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目的 观察玻璃体腔注射全氟丙烷(C3F8)治疗玻璃体黄斑牵拉综合征(VMT)的临床疗效.方法 回顾性系列病例研究.2016年3月至2017年6月于解放军中部战区总医院眼科检查确诊的VMT患者36例38只眼纳入研究.其中,男性16例16只眼,女性20例22只眼;平均年龄(64.11±9.49)岁;平均病程(151.55±127.87)d.所有患者均于确诊后1周内接受玻璃体腔注射C3F8治疗.患眼均行BCVA、视物变形度、频域OCT(SD-OCT)检查.BCVA检查采用国际标准视力表,将结果转换为logmMAR视力进行记录;采用视物变形评分表检测患眼水平(MH)、垂直(MV)视物变形度;采用SD-OCT测量患眼玻璃体黄斑粘附(VMA)范围、黄斑中心视网膜厚度(CMT).患眼平均logMAR BCVA为0.58±0.22;平均MH、MV值分别为0.34±0.30、0.50±0.42;平均CMT为(415.15±89.59) μ m.平均水平VMA为(1168.68±400.61) μm,其中VMA≤1500、＞1500 μm分别为30、8只眼;平均垂直VMA为(976.89±295.92) μm.椭圆体带(EZ)完整22只眼,EZ不完整16只眼.有晶状体33只眼,IOL 5只眼.平均随访时间为10.7个月.观察治疗后6个月患眼BCVA、MH值和MV值、CMT的变化和EZ完整性,以及VMT的改善情况.VMT的治愈率与治疗前BCVA、MH、MV、CMT、VMA、性别、年龄及病程的相关性分析均采用Spearman秩相关分析.结果 治疗后6个月,38只眼中,VMT完全缓解29只眼,治愈率76.3％;VMT完全缓解的平均时间为2.2周.VMT持续存在7只眼;发生孔源性视网膜脱离、全层黄斑裂孔分别各1只眼.患眼平均IogMARBCVA为0.43±0.23;平均MH、MV值分别为0.25±0.23、0.24±0.23.平均CMT为(310.61±63.10) μm.与治疗前比较,治疗后6个月患眼BCVA明显提高,差异有统计学意义(F=3.779,P=0.012);平均MH值差异无统计学意义(F=0.879,P=0.453);平均MH值明显改善,差异有统计学意义(F=4.958,P=0.003);平均CMT明显降低,差异有统计学意义(F=13.419,P＜0.001).EZ不完整16只眼中,EZ恢复完整性9只眼;EZ完整性较治疗前明显改善,差异有统计学意义(,=5.050,P=0.025).相关性分析结果显示,VMT治愈率与治疗前水平VMA范围、logMAR BCVA及CMT呈负相关(r=-0.429、-0.514、-0.348,P=0.009、0.001、0.038).结论 玻璃体腔注射C3F8治疗VMT治愈率较高;可改善患眼视力、视物变形度及黄斑结构.

Objective To evaluate the efficacy of single intravitreal injection of C3F8 in treating vitremacular traction (VMT) syndrome.Methods A retrospective case series of 38 eyes of 36 patients affected with VMT syndrome in Department of Ophthalmology,Central Theater Command General Hospital from March 2016 to June 2017 were enrolled in this study.There were 16 males (16 eyes) and 20 females (22 eyes),with the mean age of 64.1 1 ± 9.49 years and the mean courses of 151.55 ± 127.87 days.All the patients received an intravitreal injection of 0.3 ml of 100％ C3F8 within one week.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.The severity of metamorphopsia was detected using M-charts.The extent of vitreomacular adhesion (VMA),central macular thickness (CMT) and the status of ellipsoid zone (EZ) were assessed with spectral-domain OCT at baseline and each month after treatment.The average BCVA was 0.58± 0.22.The mean horizontal metamorphopsia (MH)and vertical metamorphopsia (MV) were 0.34±0.30 and 0.50±0.42,respectively.The mean CMT was 415.15 ± 89.59 μm.The mean horizontal VMA was 1168.68± 400.61 μm (30 eyes with VMA ≤ 1500 μtm and 8 eyes with VMA＞ 1500 μm).The mean vertical VMA was 976.89±295.92 μtm.There were 22 eyes with integrity EZ and 16 eyes without integrity EZ,33 eyes with crystalline lens and 5 eyes with IOL.The mean follow-up time was 10.7 months.The differences in BCVA,MH,MV,CMT,the integrity of EZ before and after treatment were analyzed.The VMT release rates were assessed.The Spearman rank correlation analysis was performed to investigate the relationship of VMT release rates with the data at baseline.Results Vitreomacular traction release occurred in 29 of 38 eyes by the final follow-up visit,the VMT release rate was 76.3％.VMT release occurred and the average time of VMT release occurred was 2.2 weeks.VMT persisted in 7 eyes,in the rest two eyes,one eye developed a retinal detachment and another eye formed macular hole,both eyes responded to vitrectomy.At 6 months after treatment,the average logMAR BCVA was 0.43±0.23,the mean MH and MV were 0.25± 0.23 and 0.24± 0.23,the mean CMT was 310.61 ± 63.10 pm.Among 16 eyes without integrity EZ before treatment,there were 9 eyes with integrity EZ at 6 months after treatment.There were 16 eyes with integrity EZ and 9 Compared with baseline,the mean BCVA at 6 months after treatment was significantly increased (F=3.779,P=0.037),but the MV (F=4.958,P =0.003) and CMT (F=13.419,P＜0.001) were significantly decreased,the integrity of EZ was improved significantly (22=5.050,P=0.025).The VMT release correlated inversely with the extent of horizontal VMA,BCVA,and CMT at baseline (r=-0.514,-0.348,-0.429;P=0.009,0.001,0.038).Conclusion Intravitreal injection of C3F8 can induce a posterior vitreous detachment and release vitreomacular traction,it is an efficient and safe treatment for VMT syndrome.It can improve the visual acuity,metamorphopsia and foveal morphology in patients with VMT syndrome.