重水辅助下游离内界膜填塞术治疗黄斑裂孔合并 视网膜脱离的疗效分析

Effect of free internal limiting membrane tamping with help of deuterium oxide to treat macular hole with retinal detachment

摘要:

目的 观察重水辅助下游离内界膜填塞术治疗黄斑裂孔（MH）合并视网膜脱离（RD）的疗效， 并与单纯内界膜剥离术相比较，分析2 种术式的安全性及有效性。方法 回顾性分析2015 年1 月—2016 年 12 月南昌大学第一附属医院收治的42 例MH 合并RD 患者的临床资料，所有患者行25G plus 玻璃体切除术。 其中，23 例联合行重水辅助下游离内界膜填塞术（填塞组），19 例联合行单纯内界膜剥离术（未填塞组）。两 组术中均填充硅油，术后均行俯卧位治疗，随访时间分别为3 和6 个月。对比两组患者术后最佳矫正视力、 眼底照相、光学相干断层扫描（黄斑区）、光学相干断层扫描血管成像（黄斑区）、MH 闭合、视网膜复位及 RD 复发情况。结果 两组最佳矫正视力较术前提高（P >0.05）。术后3 个月填塞组与未填塞组MH 闭合率 分别为95.7% 和63.2%（P <0.05）。两组术后6 个月MH 闭合率比较，差异有统计学意义（P <0.05）。两组术 后3 和6 个月视网膜复位率比较，差异无统计学意义（P >0.05）。结论 重水辅助下游离内界膜填塞术治疗 MH 合并RD 较单纯内界膜剥离术更加安全有效，可促进黄斑区及脱离视网膜的解剖复位与视功能恢复。

Abstract:

Objective To observe the effect of free internal limiting membrane tamping with the help of deuterium oxide to treat macular hole with retinal detachment and compare it with internal limiting membrane peeling. Methods A retrospective study design was used to collect 42 patients who had macular hole with retinal detachment from 2015 to 2016, all patients did 25g plus vitrectomy surgeries. Among them, 23 cases were combined with the free internal limiting membrane tamping with the help of deuterium oxide (tamping), and 19 cases were combined with the internal limiting membraneof peeling (peeling). Two groups were filled with silicone oil and were prone position after surgery. Follow-up time were 3 and 6 months to compare two groups patients of postoperative best corrected visual acuity, fundus photography, optical coherence tomography (macular area), optical coherence tomography angiography (macular area), macular hole closed, retinal reposition and recurrence of retinal detachment and so on. Results The postoperative best corrected visual acuity improved in both groups (P > 0.05). Macular hole healing rate of tamping group was 95.7%, peeling group was 63.2%, and there was statistically significant difference between two groups (P < 0.05). The MH healing rate had significantly difference between two groups 6 months after operation (P < 0.05). There was no difference in the reduction rate of retina between two groups 3 or 6 months after operation (P > 0.05). Conclusion To compare with internal limiting membrane peeling, the free internal limiting membrane tamping with the help of Deuterium oxide to treat macular hole with retinal detachment is more safe and effective. It can promote the anatomical reduction and visual function recovery of macular area and detached retina.