玻璃体切割联合单层内界膜倒置皮瓣覆盖术治疗孔源性视网膜脱离并发黄斑裂孔的疗效观察

Q4 Medicine

中华眼底病杂志 Pub Date : 2019-11-25 DOI:10.3760/CMA.J.ISSN.1005-1015.2019.06.004

Haiyun Liu, Yifan Zhou

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引用次数: 0

摘要

目的观察玻璃体切除术联合单层倒内限制膜(ILM)皮瓣覆盖技术治疗孔源性视网膜脱离(RRD)合并黄斑裂孔(MH)的疗效。方法回顾性分析病例。本研究选取2015年1月至2019年8月在上海交通大学附属第一人民医院确诊的29例RRD和MH患者的29只眼睛。男性16只(16眼)，女性13只(13眼)。所有眼均为外周性RRD，累及黄斑区，c期以下合并MH及增殖性玻璃体视网膜病变。所有眼行BCVA和oct检查。BCVA检查采用Snellen视度表，换算成logMAR视力。2017年以前行玻璃体切除联合ILM剥离18眼(ILM剥离组);2017年以后，采用玻璃体切除联合单层逆行ILM瓣覆盖技术治疗11眼(ILM逆行组)。两组患者年龄(t=0.360)、发病时间(t=1.235)、除MH孔数(t=0.060)、RRD范围(t=1.232)、充气眼(χ2=0.324)差异均无统计学意义(P < 0.05)。术后平均随访时间为4.5个月。对比观察两组患者末次随访时BCVA、视网膜再附着、MH闭合情况。u形或v形视网膜定义为MH闭合。结果最后一次随访时，所有眼视网膜再植成功。ILM剥脱组5只眼(27.8%，5/18)完全闭合Ⅰ型。ILM倒置组9只眼(81.8%，9/11)完全闭合Ⅰ型。两组Ⅰ型闭合率比较，差异有统计学意义(χ2=5.968, P=0.015)。ILM去皮组和ILM倒立组的logMAR BCVA平均值分别为1.24±0.28和0.97±0.39。两组患者logMAR BCVA差异有统计学意义(t=2.179, P=0.038)。结论玻璃体切除术联合单层逆行ILM瓣覆盖技术可提高RRD合并MH患者的BCVA和MH闭合率。关键词:视网膜穿孔/手术;视网膜脱离/手术;手术适应症

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Therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane flap covering technique for rhegmatogenous retinal detachment complicated with macular hole

Objective To observe the therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane (ILM) flap covering technique for rhegmatogenous retinal detachment(RRD) complicated with macular hole (MH). Methods A retrospective case analysis. From January 2015 to August 2019, 29 eyes of 29 patients with RRD and MH diagnosed in the First People's Hospital Affiliated to Shanghai Jiaotong University were included in this study. There were 16 males (16 eyes) and 13 females(13 eyes). All the eyes were peripheral RRD and involving the macular area, while complicated with MH and proliferative vitreoretinopathy in stage less than C. All the eyes were examined by BCVA and OCT. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. Before 2017, 18 eyes were treated with vitrectomy combined with ILM peeling (ILM peeling group); after 2017, 11 eyes were treated with vitrectomy combined with single-layer inverted ILM flap covering technique (ILM inverted group). The differences of age (t=0.360), onset time (t=1.235), number of holes except MH (t=0.060), RRD range (t=1.232), gas filled eyes (χ2=0.324) between the two groups were not statistically significant (P>0.05). The average follow-up time after surgery was 4.5 months. The BCVA, retinal reattachment and MH closure at the last follow-up in the two groups were comparatively observed. U-shaped or V-shaped retina was defined as MH closure. Results At the last follow-up, retinal reattachments were achieved in all the eyes. In ILM peeling group, 5 eyes (27.8%, 5/18) were completely closed in typeⅠ . In ILM inverted group, 9 eyes (81.8%, 9/11) were completely closed in typeⅠ . There was a statistically significant difference of closure rate in type Ⅰ closure between the two groups (χ2=5.968, P=0.015). The mean logMAR BCVA in ILM peeling group and ILM inverted group were 1.24±0.28 and 0.97±0.39, respectively. The difference of logMAR BCVA between the two groups was statistically significant (t=2.179, P=0.038). Conclusion Vitrectomy combined with single-layer inverted ILM flap covering technique can increase the BCVA and MH closure rates in RRD patients with MH. Key words: Retinal perforations/surgery; Retinal detachment/surgery; Vitreoretinal surgery

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来源期刊

中华眼底病杂志 Medicine-Ophthalmology

CiteScore

0.40

自引率

0.00%

发文量

5383

期刊介绍： Chinese Journal of Ocular Fundus Diseases is the only scientific journal in my country that focuses on reporting fundus diseases. Its purpose is to combine clinical and basic research, and to give equal importance to improvement and popularization. It comprehensively reflects the leading clinical and basic research results of fundus disease disciplines in my country; cultivates professional talents in fundus disease, promotes the development of fundus disease disciplines in my country; and promotes academic exchanges on fundus disease at home and abroad. The coverage includes clinical and basic research results of posterior segment diseases such as retina, uveal tract, vitreous body, visual pathway, and internal eye diseases related to systemic diseases. The readers are medical workers and researchers related to clinical and basic research of fundus diseases. According to the journal retrieval report of the Chinese Institute of Scientific and Technological Information, the comprehensive ranking impact factor and total citation frequency of the Chinese Journal of Ocular Fundus Diseases have been among the best in the disciplines of ophthalmology, otolaryngology, and ophthalmology in my country for many years. The papers published have been included in many important databases at home and abroad, such as Scopus, Peking University Core, and China Science Citation Database (CSCD).