發(fā)布時(shí)間：2018-03-17 20:01

  本文選題：黃斑裂孔　切入點(diǎn)：特發(fā)性黃斑裂孔　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的探討前后聯(lián)合手術(shù)治療特發(fā)性黃斑裂孔(idiopathic macular hole,IMH)、高度近視性黃斑裂孔(high myopicmacular hole.,HMMH)伴視網(wǎng)膜脫離以及不伴視網(wǎng)膜脫離三種類(lèi)型的患者最佳矯正視力(best-corrected visual acuity,BCVA)相關(guān)因素的分析。方法從2015年1月至2015年12月在天津市眼科醫(yī)院的43例黃斑裂孔患者(特發(fā)性黃斑裂孔25例、高度近視性黃斑裂孔伴視網(wǎng)膜脫離9例、高度近視性黃斑裂孔不伴視網(wǎng)膜脫離9例)行前后聯(lián)合手術(shù),術(shù)前眼部檢查包括視力、眼內(nèi)壓(intraocular pressure,IOP)、裂隙燈、間接眼底鏡、頻域光學(xué)相干斷層掃描(spectral-domain optical coherence tomography,SD-OCT)。所有患者全部行三通道平坦部玻璃體切割、吲哚青綠染色,同時(shí)行白內(nèi)障超聲乳化聯(lián)合后房型人工晶體植入,行氣液交換后,玻璃體腔注入0.3ml純C3F8,術(shù)后2w、1m、3m、6m門(mén)診復(fù)查,復(fù)查時(shí)進(jìn)行最佳矯正視力、裂隙燈下前置鏡觀察眼底、眼壓、IOL Master、黃斑區(qū)OCT檢查,每個(gè)患者隨訪(fǎng)6個(gè)月后進(jìn)行數(shù)據(jù)整理,記錄術(shù)前術(shù)后最佳矯正視力、眼軸、黃斑裂孔愈合情況、驗(yàn)光結(jié)果及患者基本資料等指標(biāo),并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果三種類(lèi)型黃斑裂孔術(shù)后結(jié)果表明特發(fā)性黃斑裂孔術(shù)后6個(gè)月觀察期間中心凹外層視網(wǎng)膜不斷發(fā)生形態(tài)學(xué)改變,25例全部可見(jiàn)外界膜愈合出現(xiàn),92%集中在3-6個(gè)月出現(xiàn)外界膜愈合,外界膜愈合時(shí)間與術(shù)前視力呈負(fù)相關(guān)(r=-0.4047,p=0.0448),術(shù)前平均視力0.16±0.12,術(shù)后6m平均視力0.63±0.22。眼軸與視力呈負(fù)相關(guān)(P=0.0482),術(shù)前眼軸與術(shù)后2w、1m、3m、6m眼軸差異有統(tǒng)計(jì)學(xué)意義(P0.0001),術(shù)后2w、1m、3m、6m之間比較眼軸差異沒(méi)有統(tǒng)計(jì)學(xué)意義。高度近視性黃斑裂孔伴視網(wǎng)膜脫離的術(shù)前平均視力0.05±0.07,術(shù)后6m平均視力視力0.39±0.29,眼軸與各時(shí)間點(diǎn)視力沒(méi)有相關(guān)性(p=0.6718),術(shù)前術(shù)后眼軸沒(méi)有統(tǒng)計(jì)學(xué)意義,術(shù)前視力是外界膜愈合的保護(hù)因素(χ~2=16.49 P0.0001)。高度近視性黃斑裂孔不伴視網(wǎng)膜脫離的術(shù)前平均視力0.13±0.09,術(shù)后6m平均視力視力0.42±0.26,年齡是外界膜愈合的危險(xiǎn)因素(χ~2=8.35 p=0.0038),術(shù)前視力是外界膜愈合的保護(hù)因素(χ~2=4.12 p=0.0425),各個(gè)時(shí)間點(diǎn)的視力與眼軸呈負(fù)相關(guān)(p=0.0025),術(shù)前、術(shù)后眼軸各時(shí)間點(diǎn)的變化有統(tǒng)計(jì)學(xué)意義,術(shù)后各個(gè)時(shí)間點(diǎn)眼軸自身對(duì)比沒(méi)有意義。結(jié)論1.黃斑裂孔術(shù)后外層視網(wǎng)膜超微結(jié)構(gòu)和形態(tài)是不斷發(fā)生變化的,而且與視功能有密切聯(lián)系,術(shù)前視力越好,外界膜愈合的越早,而且外界膜的愈合多發(fā)生在3-6個(gè)月,外界膜出現(xiàn)越早,術(shù)后視力越好。年齡是外界膜的危險(xiǎn)因素,術(shù)前視力是外界膜愈合的保護(hù)因素。2.眼軸的變化與視力有相關(guān)性,眼軸越短,視力越好。在黃斑裂孔術(shù)后眼軸的變化是沒(méi)有統(tǒng)計(jì)學(xué)意義的。而與術(shù)前的變化可能是由于黃斑區(qū)視網(wǎng)膜組織的形態(tài)學(xué)改變和偏心注視造成的。
[Abstract]:Objective to investigate the factors associated with combined anterior and posterior surgery for the treatment of idiopathic macular hole macular, high myopicmacular HMMH with high myopic macular hole and retinal detachment and without retinal detachment. Methods from January 2015 to December 2015, 43 patients with macular hole (25 cases of idiopathic macular hole) in Tianjin Eye Hospital were analyzed. 9 cases of high myopic macular hole with retinal detachment and 9 cases of high myopic macular hole without retinal detachment) were performed combined anterior and posterior surgery. Preoperative eye examination included visual acuity, intraocular pressure, intraocular pressure IOP, slit lamp, indirect fundus lens. Frequency-domain optical coherence tomography (OCTA) optical coherence tomphography. All patients were treated with three-channel flat vitrectomy, indocyanine green staining, cataract phacoemulsification and posterior chamber intraocular lens implantation, and after gas-liquid exchange, all the patients underwent phacoemulsification and posterior chamber intraocular lens implantation. A total of 0.3 ml pure