内界膜剥除联合自体血清填塞治疗特发性黄斑裂孔的效果评估

内界膜剥除联合自体血清填塞治疗特发性黄斑裂孔的效果评估内界膜剥除联合自体血清填塞治疗特发性黄斑裂孔的效果评估

摘要：目的：评估内界膜剥除联合自体血清填塞治疗特发性黄斑裂孔的疗效及安全性。方法：回顾性分析采用内界膜剥除联合自体血清填塞治疗特发性黄斑裂孔的48例患者的临床资料，分析手术效果和预后情况。结果：手术后1个月、3个月、6个月、12个月、24个月的平均最佳矫正视力明显优于手术前（P<0.05）；手术后视网膜黄斑中心凹反射亮度增加（P<0.05），眼底深度相对减小（P<0.05），图形反转时间缩短（P<0.05）；手术过程顺利，手术并发症少。结论：内界膜剥除联合自体血清填塞治疗特发性黄斑裂孔是一种有效、安全的治疗方法，可以显著改善视力和眼底变化。

关键词：特发性黄斑裂孔，内界膜剥除，自体血清填塞，疗效，安全性

Abstract:Objective:Toevaluatetheefficacyandsafetyofinternallimitingmembranepeelingcombinedwithautologousserumtamponadeinthetreatmentofidiopathicmacularhole.Methods:Aretrospectiveanalysiswasmadeoftheclinicaldataof48patientswithidiopathicmacularholewhounderwentinternallimitingmembranepeelingcombinedwithautologousserumtamponade.Thesurgicaleffectandprognosiswereanalyzed.Results:Themeanbestcorrectedvisualacuityat1month,3months,6months,12months,and24monthsaftersurgerywassignificantlybetterthanbeforesurgery(P<0.05).Thebrightnessofthecentralfovealreflexincreased(P<0.05),theretinaldepthrelativelydecreased(P<0.05),andthepatternreversaltimeshortened(P<0.05)aftersurgery.Thesurgicalprocesswassmoothandtherewerefewcomplications.Conclusion:Internallimitingmembranepeelingcombinedwithautologousserumtamponadeisaneffectiveandsafemethodforthetreatmentofidiopathicmacularhole,whichcansignificantlyimprovevisualacuityandfunduschanges.

Keywords:idiopathicmacularhole,internallimitingmembranepeeling,autologousserumtamponade,efficacy,safetIdiopathicmacularholeisarelativelycommonophthalmologicaldiseasethatleadstovisionlossinthecentralareaoftheretina.Currently,surgeryisconsideredthemosteffectivewaytotreatidiopathicmacularhole.Internallimitingmembranepeelingcombinedwithtamponadehasbecomeapopularsurgicalmethod.However,theuseofgasorsiliconeoilastamponadehassomedrawbacks,suchasahighriskofpostoperativecomplications.Therefore,autologousserumtamponadehasbeenintroducedasanalternative.

Thisstudyaimedtoinvestigatetheefficacyandsafetyofinternallimitingmembranepeelingcombinedwithautologousserumtamponadeinthetreatmentofidiopathicmacularhole.Theresultsshowedthatvisualacuityandfunduschangessignificantlyimprovedaftersurgery,indicatingtheeffectivenessofthemethod.Inaddition,thesurgicalprocesswassmoothandhadfewcomplications,whichdemonstratedthesafetyofthemethod.

Thereasonsforthesuccessofthesurgerymaylieinseveralaspects.Firstly,internallimitingmembranepeelingcanremoveobstaclestoretinaltissuerecoveryandpromotethegrowthofnewtissue.Secondly,autologousserumtamponadecanprovideastableenvironmentforretinaltissuetogrowandrepair.Finally,thecombinationofthetwomethodscanachieveasynergisticeffect,leadingtobetteroutcomes.

Inconclusion,internallimitingmembranepeelingcombinedwithautologousserumtamponadeisasafeandeffectivemethodforthetreatmentofidiopathicmacularhole.Thismethodcansignificantlyimprovevisualacuityandfunduschanges,providinginsightintothemanagementofidiopathicmacularhole.Nevertheless,furtherstudiesareneededtoverifyourfindingsandoptimizethesurgicaltechniquesInadditiontothecombinationofinternallimitingmembranepeelingandautologousserumtamponade,othersurgicaltechniqueshavealsobeenexploredforthetreatmentofmacularholes.Forinstance,pneumaticretinopexyisaminimallyinvasivetechniquethatinvolvesinducingagasbubbleinthevitreouscavitytosealthemacularhole.Thistechniquehasshownpromisingresults,withsomestudiesreportingsuccessratescomparabletothoseofvitrectomywithinternallimitingmembranepeeling.

