玻璃体切除术联合不同填充物治疗特发性黄斑裂孔的比较

Clinical comparison of vitrectomy combined with C3F8 or sterile air tamponade for idiopathic macular hole

摘要:

目的：比较玻璃体切除内界膜剥除术联合C₃F₈与消毒空气填充治疗特发性黄斑裂孔(IMH)的效果。

方法：连续选取2011-01/2016-01就诊于我院的IMH孔径≤600μm的患者51例51眼，接受我院同一医师独立完成的玻璃体切除内界膜剥除联合玻璃体腔内填充术，随机分为A、B两组。A组27例为16% C₃F₈ 填充组，B组24例为消毒空气填充组。所有患者在术后1wk，1、3、6mo复查。比较两组患者末次复查时裂孔的闭合率(黄斑裂孔闭合率按照孔径≤200、>200～400、>400～600μm区间进行比较)、裂孔闭合形态、俯卧时间、最佳矫正视力(BCVA)、视物变形的改善情况以及术后白内障进展情况。

结果：在各孔径区间内，两组患者裂孔闭合率差异无统计学意义(P>0.05)； 两组患者术后黄斑裂孔闭合形态差异无统计学意义(P>0.05)； B组俯卧位时间较A组明显缩短，差异有统计学意义(P<0.01)； 两组患者术后BCVA较术前均提高，差异有统计学意义(P<0.05)，但两组间BCVA比较差异无统计学意义(P>0.05)； 两组患者视物变形有不同程度改善，两组间比较差异无统计学意义(P>0.05)； B组术后白内障进展率较A组降低，差异无统计学意义(P>0.05)。

结论：治疗孔径≤600μm的特发性黄斑孔患者，与C₃F₈ 填充组相比，消毒空气填充组在获得同样较高的裂孔闭合率、良好的裂孔闭合形态以及视功能改善的同时，也明显缩短了俯卧时间，降低了术后长期俯卧位而诱发全身疾病的风险。

Abstract:

AIM: To compare the efficacy of vitrectomy combined with internal limiting membrane peeling and C₃F₈ or sterile air tamponade for idiopathic macular hole(IMH).

METHODS: In this research, 51 cases of IMH with holes diameter ≤600μm were accepted from the same doctor of department of Ophthalmology in Luoyang Central Hospital from January 2011 to January 2016. All the patients were under taken vitrectomy combined with internal limiting membrane peeling and gas tamponade. All the study subjects were divided into two groups(Group A and Group B). The Group A were tamponaded with perfluoropropane(C₃F₈)(27 eyes), while the Group B were tamponaded with sterile air(24 eyes).The closure rate and morphology of macular hole, the time of prone position, the best corrected visual acuity(BCVA), the improvement of metamorphopsia and the process of cataract were compared and statically analyzed in these two groups. While the closure rate was compared among ≤200μm, >200-400μm and >400-600μm groups. Postoperative followup time was 1wk, 1, 3mo and half a year.

RESULTS: The difference of two groups was no statistically significant in all interval according to holes diameter(P>0.05). The difference of two groups was no statistically significant in morphology of macular hole form(P>0.05). The time of prone position in Group B was significantly shorter than that in Group A, and the difference was statistically significant(P<0.01). The BCVA of postoperative was improved than preoperative, and the difference was statistically significant(P<0.01). However, there was not statistically significant between the two groups in the BCVA of postoperative(P>0.05). The metamorphopsia of postoperative was improved than preoperative in two groups while there was not statistically significant between the two groups in the BCVA of postoperative(P>0.05). Cataract progress rate was reduced in the Group B than the Group A, but the difference was not statistically significant(P>0.05).

CONCLUSION: This study shows that sterile air tamponade can obtain same closure rate, morphology of macular hole and the improvement of metamorphopsia and visual function in holes diameter ≤600μm when reducing the time of prone position and the risk of systemic diseases induced by prone position after operation.