目的：探讨特发性黄斑裂孔(idiopathic macular hole，IMH)不同分期行白内障摘除玻璃体切割气体填充术后视力的恢复情况。

方法：选取2014-08/2016-08于我院治疗的IMH合并白内障患者75例75眼，所有患者均行白内障摘除玻璃体切割过氟丙烷(C₃F₈)气体填充术治疗，按IMH不同Gass分期分为Ⅱ期组(18眼)、Ⅲ期组(36眼)、Ⅳ期组(21眼)。比较术后1、3mo黄斑裂口闭合情况； 手术前后进行常规视力检查，比较各组患眼视力提高情况； 光学相干断层扫描(optical coherence tomography，OCT)检查手术前后黄斑厚度。

结果：术后1mo，Ⅱ期组黄斑裂口闭合率显著高于Ⅲ期与Ⅳ期组，Ⅲ期组显著高于Ⅳ期组，差异有统计学意义(P<0.05)； 术3moⅡ期组、Ⅲ期组黄斑裂孔闭合率比较，差异无统计学意义(P>0.05)。所有患者手术前后视力数指、0.02～0.08、0.10～0.20、0.25～0.40、≥0.50人数比例比较，差异有统计学意义(P<0.05)，Ⅱ期组视力提高率为94%，显著高于Ⅲ期(83%)与Ⅳ期组(67%)。Ⅱ期、Ⅲ期组手术后黄斑厚度较手术前均显著降低，Ⅳ期组手术前后差异无统计学意义(P>0.05)，Ⅱ期、Ⅲ期组降低幅度差异无统计学意义(P>0.05)，均显著高于Ⅳ期组，差异具有统计学意义(P<0.05)。

结论：白内障摘除玻璃体切割气体填充术有助于IMH视力恢复，但不同Gass分期疗效具有差异，应尽早进行手术，有助于黄斑裂孔闭合，改善视力。

METHODS: In this study, 75 IMH patients(75 eyes)treated in our hospital from August 2014 to August 2016 were enrolled and underwent cataract extraction, vitrectomy and C₃F₈ gas tamponade. Patients were divided into stage Ⅱ Group(18 cases), stage Ⅲ(36 cases)and stage Ⅳ(21 cases)according to Gass stages, and macular hole closure at 2 and 4wk postoperatively were compared. The routine visual acuity examination before and after surgery were performed, and the visual acuity in each group were compared. The optical coherence tomography(OCT)was used to measure the macular thickness before and after surgery.

RESULTS: The closure rate of macular hole in stage Ⅱ was significantly higher than that of stage III and IV at the 1mo after operation, that at the stage Ⅲ was significantly higher than that of stage Ⅳ group, and the difference was statistically significant(P<0.05). There was no significant difference in the rate of closure of macular hole between stage Ⅱ and stage Ⅲ at 3mo after operation(P>0.05). The proportion of eyes with visual acuity of finger counting, 0.02-0.08, 0.10-0.20, 0.25-0.40 and ≥0.50 was statistically significant different before and after surgery(P<0.05). The improvement rate of visual acuity was 94% in stage Ⅱ, which was significantly higher than that in stage Ⅲ(83%)and stage Ⅳ(67%). The macular thickness of the stage Ⅱ and Ⅲ was significantly lower after the surgery, but there was no significant difference in the stage Ⅳ before and after surgery(P>0.05), the decreasing range of the stage Ⅱ and Ⅲ was not statistically significantly different(P>0.05), which were significantly higher than that of the stage Ⅳ, the difference was statistically significant(P<0.05).

CONCLUSION: Cataract extraction, vitrectomy and C₃F₈ gas tamponade surgery is conducive to the vision recovery after idiopathic macular hole, but the effects with different Gass staging are different, surgery should be performed as early as possible to improve macular hole closure and eyesight recovery.