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[摘要]
目的:探讨不同填充物联合玻璃体切除及内界膜剥除治疗特发性黄斑裂孔(IMH)的疗效及安全性。方法:回顾性研究。选择2018-07/2020-03本院眼科收治的IMH患者117例117眼作为研究对象,两组患者均行玻璃体切除联合内界膜剥除术,根据术中填充材料不同分为两组:采用空气填充者65眼; 采用C3F8填充者52眼。于术前及术后1、2、3mo时进行复查,统计患者末次随访时裂孔闭合率、闭合形态、最佳矫正视力(BCVA)、黄斑中央视网膜厚度(CRT)、外界膜层(ELM)缺损直径、椭圆体带缺损直径、眼压、术后并发症发生情况。结果:空气填充组、C3F8填充组患者术后气体吸收时间分别为8.55±2.17、25.74±7.41d(P<0.05); 空气填充组及C3F8填充组黄斑裂孔闭合率(95.4% vs 98.1%)和闭合孔形态比例比较均无差异(P>0.05)。两组患者术后3mo时BCVA和CRT较术前有差异(P<0.001),ELM缺损直径、椭圆体带缺损直径较术前降低(P<0.001),两组间BCVA、CRT、ELM缺损直径、椭圆体带缺损直径比较均无差异(P>0.05)。两组患者治疗前后眼压比较无差异(P>0.05),两组患者均未发生严重并发症。结论:玻璃体切除及内界膜剥除联合空气填充及C3F8填充治疗IMH疗效及安全性相当,临床可根据实际情况选择。
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[Abstract]
AIM:To investigate the efficacy and safety of different fillers combined with vitrectomy and internal limiting membrane stripping in the treatment of idiopathic macular hole(IMH).METHODS: This retrospective study included 117 patients(117 eyes)with IMH who were admitted to the department of ophthalmology in the hospital between July 2018 and March 2020. Both groups were treated with vitrectomy combined with internal limiting membrane stripping. Sixty-five patients(65 eyes)receiving air filling were included in the air group, while 52 cases(52 eyes)receiving C3F8 filling were included in the C3F8 group. Re-examination was performed before operation and at 1, 2, and 3mo after operation. The rate of hole closure, closed shape, visual acuity, central macular thickness(CRT), exterior limiting membrane(ELM)defect diameter, ellipsoid band defect diameter, intraocular pressure, and the incidence of postoperative complications at the last follow-up were counted. RESULTS: The postoperative air absorption time of air group and C3F8 group was 8.55±2.17d and 25.74±7.41d, respectively(P<0.05). The macular hole closure rates in air group and C3F8 group were 95.4% and 98.1%, respectively(P>0.05). There were no significant differences in the proportions of different shapes of closed holes between the two groups(P>0.05). Visual acuity of the two groups was significantly improved at 3mo after operation(P<0.001). There were no significant differences in LogMAR visual acuity and visual acuity changes between air group and C3F8 group(P>0.05). The CRT was increased significantly after operation(P<0.001), and the diameters of ELM defect and ellipsoid band defect were reduced(P<0.001). There were no significant differences in above indicators between the two groups(P>0.05). There was no significant difference in intraocular pressure between the two groups before and after treatment(P>0.05). No serious complications were observed in the two groups. CONCLUSION: Vitrectomy and internal limiting membrane stripping combined with air filling and C3F8 filling are effective and safe in the treatment of IMH. Clinically, the operation mode can be selected according to the actual situation.
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