玻璃体切割联合内界膜瓣覆盖术中行球内无菌空气填充治疗特发性黄斑裂孔

Effectiveness of inverted internal limiting membrane flap technique combined with sterile air tamponade surgery on managing idiopathic macular hole

摘要:

目的：比较无菌空气填充和C₃F₈填充在玻璃体切割(PPV)联合内界膜瓣(ILMF)覆盖术中治疗特发性黄斑裂孔(IMH)的疗效差异。

方法：回顾性对照研究。选取武汉大学人民医院眼科2014-01/2017-06就诊的符合纳入标准的IMH患者，行PPV联合黄斑区ILMF翻转覆盖黄斑裂孔术，根据术中是否行C₃F₈填充，分为球内空气填充组(A组112眼)和球内C₃F₈填充组(B组63眼)，比较两组术后高眼压发生情况、黄斑裂孔闭合率、术后1、3mo时最佳矫正视力(BCVA)和黄斑区结构重建情况。

结果：A组和B组在术后1、3mo时，较术前BCVA均有提高，差异有统计学意义(P<0.05)； 两组手术后1mo时BCVA比较差异均无统计学意义，术后3mo时，A组BCVA较B组恢复更佳，差异具有统计学意义(P<0.05)； A组黄斑裂孔闭合率为97.5%，B组为96.8%，两组比较差异无统计学意义； 两组的光感受器细胞内外节交界面连接带(EZ)缺损直径较术前均有明显减小，差异有统计学意义(P<0.05)，在术后1、3mo时两组比较，差异均无统计学意义； B组术后高眼压发生率为9.5%，而A组无术后高眼压情况发生，两者差异有统计学意义(P<0.05)。

结论：PPV联合ILMF覆盖治疗特发性黄斑裂孔安全有效，玻璃体腔无菌空气填充可减少术后高眼压发生率，在该手术中可以代替C₃F₈填充。

Abstract:

AIM:To compare the effectiveness of inverted internal limiting membrane flap(ILMF)coverage combined with sterile air tamponade or C₃F₈-filled surgery for idiopathic macular hole(IMH).

METHODS: In this retrospective study, 165 patients(175 eyes)who underwent pars plana vitrectomy(PPV)combined with inverted ILMF coverage were evaluated. The surgeries were performed by one surgeon at the Renmin Hospital, Wuhan University between January 2014 and June 2017. The patients were divided into sterile air(Group A)and C₃F₈-filled(Group B)groups, based on the technique used for intraocular tamponade. With a minimum 3-month follow-up, pre- and post-operative best corrected visual acuity(BCVA), macular hole closure rate, and major postoperative complications were analyzed.

RESULTS: Both groups showed significant improvement in visual acuity at 1 and 3mo postoperatively(P<0.05). There was no significant difference between the two groups 1mo postoperatively, but the average BCVA in Group A was better than that in Group B at 3mo, to a level of statistical significance(P<0.05). The closure rate of macular hole was 97.5% in Group A and 96.8% in Group B, a statistically non-significant difference. There were no statistically significant differences in defect diameters of the inner and outer junctions between the two groups at 1 and 3mo postoperatively(P<0.05), but significant differences compared to before surgery in both groups(P<0.05). The rate of IOP elevation was 9.5% in Group B, and zero(0)in Group A; this difference was statistically significant(P<0.05).

CONCLUSION: We postulate that PPV combined with inverted ILM flap is a safe and effective method for surgical management of IMH. Compared to C₃F₈-filling, sterile air tamponade can avoid IOP elevation; it may replace C₃F₈-filling in PPV for IMH.