C3F8 was injected into the vitreous cavity. The outpatient examination was performed 2 weeks after operation. The best corrected visual acuity (BCVA), intraocular pressure (IOL) Masterboard, macular OCT were observed under slit lamp, and each patient was followed up for 6 months for data collation. The preoperative and postoperative best corrected visual acuity (BCVA), eye axis, macular hole healing, optometry and basic data of the patients were recorded. Results the postoperative results of three types of macular holes showed that there were continuous morphological changes in the outer retina of the central fovea during 6 months after the operation of idiopathic macular holes. All 25 cases had external membrane healing. At present, 92% of the patients had external membrane healing in 3-6 months. There was a negative correlation between the healing time of external membrane and preoperative visual acuity. The mean visual acuity was 0.16 鹵0.12 before operation and 0.63 鹵0.22 at 6 m after operation. There was a negative correlation between eye axis and visual acuity. There was significant difference between preoperative eye axis and postoperative visual acuity (P 0.0001). The mean preoperative visual acuity of high myopic macular hole with retinal detachment was 0.05 鹵0.07, the average visual acuity of 6 m after operation was 0.39 鹵0.29, and there was no correlation between eye axis and visual acuity at different time points. There was no statistical significance between preoperative and postoperative visual acuity. Preoperative visual acuity was the protective factor of external membrane healing (蠂 ~ 2 / 2 ~ (16.49) P _ (0.0001)). The mean preoperative visual acuity without retinal detachment was 0.13 鹵0.09 in high myopic macular hole and 0.42 鹵0.26 in 6 m postoperatively. Age was a risk factor for external membrane healing (蠂 ~ 2 / 2 ~ (8.35) p ~ (0.0038), preoperative visual acuity). It is a protective factor of external membrane healing (蠂 ~ 2 ~ 2 ~ 4. 12 p ~ (0.0425)). The visual acuity of each time point is negatively related to the axial axis of the eye. Before operation, there is a negative correlation between the visual acuity and the axial axis of the eye. There was statistical significance in the changes of the ocular axis at each time point after operation, but there was no significance in the contrast of the eye axis itself at each time point after operation. Conclusion 1. The ultrastructure and morphology of the outer retina after macular hole surgery are constantly changing. Moreover, there is a close relationship with visual function. The better the preoperative visual acuity, the earlier the external membrane is healed, and the more the external membrane healing occurs in 3-6 months, the earlier the external membrane appears, the better the postoperative visual acuity. Age is the risk factor of the external membrane. Preoperative visual acuity is the protective factor of external membrane healing. The visual acuity is better. There is no statistical significance in the change of eye axis after macular hole. The changes before operation may be caused by morphological changes of retinal tissue in macular area and eccentricity fixation.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R779.6

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