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特发性全层黄斑裂孔的观察

美国医学会眼科杂志（中文版） 1995年第1期7卷 6-10,29页

作者： Yuza.,M 曹小燕

特发性黄斑裂孔行玻璃体切除并内界膜剥离术后发生医源性偏心性全层黄斑裂孔

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世界核心医学期刊文摘（眼科学分册） 2006年第5期2卷 32-32页

作者： Rubinstein A Bates R Benjamin L Shaikh A 王海燕(译) Department of Ophthalmology Stoke Mandeville Hospital Aylesbury HP21 8AL United Kingdom 不详

PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the ILM for idiopathic macular holes from 1996 to 2001. Four patients were found to have eccentric iatrogenic macular holes postoperatively. Optical coherence tomography was used to evaluate these holes. Results: The idiopathic macular holes were graded from stages II to IV preoperatively with visual acuities from 6/18 to 6/60. All patients had surgery within 6 months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the ILM, injection of platelets (0.1ml), and gas tamponade with SF6 20%. Postoperatively the patients postured strictly face down for 10 days. Follow-up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted postoperatively. The holes were located between 3 and 6 o’clock in three patients and at 9 o’clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up. Comment: To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6 years of follow-up.

关键词：特发性黄斑裂孔全层黄斑裂孔内界膜剥离玻璃体切除术后发现偏心性医源性光学相干断层患者发现回顾性分析

特发性黄斑裂孔的光学相干断层扫描的量化分析

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特发性黄斑裂孔的光学相干断层扫描的量化分析

作者：刘佳中南大学

学位级别：硕士

目的：通过观察特发性黄斑裂孔患者的光学相干断层图像,分析相关数据,评估手术治疗效果,对比分析多项相关因素,以期找出评价预后更好的客观指标。方法：回顾性分析自2011年8月到2012年4月在我院就诊的52例（52眼）特发性黄斑裂孔患... 详细信息

目的：通过观察特发性黄斑裂孔患者的光学相干断层图像,分析相关数据,评估手术治疗效果,对比分析多项相关因素,以期找出评价预后更好的客观指标。方法：回顾性分析自2011年8月到2012年4月在我院就诊的52例（52眼）特发性黄斑裂孔患者,所有患者均在我院眼科接受了患眼的玻璃体切除合并内界膜剥离术,并在眼内填充了惰性气体C3F8。对患者术前及术后进行视力检查及黄斑部光学相干断层扫描。对所得数据进行统计学分析处理。结果： 1.52例（52眼）特发性黄斑裂孔患者中,女性34人（34眼）,男性18人（18眼）,平均年龄59±8岁,在行玻璃体切除合并内界膜剥离、C3F8惰性气体填充术后,术眼裂孔解剖复位率90%,术后视力提高的患者比例为88%。 2.特发性黄斑裂孔术前裂孔孔径与术后视力呈负相关（P=0.001）;术前裂孔底径与术后视力呈负相关（P=0.003）;HFF值与术后视力呈正相关（P=0.001）;裂孔是否封闭与术后视力有相关性（P=0.043）。 ***≥0.6的患者,裂孔封闭,成功达到解剖学复位;HFF＜0.51的患者,裂孔未封闭,未成功达到解剖学复位。0.51≤HFF＜0.6的患者,3例裂孔闭合,3例裂孔未闭合。 4.病程的长短与患者术前孔径（P1）,底径大小（P2）及术后视力（P3）无明显相关性。（P1=0.612,P2=0.633,P3=0.765）结论： 1.特发性黄斑裂孔患者术后裂孔解剖复位率达90%,视力提高的患者比例为88%。 ***值能较术前黄斑裂孔孔径及裂孔底径反映患者手术预后的情况。 3.病程的长短与患者孔径,底径大小无明显相关性;病程的长短与患者术后裂孔是否闭合无明显相关性;病程的长短与患者术后的视力无明显相关性。

关键词：特发性黄斑裂孔全层黄斑裂孔板层黄斑裂孔光学相干断层扫描裂孔形成因子

板层裂孔和玻璃体黄斑界面的重新定义:超高分辨率的光学相干断层扫描研究

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世界核心医学期刊文摘（眼科学分册） 2006年第8期2卷 51-52页

作者： Witkin A.J. Ko T.H. Fujimoto J.G. J.S. Duker 张少娟 Ophthalmology Department Tufts-New England Medical Center 750Washington Street Boston MA 02111 United States Dr.

