检索历史 清除

目的 观察内界膜剥除联合内界膜移植手术对难治性黄斑裂孔患者的视功能相关生存质量的影响.方法 回顾性病例研究.2016年1～12月在南京医科大学第一附属医院眼科就诊的难治性黄斑裂孔患者30例30只眼纳入研究.其中,男性13例13只眼,女性17例17只眼;平均年龄(57.3±6.9)岁.巨大黄斑裂孔15例15只眼,高度近视黄斑裂孔12例12只眼,继发性外伤性黄斑裂孔3例3只眼.采用Snellen视力表检测患眼BCVA,并将结果换算为logMAR视力记录;采用OCT仪测量患眼黄斑中心凹厚度(CRT)、黄斑裂孔的基底直径和最小径,计算黄斑裂孔指数(MHI).患眼logMAR BCVA为1.52±0.30,MHI为0.51±0.19.采用中文版视觉相关生存质量表(CVRQoL-25)评估患者视觉相关生存质量.患者CVRQoL-25评分为(57.60±7.13)分.所有患者均行23G玻璃体切割联合内界膜剥除及内界膜移植手术.手术后随访至少3个月.随访期间采用与手术前相同的设备和方法行相关检查,对比分析患眼BCVA、MHI、CRT以及CVRQoL-25评分的变化.手术前后计量资料比较采用配对f检验,各参数之间的相关性分析采用Spearman秩相关分析.结果 手术后3个月,30只眼中裂孔解剖闭合28只眼,裂孔闭合率为93.3％;未闭合2只眼,占6.7％.患眼logMAR BCVA为1.16±0.33,CRT为(161.00±15.26) μm;患者CVRQoL-25评分为(70.83±9.77)分.手术后患眼BCVA较手术前明显改善,差异有统计学意义(t=4.386,P=0.000);手术后患者CVRQoL-25评分较手术前明显提高,差异有统计学意义(t=-5.991,P=0.000).Spearman秩相关分析结果显示,手术后患者CVRQoL-25评分与手术前后logMAR BCVA呈负相关(r=-0.536、-0.796,P=0.002、0.000);与手术前MHI呈正相关(r=0.421,P=0.020);与手术后CRT呈正相关(r=0.589,P=0.001).结论 内界膜剥除联合内界膜移植手术治疗难治性黄斑裂孔可明显改善患者视功能相关生存质量;93.3％的患眼裂孔闭合,患眼视力明显提高.

Objective To observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.Methods A retrospective clinical study.Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study.There were 13 males (13 eyes) and 17 females (17 eyes),with the mean age of 57.3 ± 6.9 years.There were 15 patients (15 eyes) with large macular diameter,12 patients (12 eyes) with high myopia macular hole,and 3 patients (3 eyes) with secondary traumatic macular hole.The BCVA examination was performed using the Snellen visual acuity chart,which was converted into logMAR visual acuity.OCT was performed to measure the macular retinal thickness (CRT),base diameter and minimum diameter of macular hole.Then,the macular hole index (MHI) was calculated.The logMAR BCVA was 1.52±0.30,MHI was 0.51 ±0.19.The Chinese version of visual-related quality of life scale-25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients.The CVRQoL-25 score was 57.60±7.13.All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation.The follow-up was at least 3 months after surgery.The changes ofBCVA,MHI,CRT and CVRQoL-25 score before and after surgery were comparatively analyzed.Paired t test was performed to compare the measurement data before and after surgery,and Spearman rank correlation analysis was used for the correlation analysis among the parameters.Results At 3 months after surgery,the hole closure was detected in 28 eyes (93.3％),not detected in 2 eyes (6.7％).The logMAR BCVA was 1.16± 0.33,CRT was 161.00± 15.26,and CVRQoL-25 scores was 70.83 ± 9.77.Compared with before surgery,the BCVA (t=4.386,P=0.000) and CVRQoL-25 score (t=-5.991,P=0.000) after surgery were improved.Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=-0.536,-0.796;P=0.002,0.000);positively correlated with preoperative MHI (r=0.421,P=0.020) and postoperative CRT (r=0.589,P=0.001).Conclusion Internal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity,while achieved a high hole closure rate (93.3％).