摘要目的 比较玻璃体切除联合内界膜剥除治疗特发性黄斑孔(IMH),手术中空气填充和全氟丙烷(C3F8)填充的效果.方法 回顾性分析玻璃体切除联合内界膜剥离术治疗的IMH 167例(179只眼)的临床资料.病例随机分为两组,术中分别进行空气填充和C3F8填充.空气组87例(92只眼),C3F8组80例(87只眼).术后患者保持俯卧位,当气体吸收能看清黄斑区视网膜时行OCT检查.于术后1周、2周和1个月进行随访,比较两组视力、眼压、孔闭合率、气体吸收时间、俯卧位时间及手术并发症的发生率.结果 术后两组视力比较,差异无统计学意义(t=-1.134,P=0.149).空气组气体吸收黄斑区的露出时间较C3F8组者短,差异有统计学意义(t=18.750,P=0.000).空气组俯卧(面向下)位时间较C3F8组短,差异有统计学意义(t=11.920,P=0.001).空气组黄斑孔闭合率为96.60%,C3F8组黄斑孔闭合率为95.70%,两组间差异无统计学意义(χ2=0.427,P=0.716).空气组术后4例眼压升高,占4.60%,C3F8组术后7例眼压升高,占7.61%,两组间差异无统计学意义(χ2=0.947,P=0.364).结论 IMH术中空气填充和C3F8气体填充具有相似的效果,同样可以获得较好的术后视力,较高的孔闭合率.但空气的气体吸收时间较短、所需俯卧位时间较短,术后并发症较少而且费用较少.

abstractsObjective To compare the efficacy between air tamponade and perfluoropropane (C3F8) tamponade in vitrectomy combined with internal limiting membrane peeling for the treatment of idiopathic macular hole (IMP).Methods A retrospective analysis.The data of 179 eyes of 167 cases of IMH treated with vitrectomy combined with internal limiting membrane peeling were collected.All cases were randomly divided into 2 groups: air tamponade group,92 eyes of 87 cases and C3F8 tamponade group,87 eyes of 80 cases.After operation,patients kept prone position and received OCT examination when air was absorbed and the macular region could be seen.Patients were followed up at 1 week,2 weeks and 1 month after operation.The visual acuity,intraocular pressure,hole closure rate,air absorption time,prone position time and occurrence rate of operation complications between the two groups were compared.Results The postoperative visual acuities were compared between two groups,and the difference was not statistically significant (t=-1.134,P=0.149).The exposure time of macula lutea in the air group was shorter than that in C3F8 group (t=18.750,P=0.000).The prone position time in the air group was shorter than that of C3F8 group,and the difference was statistically significant (t=11.920,P=0.001).The hole closure rate in C3F8 group was 95.70% and in the air group was 96.60%.The difference in the hole closure rate between two groups was not statistically significant (χ2=0.427,P=0.716).After operation,the high intraocular pressure occurred in 7 cases (7.61%) in C3F8 group,and 4 cases (4.60%) in air group,the difference between two groups was not statistically significant (χ2=0.947,P=0.364).Conclusion For the treatment of IMH,the efficacy of air tamponade and C3F8 tamponade are similar.Two surgeries can obtain better visual acuity and high hole closure rate.But the air tamponade method is with shorter absorption time,shorter prone position time,less postoperative complication and less cost.