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目的 :探讨玻璃体手术治疗特发性黄斑裂孔的疗效以及光学相干断层成像 (opticalcoherencetomography ,OCT)对黄斑裂孔手术疗效评价的价值。方法 :回顾性分析经玻璃体手术治疗的特发性黄斑裂孔患者 4 4例 4 4只眼的临床资料。结果 :经平均 7 4个月的随访 ,黄斑裂孔闭合消失者 14例 ,裂孔缩小晕轮消失者 16例 ,裂孔大小未变而晕轮消失者 9例 ,此 39例 (88 6 % )孔缘神经上皮层间小囊腔消失、晕轮消失 ,属于解剖学愈合 ;2 7例手术中用自体血清封闭裂孔 ,17例未用 ,裂孔解剖学愈合的前者为 2 1例 (77 8% ) ,后者为 15例 (88 2 % ) ;术后视物变形症状明显改善者 38例 ,视力提高 2行以上 18例(4 0 9% ) ;术后短暂高眼压 7只眼 ,晶状体混浊加重 16只眼 ,医源性视网膜裂孔 2只眼 ,视网膜脱离 1只眼 ,黄斑前膜 3只眼。经玻璃体手术治疗成功者OCT图像表现为裂孔周围神经上皮脱离的晕轮消失 ,裂孔边缘视网膜厚度恢复正常 ,神经上皮内小囊泡消失 ,裂孔明显变小甚至消失。结论 :玻璃体手术是治疗特发性黄斑裂孔的安全有效方法 ,OCT是客观评价特发性黄斑裂孔手术疗效的有价值的方法。
Objective: To evaluate the efficacy of vitrectomy in the treatment of idiopathic macular hole and the value of optical coherence tomography (OCT) in evaluating the curative effect of macular hole surgery. Methods: The clinical data of 44 patients (44 eyes) with idiopathic macular hole treated by vitreous surgery were analyzed retrospectively. Results: After an average of 74 months of follow-up, there were 14 cases of disappearance of macular hole, 16 cases of disappearance of halo and 6 cases of disappearance of halo, 9 of 39 cases (88.6%) The disappearance of the small cysts in the neuroepithelial layer and the disappearance of the halo appeared in the anatomy of the neuroepithelial neoplasm. Seventy-seven cases were closed with autologous serum and 21 cases (77.8% The latter were 15 cases (88.2%); visual acuity improved significantly in 38 cases, visual acuity improved more than 2 lines in 18 cases (49%); postoperative transient high intraocular pressure in 7 eyes, lens opacity increased 16 eyes, iatrogenic retinal holes 2 eyes, retinal detachment 1 eye, macular membrane 3 eyes. OCT images of vitreous surgeries showed the disappearance of the halo of the perineural epithelium, the normal retinal thickness at the edge of the hiatus, the disappearance of small vesicles in the neuroepithelial fossa, and the cleavage of the oculi. Conclusion: Vitreous surgery is a safe and effective method for the treatment of idiopathic macular hole. OCT is a valuable method to objectively evaluate the curative effect of idiopathic macular hole surgery.