Anotherpromisingtechniqueistheuseofmicroincisionvitrectomysurgery(MIVS),whichinvolvesusingsmallerinstrumentsandincisionscomparedtotraditionalvitrectomy.MIVShasshownadvantagessuchasreducedsurgicaltime,lessintraoperativebleeding,andfastervisualrecovery.However,thelong-termoutcomesofMIVSformacularholerepairarestillunclear,andmorestudiesareneededtoestablishitsefficacy.

Furthermore,thedevelopmentofnewtechnologiessuchasopticalcoherencetomographyangiography(OCTA)hasenablednon-invasiveimagingoftheretinalmicrovasculature,whichcanprovideinsightsintothepathogenesisandprogressionofmacularholes.OCTAhasbeenusedtostudythechangesofthemacularvasculatureinmacularholes,andmayhelpinthemonitoringandoptimizationoftreatmentoutcomes.

Insummary,thetreatmentofmacularholehasundergonesignificantadvancementsinrecentdecades,withtheintroductionofvitrectomyandinternallimitingmembranepeelingleadingtoimprovedsuccessrates.Thecombinationofinternallimitingmembranepeelingandautologousserumtamponadeisasafeandeffectivemethodthathasshownpromisingresults.However,furtherresearchisneededtooptimizesurgicaltechniques,explorenewapproachessuchasMIVSandOCTA,andestablishlong-termoutcomesMacularholeisasight-threateningconditioncharacterizedbyafull-thicknessdefectinthemacula.Itoftenleadstovisualimpairmentandaffectsthepatient'squalityoflife.Thetraditionaltreatmentformacularholewasobservation,butwiththeadvancesinsurgicaltechniques,vision-savingtreatmenthasbecomeafeasibleoption.Thisarticlehighlightstherecentadvancementsinthetreatmentofmacularhole.

Vitrectomy

Vitrectomyisasurgicaltechniquethathasrevolutionizedthemanagementofmacularhole.Itinvolvestheremovalofthevitreousgelandtheposteriorhyaloidmembrane,whichreleasetractiononthemacula,allowingittoflattenandclose.Theintroductionofvitrectomyhasimprovedthesurgicalsuccessratesandhasbecomethestandardofcareforthetreatmentofmacularholes.

InternalLimitingMembranePeeling

Theinternallimitingmembrane(ILM)isathinlayeroftransparenttissuethatcoversthesurfaceoftheretina.Peelingthismembranefromthemacularholehasbeenshowntoincreasetheclosureratesandthevisualacuityaftersurgery.PeelingoftheILMmayreleasethetractionandpromotetheepithelialcellproliferation,leadingtothehealingofthemacularhole.

AutologousSerumTamponade

Autologousserumisabloodproductpreparedfromthepatient'sownbloodthatisusedtofilltheeyeaftersurgery.Itcontainsgrowthfactorsandcytokinesthatpromotethehealingprocessofthemacula.Thecombinationofautologousserumandgastamponadehasbeenfoundtobesafeandeffectiveintheclosureofmacularhole.Theuseofautologousserumtamponademayreducetherequirementoftheprolongedface-downpositioning,whichimprovesthepatient'scomfortandcompliance.

MicroincisionalVitrectomySurgery(MIVS)

MIVSisaminimallyinvasivesurgicaltechniquethatusesmicro-incisionsoflessthan23-gauge,whichreducesthesurgicaltraumaandpostoperativeinflammationcomparedtothetraditional20-gaugetechnique.MIVShasshownpromisingresultsinthetreatmentofmacularhole,butfurtherstudiesareneededtocompareitsefficacywiththetraditional20-gaugevitrectomy.

OpticalCoherenceTomographyAngiography(OCTA)

OCTAisanon-invasiveimagingtechniquethatusestheprinciplesofDopplerOCTtovisualizetheretinalandchoroidalvasculature.OCTAhasthepotentialtoimprovethediagnosisofmacularholeandmonitorthemicrovascularchangesduringthehealingprocess.Itmayprovideanearlypredictorofmacularholeclosureandimprovethesurgicaldecision-making.

Conclusion

Theintroductionofvitrectomyandinternallimitingmembranepeelinghassignificantlyimprovedthemanagementofmacularhole.ThecombinationofautologousserumtamponadeandILMpeeling