玻璃体切除联合内界膜剥除治疗外伤性黄斑孔

目的回顾性分析对外伤性黄斑孔行玻璃体切除联合内界膜剥除治疗的结果。方法分析本院2004年7月～2005年5月期间收治外伤性黄斑孔病人8例8眼,均进行闭合式玻璃体切除、吲哚青绿辅助下的视网膜内界膜剥除及过氟化碳眼内填充术。观察黄斑孔愈合和视功能恢复情况。结果8例均为全层黄斑孔。术前视力范围CF/30cm～0.2,低于0.01者3眼,0.01～0.1者3眼,0.1以上者2眼。挫伤直接造成黄斑孔3眼,陈旧伤、伴随黄斑前膜等改变者5例5眼。8例均顺利剥除内界膜。随访3m～6m,1眼因发生增殖性视网膜病变而再次手术,其余7眼(87.5%)黄斑孔闭合。术后视力范围眼前数指～0.5。视力<0.01者1眼,0.01～0.1者2眼,0.1～0.3者1眼,0.3以上者4眼,较术前明显提高(P<0.01)。结论玻璃体切除联合内界膜剥除及气体填充能有效促进外伤性黄斑孔闭合、提高视力。

A clinical study of vitrectomy and internal limiting membrane peeling for traumatic macular hole.

Objective To retrospectively investigate traumatic macular hole under vitrectomy and internal limiting membrane peeling. Methods 8 patients with traumatic macular hole in 8 eyes were collected from the July, 2004 to May, 2005. All of them had undergone pars plana vitrectomy, indocyanine green-assisted peeling of the internal limiting membrane and intraocular perfluoropropane tamponade. The closing of trau- matic macular hole and the visual acuity were observed. Results All the 8 cases were full-thickness macular hole. The primary visual acuity was range from counting finger 30 centimeter before the eye to 0.2. Three eyes got vision lower than 0.01. Three between 0.01 and 0.1. Two no lesser than 0.1. Macular hole were formed directly by contusion in three eyes. The other five were chronic ones with epimacular membranes. A complete peeling of internal limiting membranes had been done in each of the 8 cases, and the following-up had been made from 3 months to 6 months. Except for one case being complicated with proliferative retinopathy and undergone a secondary surgery, seven cases (87.5%) had got a closing of macular hole. The best-corrected visual acuity were increased (P<0.01) and ranged from counting finger to 0.5 after surgery. The vision of one case was under 0.01, two between 0.01 and 0.1, one between 0.1 and 0.3, four over 0.3. Conclusion Vitrectomy combining with internal limiting membrane peeling and gas tamponade could prompt the closure of traumatic macular hole together with increasing of the vision.