Objectives: To define optical coherence tomographic (OCT)-criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ultrahigh-resolution optical coherence tomography (UHR OCT). Design: Retrospective observational case series. Participants: Nineteen eyes of 18 patients with lamellar holes were imaged with UHR OCT between 2002 and 2004. Methods: A UHR OCT system was developed for use in the ophthalmology clinic. All 6 UHR OCT images for each eye imaged were examined. Lamellar holes were diagnosed based on a characteristic OCT appearance. Criteria for the OCT diagnosis of a lamellar hole were as follows: (1) irregular foveal contour; (2) break in the inner fovea; (3) intraretinal split; and (4) intact foveal photoreceptors. From 1205 eyes of 664 patients imaged with UHR OCT, and retrospectively reviewed, 19 eyes of 18 patients were diagnosed with a lamellar hole based on these criteria. All 19 eyes were also imaged with standard resolution OCT. Their charts were retrospectively reviewed. Main Outcome Measures: Standard and ultrahigh-resolution OCT images. Results: On chart review, clinical diagnosis of a lamellar hole was made in only 7 of 19 eyes (37% ). Twelve of 19 eyes (63% ) had an epiretinal membrane (ERM) on clinical examination. Ten of 19 eyes (53% ) had a posterior vitreous detachment. On UHR OCT, 17 of 19 eyes (89% ) had ERMs. Eleven ERMs had an unusual thick appearance on UHR OCT. Due to poor visual acuity, 4 eyes underwent vitrectomy. Only 1 of 4 surgeries (25% ) was visually and anatomically successful. Another eye improved visually, but a lamellar hole persisted. One eye progressed to a full-thickness macular hole preoperatively, which reopened after surgery. One eye developed a full-thickness hole postoperatively. Conclusions: The diagnosis of a lamellar hole can be made based on OCT criteria, which could be applied to both standard and ultrahigh-resolution

关键词：玻璃体切除术板层黄斑裂孔中心凹层裂全层黄斑裂孔玻璃体手术超高分辨率视功能解剖形态标

玻璃体切除术治疗经OCT确诊的1期黄斑裂孔

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世界核心医学期刊文摘（眼科学分册） 2006年第6期2卷 37-38页

作者： Subramanian M. L . Truong S.N. Rogers A.H. 邢咏新(译) 不详 Subramanian 85 East Concord Street Boston MA 02118 United States

BACKGROUND AND OBJECTIVE: To describe a series of patients with decreased vision secondary to stage 1 macular hole confirmed by optical coherence tomography (OCT) that failed to spontaneously resolve with observation. To determine whether current surgical techniques can prevent progression to a full-thickness macular hole and lead to improved visual acuity. PATIENTSANDMETHODS: Retrospective,comparative case series presenting patient demographics,duration of symptoms,timing of surgery,preoperative and postoperative vision,and clinical outcome based on examination and OCT. RESULTS: Five eyes of five patients with stage 1 macular holes identified on OCT required surgical repair. All eyes showed anatomic closure and lack of progression to a full-thickness hole confirmed by OCT after one procedure. Mean preoperative visual acuity was 20/102 (range,20/50 to 20/200) and mean postoperative visual acuity was 20/52 (range,20/25 to 20/200). Average improvement for all five eyes was 3 Snellen lines,with four of the five (80% ) improving 5 lines each. CONCLUSION: In symptomatic eyes with stage 1 macular holes that fail to spontaneously resolve with observation,vitrectomy with intraocular gas tamponade may prevent progression to a full-thickness hole and lead to improved visual acuity.

关键词：全层黄斑裂孔玻璃体切除术 OCT Snellen视力确诊治疗视力下降术后视力眼内气体填充常规检查

保留黄斑中心凹的内界膜剥除术治疗黄斑水肿和高度近视性黄斑劈裂的效果研究

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保留黄斑中心凹的内界膜剥除术治疗黄斑水肿和高度近视性黄斑劈裂...

作者：曾芹汕头大学

学位级别：硕士

目的:探讨保留黄斑中心凹内界膜剥除术治疗黄斑水肿和高度近视性黄斑劈裂的疗效。方法:收集2017年12月至2020年12月于汕头大学·香港中文大学联合汕头国际眼科中心眼底一科行保留黄斑中心凹内界膜剥除术（fovea-sparing internal limiti... 详细信息

