治疗特发性黄斑裂孔的疗效及影响因素分析 |
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| 引用本文： | 李斌,孔宁.玻璃体切割联合内界膜剥离及消毒空气注入术治疗特发性黄斑裂孔的疗效及影响因素分析[J].眼科新进展,2018,0(7):680-683. |
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| 作者姓名： | 李斌 孔宁 |
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| 作者单位： | 520000 广东省广州市番禺区中心医院眼科 |
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| 摘 要： | 目的 观察特发性黄斑裂孔行玻璃体切割联合内界膜剥离及消毒空气注入术后的临床疗效，并分析术黄斑裂孔闭合的影响因素。方法 回顾性分析2015年1月至2017年8月在我院诊断为特发性黄斑裂孔并行25 G玻璃体切割联合内界膜剥离及消毒空气注入术的43例43眼患者的临床资料。所有患者术前和术后均行最佳矫正视力（best corrected visual acuity，BCVA）、裂隙灯显微镜及光学相干断层扫描检查。术前测量黄斑裂孔最小直径、裂孔最大基底直径、裂孔高度，并计算裂孔牵拉指数（tractional hole index，THI）及黄斑裂孔指数（macular hole index，MHI）等参数。术后随访3~36个月，观察患眼术后BCVA、黄斑裂孔闭合情况，分析该术式下影响术后黄斑裂孔闭合的相关因素。结果 43例43眼中黄斑裂孔闭合者37眼（86.05%），其中完全闭合29眼，暴露性闭合8眼，未闭合6眼。手术前患眼BCVA为（1.15±0.35）logMAR，术后为（1.04±0.40）logMAR，差异有统计学意义（t=3.197，P=0.003）。术前黄斑裂孔最小直径、最大基底直径与术后BCVA（logMAR）呈正相关，THI及MHI与术后BCVA（logMAR）呈负相关（均为P<0.05）。术后BCVA与术前黄斑裂孔高度无相关性（P=0.339）。当THI＞1.0或MHI＞0.5时，黄斑裂孔闭合率（包括完全闭合和暴露性闭合）为100%，当THI＞0.5或MHI＞0.3时，黄斑裂孔闭合率（包括完全闭合和暴露性闭合）分别为94.74%和97.14%。结论 玻璃体切割联合内界膜剥离及消毒空气注入术治疗特发性黄斑裂孔临床疗效较好，THI、 MHI是影响黄斑裂孔闭合的重要指标。
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| 关 键 词： | 黄斑裂孔 玻璃体切割 内界膜剥离 消毒空气 |
Effects of 25-gauge vitrectomies combined with air tamponade for the treatment of idiopathic （IMH） and the affecting factors of closure of macular hole |
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| LI Bin,KONG Ning.Effects of 25-gauge vitrectomies combined with air tamponade for the treatment of idiopathic （IMH） and the affecting factors of closure of macular hole[J].Recent Advances in Ophthalmology,2018,0(7):680-683. |
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| Authors: | LI Bin KONG Ning |
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| Affiliation: | Ophthalmology，Panyu Central Hospital，Guangzhou 520000，Guangdong Province，China |
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| Abstract: | Objective To evaluate the outcomes of 25-gauge vitrectomies combined with air tamponade for the treatment of idiopathic macular hole （IMH）.The anatomical changes and closure of macular hole （MH） were recorded and analyzed by the optical coherence tomography （OCT） to explore the best indication for this treatment.Methods Retrospective study.Forty-three eyes of 43 IMH patients underwent 25-gauge vitrectomy combined with air tamponade were included.The logMAR best corrected visual acuity （BCVA），slit lamp examination and OCT were conducted before and after the operation.Preoperative parameters of MH，such as minimum diameter（M），base diameter（B），maximum height（H），tractional hole index（THI） and macular hole index（MHI），were correlated with the postoperative BCVA and anatomical closure.Results The macular holes closed successfully in 37 eyes（86.05%） after the primary vitrectomy，including 29 eyes were complete closure，and 8 eyes were exposed closure.The mean logMAR BCVA improved from 1.15±0.35 preoperatively to 1.04±0.40 postoperatively （t=3.197，P=0.003）.The preoperative parameters minimum diameter and base diameter had positive correlations with postoperative BCVA，and the THI and MHI were negatively correlated with postoperative logMAR BCVA（all P<0.05）.No correlation between postoperative BCVA and preoperative macular hole height was observed （P=0.339）.When THI>1 or MHI>0.5，closure rates （including complete closure and exposed closure） were 100%.The anatomical closure rate was 94.74% when THI>0.5，and 97.14% respectively when MHI>0.3.Conclusion The 25-gauge vitrectomies and air tamponade have effectively treatment for IMH，and THI and MHI are important indexes affecting macular hole closure. |
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| Keywords: | idiopathic macular hole vitrectomy internal limiting membrane peeling air |
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