不同方向撕除内界膜方式对特发性黄斑裂孔术后视网膜位移的影响

目的:比较玻璃体切割切术中不同方向撕除内界膜对特发性黄斑裂孔愈合后视网膜位移、视功能的影响。方法:纳入特发性黄斑裂孔患者25例(25眼),按照术中内界膜(ILM)撕除方向,以1:1随机分为NS-TI组(13眼)和TI-NS组(12眼)。NS-TI组患者接受内界膜撕除方向为鼻上起瓣,向颞下方向撕除ILM;TI-NS组患者接受内界膜撕除方向为颞下起瓣,向鼻上方向撕除ILM。术前、术后1月、术后3月采集患者自发荧光照相,通过影像学上血管标记点或交叉点的位置计算黄斑视盘距离(FMD)、颞侧血管至视盘距离(T-OD)、鼻侧血管至视盘距离(N-OD)、黄斑区垂直血管距离(VIAD)、黄斑区水平血管距离(HIAD)、黄斑区面积(PMA)。对比两种撕膜方式后术后1月、3月视网膜位移(包括FMD、T-OD、N-OD、VIAD、HIAD、PMA)、裂孔闭合率,术后最佳矫正视力,分析两种撕膜方式的异同。结果:术后1月及3月,两组患者的视网膜皆向视盘方向偏移,表现为FMD、T-OD、N-OD、VIAD、HIAD、PMA五项指标均较术前增大(p 0.05)。术后1月及3月,NS-TI组和TI-NS组FMD、T-OD、N-OD、VIAD、HIAD、PMA、黄斑裂孔愈合率(皆100%)和最佳矫正视力比较差异均无统计学意义(P0.05)。结论:不同方向撕除内界膜不是特发性黄斑裂孔术后视网膜位移的影响因素。

Effect of Different Internal Limiting Membrane Peeling Pattern on the Retinal Displacement after Closure of Idiopathic Macular Hole

ABSTRACT Objective: To compare two different internal limiting membrane (ILM) peeling pattern on the retinal displacement af- ter closure of idiopathic macular hole (IMH). Methods: Twenty-five eyes from 25 patients with idiopathic macular hole were randomly allocated into two groups, NS-to-TI group (13 eyes) and TI-to-NS (12 eyes) group. For patients in NS-to-TI group, ILM was peeled off from nasal-superior retina to temporal-inferior retina. For patients in TI-to-NS group, ILM was peeled off from temporal-inferior retina to nasal-superior retina. Baseline, 1 month, and 3 months after surgery, autofluorescence fundus images were collected for measurement of distance between macular hole or foveal center to margin of optic disc (FMD), temporal vessel to optic disc (T-OD), nasal vessel to optic disc (N-OD), vertical Interarcade distance (VIAD), horizontal Interarcade distance (HIAD), and perimacular area (PMA) based on the retinal vessels with bifurcation or crossing on retina. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery. Results: At 1 and 3 months after surgery, the macular seemed slippery to optic nerve, which manifested by the decreased FMD, T-OD, N-OD, VIAD, HIAD, PMA(P<0.05); no significant difference was found in the FMD, T-OD, N-OD, VIAD, HIAD and PMA between NS-TI group and TI-NS group. Both group yield 100 % macular hole closure rate. no obvious difference was found in the postoperative BCVA between the two groups(P<0.05). Conclusion: The two different ILM peeling pattern showed similar visual outcome and retinal displacement, which means the surgeons can peel the ILM with different grasp site and different orientation.