玻璃体切割联合重水及透明质酸钠凝胶辅助内界膜翻转覆盖治疗难治性黄斑裂孔的疗效观察

Clinical Efficacy of Vitrectomy Combined with Perfluorocarbon Liquids and Sodium Hyaluronate Gel Assisted Inverted Internal Limiting Membrane Flap Technique for Refractory Macular Holes

摘要: 目的：回顾性分析观察玻璃体切割联合重水及透明质酸钠凝胶辅助内界膜(ILM)翻转覆盖治疗难治性黄斑裂孔的临床疗效。方法：收集2021年9月2022年7月于青岛市立医院眼科中心行玻璃体切割联合重水及透明质酸钠凝胶辅助ILM翻转覆盖治疗的难治性黄斑裂孔患者21例(21眼)。手术后随访至少3个月以上，利用OCT评估患者黄斑裂孔闭合情况，观察手术后ILM瓣膜位置、BCVA变化、术后并发症等情况。结果：21例患者裂孔闭合率100%，其中U形闭合17眼；V形闭合2眼；W形愈合2眼。患者术前BCVA (logMAR)为1.23 ± 0.55，术后为0.64 ± 0.09，术后BCVA较术前提高，差异有统计学意义(t = 5.23, P < 0.01)。术中及随访期间翻转的ILM均在位，重水残留发生率0%，术眼未出现严重并发症。结论：玻璃体切割联合重水及透明质酸钠凝胶辅助的ILM翻转覆盖能有效治疗难治性黄斑裂孔，避免ILM瓣膜滑脱，提高裂孔闭合率，促进视功能的恢复。

Abstract: Objective: To observe the clinical efficacy of vitrectomy combined with perfluorocarbon liquids and sodium hyaluronate gel assisted inverted internal limiting membrane flap technique for refractory macular holes. Methods: A total of 21 patients (21 eyes) with refractory macular holes treated by vitrectomy combined with inverted internal limiting membrane flap technique in the Ophthalmol-ogy Department of the Qingdao Municipal Hospital from September 2021 to July 2022 were col-lected. The closure of macular holes was evaluated by optical coherence tomography (OCT). Pre-operative and postoperative best corrected visual acuity (BCVA) was compared. Intraoperative and postoperative complications were recorded. The patients were followed up for at least 3 months. Results: The rate of macular hole closure in 21 patients was 100%, including U-shaped closure of 17 eyes; V-shaped closed 2 eyes; W-shaped closure 2 eyes. The postoperative BCVA (logMAR) was 1.23 ± 0.55, which improved significantly compared with postoperative level (0.64 ± 0.09) (t = 5.23, P < 0.01). The inverted ILM was present both during the operation and during follow-up. The incidence of heavy water residue was 0%, and no serious intraocular complications occurred. Conclusion: Vitrectomy combined with perfluorocarbon liquids and sodium hyaluronate gel assisted inverted internal limiting membrane flap technique can effectively treat refractory macular holes. It can en-sure the stability of the ILM flap, avoid ILM valve slip, improve hole closure rate, and promote visual function recovery.