目的:探讨保留黄斑中心凹内界膜剥除术治疗黄斑水肿和高度近视性黄斑劈裂的疗效。方法:收集2017年12月至2020年12月于汕头大学·香港中文大学联合汕头国际眼科中心眼底一科行保留黄斑中心凹内界膜剥除术（fovea-sparing internal limiting membrane peeling,FSILP）的黄斑水肿和高度近视性黄斑劈裂患者。对术前、术后最佳矫正视力（best corrected visual acuity,BCVA）,黄斑中心凹厚度（central fovea thickness,CFT）,黄斑区水肿及囊腔消退情况、劈裂复位情况,术后黄斑区形态变化,术后并发症情况等进行观察。采用SPSS25.0软件进行统计分析,采用均值±标准差进行统计描述,术前和术后BCVA、CFT比较采用配对T检验或Wilcoxon秩和检验,计数资料以率或构成比表示,黄斑区形态转归、等级资料比较采用卡方检验或Fisher精确概率检验,P＜0.05差异有统计学意义。结果:1.黄斑区形态变化:黄斑水肿组23只眼中有20只眼术后黄斑区形态得到改善,3只眼无明显改善。术后形态分为三型:A型:CFT下降伴囊腔消失;B型:CFT下降,仍有囊腔;C型:CFT未下降伴囊腔存在,或发生全层黄斑裂孔。术后符合A型分类的有12例（52.17%）,B型8例（34.78%）,C型3例（13.04%）。高度近视性黄斑劈裂组12只眼根据术前形态分为三型:单纯视网膜劈裂（retinoschisis,RS）5例,视网膜劈裂伴神经上皮层脱离（foveal detachment,FD）2例,视网膜劈裂伴板层黄斑裂孔（lamellar macular hole,LMH）5例。术后12只眼完全复位8例（66.67%）;部分复位3例（25.00%）;未复位1例（8.33%）。两组术后均未观察到保留区内界膜（internal limiting membrane,ILM）有增厚收缩现象。2.黄斑中心凹厚度:黄斑水肿组术前平均CFT（472.26±149.01）μm,末次随访时下降至（264.39±106.15）μm,差异有统计学意义（t=5.018,P=0.000＜0.05）,高度近视性黄斑劈裂组术前平均CFT（442.67±257.16）μm,末次随访时下降至（146.17±46.00）μm,差异有统计学意义（t=4.270,P=0.001＜0.05）。3.最佳矫正视力:黄斑水肿组术前BCVA平均Log MAR（0.77±0.34）,至末次随访时提高至（0.43±0.29）,差异有统计学意义（t=6.760,P=0.002＜0.05）。高度近视性黄斑劈裂组,术前BCVA平均Log MAR（1.05±0.44）,至末次随访时提高至（0.73±0.57）,差异有统计学意义（Z=-1.968,P=0.049＜0.05）。4.术后并发症:黄斑水肿组所有患者23（100%）只眼术后随访均未出现全层黄斑裂孔（full-thickness macular hole,FTMH）,未发生视网膜脱离、眼内炎、眼内出血等严重并发症。高度近视性黄斑劈裂组12只眼有1例（8.33%）RS眼术后末次随访（＞12个月）发生了局部的黄斑前膜;有1例（8.33%）LMH眼7天后出现了FTMH,3个月后再次行二次手术,术后黄斑裂孔闭合,裸眼视力HM/20cm,矫正无提高。结论:1.保留黄斑中心凹的内界膜剥除术可以促进黄斑区囊腔消失,有助于恢复视网膜的结构,可以促进劈裂腔的下降,有助于视网膜的贴附和复位,使黄斑区形态和视力得到改善。2.保留黄斑中心凹的内界膜剥除术是治疗黄斑水肿和高度近视性黄斑劈裂的可行而有效的手术方法。

关键词：保留黄斑中心凹内界膜剥除术黄斑水肿高度近视性黄斑劈裂全层黄斑裂孔

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眼科学

中国临床新医学 1997年第1期10卷 61-64页

玻璃体黄斑牵拉综合征断层扫描图像特征与手术预后的关系

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世界核心医学期刊文摘（眼科学分册） 2005年第6期1卷 9-9页

作者： Yamada N. Kishi S. 陈立军

To study the relation between preoperative macular changes and surgical outcomes in vitreomacular traction syndrome. Prospective study. We prospectively examined 14 eyes of 13 patients (aged 48 to 82 years; mean 66.1) with vitreomacular traction syndrome using optical coherence tomography (OCT) before and after vitreous surgery. OCT demonstrated two types of partial posterior vitreous detachment: incomplete V-shaped detachment in 10 eyes (group 1) and partial detachment temporal to the fovea but attached nasally in 4 eyes (group 2). Preoperative OCT showed foveal retinal detachment in all eyes in group 1; the detached retina was intact in 2 eyes and edematous with (6 eyes) or without (2 eyes) cystic changes. After surgery, these 10 eyes had a normal foveal configuration accompanied by visual improvement. In group 2, 3 of the 4 eyes had prominent cystoid macular edema (CME) without foveal retinal detachment before surgery. After surgery, 2 eyes developed a full-thickness macular hole, 1 had persistent CME, and 1 developed macular atrophy. The visual acuity decreased in 2 eyes and remained the same in 2 eyes. Two types of vitreous traction develop in vitreomacular traction syndrome: an incomplete V-shaped posterior vitreous detachment that leads to foveal retinal detachment, the surgical outcome of which is favorable, and partial posterior vitreous detachment temporal to the fovea in which prominent CME developed, which may result in a macular hole or macular atrophy postoperatively.

关键词：玻璃体黄斑牵拉断层扫描图像中心凹全层黄斑裂孔手术预后黄斑部黄斑囊样水肿玻璃体后脱离玻璃体手术玻璃体牵拉