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目的 观察玻璃体切割手术(PPV)联合单层内界膜(ILM)翻转覆盖治疗孔源性视网膜脱离(RRD)合并黄斑裂孔(MH)的疗效.方法 回顾性病例分析.2015年1月至2019年8月于上海交通大学附属第一人民医院眼科检查确诊的RRD合并MH患者29例29只眼纳入研究.其中,男性16例16只眼,女性13例13只眼.患眼均为周边裂孔累及黄斑区的RRD,同时存在MH,增生性玻璃体视网膜病变＜C级.患眼均行BCVA、OCT检查.采用Snellen视力表行BCVA检查,记录时换算为logMAR视力.2017年前患眼采用PPV联合ILM剥除手术,其后采用PPV联合单层ILM覆盖手术,并据此分为ILM剥除组、ILM覆盖组,分别为18、11只眼.两组患者年龄(t=0.360)、发病时间(t=1.235)、除MH外裂孔数量(t=0.060)、RRD范围占比(t=1.232)、气体填充眼数(x2=0.324)比较,差异均无统计学意义(P＞0.05).手术后平均随访时间4.5个月.对比观察两组患眼末次随访时BCVA、视网膜复位和MH闭合状况.MH以裂孔处视网膜呈U形或V形为闭合.结果 末次随访时,所有患眼视网膜均复位.ILM剥除组18只眼中,MH呈Ⅰ型闭合5只眼(27.8％,5/18),ILM覆盖组11只眼中,MH呈Ⅰ型闭合9只眼(81.8％,9/11);两组患眼Ⅰ型闭合率比较,差异有统计学意义(x2=5.968,P=0.015).ILM剥除组、ILM覆盖组患眼平均logMARBCVA分别为1.24±0.28、0.97±0.39;两组患眼平均logMAR BCVA比较,差异有统计学意义(t=2.179,P=0.038).结论 PPV联合单层ILM覆盖可提高RRD合并MH患眼BCVA和MH闭合率.

Objective To observe the therapeutic effect ofvitrectomy 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 (x2=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 reattachmnents were achieved in all the eyes.In ILM peeling group,5 eyes (27.8％,5/18) were completely closed in type Ⅰ.In ILM inverted group,9 eyes (81.8％,9/11) were completely closed in type Ⅰ.There was a statistically significant difference of closure rate in type Ⅰ closure between the two groups (x2=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.