摘要 目的 探讨黄斑孔视网膜脱离手术治疗的最佳方法 。方法 比较玻璃体腔内注气与玻璃体切割、自体浓缩血小板封孔联合眼内填充术术后复 位率及视力。结果 玻璃体腔内注气组术后视网膜复位率为88.2%,玻璃体切割联合 眼内填充组为100%。术后视力玻璃体切割联合眼内填充组明显优于玻璃体腔内注气组( P<0.01)。术中血小板封孔组明显优于非血小板封孔组(P<0.05)。 结论 玻璃体切割、自体浓缩血小板封孔联合眼内填充术是一种增视的黄斑孔视网膜脱离 的手术方法。
A study of the effectiveness of different operativ e methods on 37 cases of
macular hole w it h retinal detachment
Jiang Yanrong Li Xi aoxin Yin Chunyue
(Department of Ophthalm ology,People’s Hospital,Beijing Medical
University,Beijing 100044)
Abstract O bjec tiveTo determine the optimum way to tre at macular holes.MethodsOperative meth o ds studied were gas-injection operation in vitreous,vitrectomy,and autologous co ncentrated platelets combined with inter nal tamponade sealing the macular hole.P ostoperatively,the effect on the reattac hment rate and visual acuity were evalua ted.Data were analysed statistically by χ2-test.Results(1)Rate of the reattach me nt:the success rate in the group of gas- injection in vitreous was 88.2%,the grou p of vitrectomy combined internal tampona de was 100%;(2)The group of vitrectomy c om bined with internal tamponade acquired b etter postoperative visual acuity than t he group of gas-injection in vitreous(P <0.01);(3)The group of macular holes se al ed with autologous concentrated platelet s acquired better postoperative visual a cuity than the group without it(P<0.05 ).ConclusionsVitrectomy and autologous concentrated platelet combined with tamp onade to seal macular holes is an ideal way to obtain best visual improvement.
Key words macular hole retinal detac hment vitrectomy autologous concentrated platelet
近年来,随着手术设备、技术、材料的进步,黄斑孔视网膜脱离的治疗手段不断更新,治愈率不断提高。自1995年4月至1997年5月我们经手术治疗黄斑孔视网膜脱离37例(37眼),报告如下。
1 临床资料和方法
1.1 一般资料 黄斑孔视网膜脱离37例,男18人,女19人,年龄12~81岁,平均58.9岁。包括多发裂孔合并黄斑裂孔9只眼,黄斑“白孔”5只眼,术前外院已行激光治疗4只眼,复发性黄斑孔视网膜脱离6只眼,PVR程度:C期6只眼,D期2只眼。
1.2 手术方法 采用玻璃体腔内注气17只眼;玻璃体切割、SF6注入1只眼;玻璃体切割、血小板封孔、SF6注入9只眼;玻璃体切割、硅油注入2只眼;玻璃体切割、血小板封孔、硅油注入8只眼。
玻璃体腔内注气:采用100%SF6或100%C3F80.3~0.7ml。
玻璃体切割术:采用扁平部玻璃体切割术,气/液交换后于黄斑孔部滴入自体浓缩血小板,继20~25%SF6注入或硅油注入。未行血小板封孔者,气/液交换后直接行眼内填充。术后取俯卧位。血小板注入者术后仰卧1h后取俯卧位。
自体浓缩血小板提取与注入方法我们已作过报道[1]。
观察期3~23个月,平均4.57个月。统计学采用卡方检验。
2 结果
复位率:玻璃体腔内注气17只眼,复位15只眼为88.2%,玻璃体切割联合眼内填充为22只眼(玻璃体腔注气2只眼失败后行玻璃体切割术)复位22只眼为100%。硅油注入10只眼,已行硅油取出8只眼,未发生视网膜脱离。
术前、术后视力比较见表1。
表1 黄斑孔视网膜脱离手术前后视力比较
Tab.1 Preoperative and postoperative visual acuities of all 37 eyes
Visual acuity |
n |
<0.02 |
>0.02 |
>0.05 |
>0.1 |
>0.5 |
Pre-operation |
37 |
16 |
15 |
6 |
0 |
0 |
Post-operation |
37 |
3 |
10 |
12 |
10 |
2 |
玻璃体切割与玻璃体腔内注气术后视力比较见表2。
表2 玻璃体切割术后,玻璃体腔内注气术后视力比较
Tab.2 Visual outcome among patients treated with vitrectomy or gas injection
Procedure |
n |
<0.02(%) |
≥0.02(%) |
≥0.1(%) |
Vitrectomy |
22 |
3(13.6) |
8(36.4) |
11(50.0) |
Gas injection |
17 |
2(11. 8) |
14(82.4) |
1(5.9) |
玻璃体切割联合眼内填充术与玻璃体注气比较,术后视力明显提高。经统计学处理差异有高度显著性(P<0.01)。
自体浓缩血小板注入 术后视力比较见表3。
表3 血小板注 入与非血小板注入术后视力比较
Tab.3 Visual outcome among patients treated with and without
autologous concentrated platelet(A CP)
Procedure |
n |
<0.02(%) |
≥0.02(%) |
≥0.1(%) |
With ACP |
17 |
3(17.6) |
7(41. 2) |
7(41.2) |
Without ACP |
20 |
0(0.0) |
15(75.0) |
5(25.0) |
血小板注入术后视力明显高于非血小板注入者。经统计学处理差异有显著性(P<0.05)。
黄斑“白孔”5只眼,手术行玻璃体切割、血小板封孔硅油注入,术后全部视网膜复位。其中3眼硅油取出,未发生视网膜脱离。视力均小于0.1。
手术并发症:本组发生持续性高眼压2只眼,白内障1只眼,角膜失代偿1只眼,黄斑前膜1只眼。
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