[1]杨中伊,游志鹏.内界膜填塞术和标准内界膜剥除术治疗大直径特发性黄斑裂孔的疗效及安全性对比分析[J].眼科新进展,2020,40(6):578-581.[doi:10.13389/j.cnki.rao.2020.0133]
　YANG Zhongyi,YOU Zhipeng.Comparative analysis of the efficacy and safety of internal limiting membrane tamponade and standard internal limiting membrane stripping in the treatment of large diameter idiopathic macular hole[J].Recent Advances in Ophthalmology,2020,40(6):578-581.[doi:10.13389/j.cnki.rao.2020.0133]
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内界膜填塞术和标准内界膜剥除术治疗大直径特发性黄斑裂孔的疗效及安全性对比分析/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
40卷
期数:
2020年6期
页码:
578-581
栏目:
应用研究
出版日期:
2020-06-05

文章信息/Info

Title:
Comparative analysis of the efficacy and safety of internal limiting membrane tamponade and standard internal limiting membrane stripping in the treatment of large diameter idiopathic macular hole
作者:
杨中伊; 游志鹏
330006　江西省南昌市，南昌大学第二附属医院眼科
Author(s):
YANG Zhongyi; YOU Zhipeng
Department of Ophthalmology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi Province,China
关键词:
特发性黄斑裂孔; 内界膜剥除术; 内界膜填塞术; 疗效
Keywords:
idiopathic macular hole;  internal limiting membrane stripping;  internal limiting membrane tamponade;  efficacy
分类号:
R774.5
DOI:
10.13389/j.cnki.rao.2020.0133
文献标志码:
A
摘要:
目的　比较内界膜填塞术与标准内界膜剥除术治疗大直径特发性黄斑裂孔（IMH）的疗效和安全性。方法　选取裂孔底径大于1000 μm的IMH患者48例48眼为研究对象；22眼纳入内界膜填塞术组，26眼纳入标准内界膜剥除术组。于术后1周、1个月、6个月观察术眼黄斑裂孔闭合情况、最佳矫正视力（BCVA）变化、黄斑中央视网膜厚度（central macular thickness，CMT）变化和并发症的情况。结果　随访6个月，内界膜填塞术组22眼（100.0%）裂孔闭合，标准内界膜剥除术组21眼（80.8%）裂孔闭合，5眼（19.2%）贴附，内界膜填塞术组裂孔闭合率高于标准内界膜剥除术组，差异有统计学意义（P<0.05）。两组患者手术前后BCVA随时间变化显著（P<0.05），但两组间比较差异无统计学意义(F时间=27.663，P时间<0.010;F组间=0.580，P组间=0.631;F交互=0.290，P交互=0.593)。对不同时间点分别进行两两比较，结果显示：术后1个月、6个月两组BCVA均优于术前，差异均有统计学意义(均为P<0.05)。两组患者手术前后CMT随时间变化显著（P<0.05），但两组间比较差异无统计学意义(F时间=20.750，P时间<0.010；F组间=1.131，P组间=0.294；F交互=1.646，P交互=0.194）。对不同时间点分别进行两两比较，结果显示：内界膜填塞术组术后1周CMT高于术前，差异有统计学意义(P<0.05)，术后1个月CMT恢复至术前水平，与术前比较差异无统计学意义(P>0.05)，术后6个月CMT低于术前水平，与术前比较差异有统计学意义(P<0.05)；标准内界膜剥除术组术后1周、术后1个月与术前比较差异均无统计学意义(均为P>0.05)，术后 6个月CMT低于术前水平，差异有统计学意义(P<0.05)。两组患者均未出现视网膜脱离、裂孔复发等严重并发症。结论　两种手术方式治疗大直径IMH均有效且安全性较好；内界膜填塞术患者裂孔闭合率优于标准内界膜剥除术，但存在瘢痕形成的可能。
Abstract:
Objective　To compare the efficacy and safety of internal limiting membrane tamponade and standard internal limiting membrane stripping in the treatment of large diameter idiopathic macular hole (IMH).Methods　A total of 48 eyes of 48 IMH patients with a diameter greater than 1000 μm were selected as the study objects; 22 eyes were included in the internal limiting membrane tamponade group and 26 eyes were included in the standard internal limiting membrane stripping group. The closure status of IMH, changes in the best corrected visual acuity (BCVA) and central macular thickness (CMT), and complications were observed 1 week, 1 month and 6 months after surgery. Results　 After 6 months of follow-up visit, 22 eyes (100%) in the internal limiting membrane tamponade group were closed, 21 eyes (80.8%) in the standard internal limiting membrane stripping group were closed and 5 eyes (19.2%) in this group were attached. The closure rate in the internal limiting membrane tamponade group was higher than that in the standard internal limiting membrane stripping group, and the difference had statistical significance (P<0.05). The BCVA in the two groups before and after surgery changed significantly with time (P<0.05), but the difference was not statistically significant between the two groups (Ftime=27.663, Ptime<0.010; Finter-group=0.580, Pinter-group=0.631; Finteraction=0.290, Pinteraction=0.593). Pairwise comparison was conducted on any two levels at different time points, and the results showed that: the BCVA in the two groups at 1 and 6 months after surgery was better than that before the operation (both P<0.05). The CMT in the two groups before and after surgery changed significantly with time (both P<0.05), but the difference had no statistical significance between the two groups (Ftime=20.750, Ptime<0.010; Finter-group=1.131, Pinter-group=0.294; Finteraction=1.646, Pinteraction=0.194). Pairwise comparison was conducted on any two levels at different time points; the results showed that: the CMT in the internal limiting membrane tamponade group at 1 week after surgery was higher than that before surgery, and the difference had statistical significance (P<0.05); the CMT at 1 month after the operation restored to the preoperative levels, and there was no difference in preoperative levels (P>0.05); the CMT at 6 months after the operation was lower than the preoperative level, and the difference had statistical significance (P<0.05); there was no significant difference in the standard internal limiting membrane stripping group at 1 week and 1 month after surgery comparing with that before surgery (both P>0.05); the CMT at 6 months after the operation was lower than the preoperative levels, and statistical significance was found (P<0.05). No severe complications such as retinal detachment and recurrence of macular hole occurred in the two groups. Conclusion　 Both surgical methods are effective and safe for the treatment of large diameter IMH. Internal limiting membrane tamponade is superior to standard internal limiting membrane stripping, but there is the possibility of scar formation.

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更新日期/Last Update: 2020-06-05