玻璃体切除术及使用自体佐剂的无接触技术治疗黄斑裂孔的结果
Results of vitrectomy and the no-touch-technique using autologous adjuvants in macular hole treatment.
作者信息
Hoerauf H, Klüter H, Joachimmeyer E, Roider J, Framme C, Schlenke P, Kirchner H, Lagua H
机构信息
Eye-Hospital, University of Lübeck, Germany.
出版信息
Int Ophthalmol. 2001;24(3):151-9. doi: 10.1023/a:1021566806836.
BACKGROUND
Anatomic and functional results of macular holes using vitrectomy and platelet-concentrate (PC) or autologous whole blood (WB) were investigated without peeling any epiretinal membrane in order to minimize retinal trauma.
METHODS
44 patients with macular holes stage II, III and IV underwent a vitrectomy with removal of posterior cortical vitreous (in stage II and III) and C2F6 gas endotamponade. No peeling of any epiretinal membrane or the ILM was performed. In 14 patients autologous WB was injected and in 30 patients autologous PC. The mean follow-up time was 9.3 months.
RESULTS
An anatomic closure was observed in 36.4% of patients in the WB-group and in 93.9% of patients in the PC-group. SLO-microperimetry showed a reduction of absolute scotomas in 80% of the WB- and in 75% of the PC-group. In the WB-group 1 retinal detachment and 1 branch vein occlusion occurred; in the PC-group 3 retinal detachments, 1 central artery occlusion, 1 macular pucker, 1 cystoid macular edema, 1 late reopening and 1 secondary glaucoma were observed. In both groups no endophthalmitis occurred.
CONCLUSION
If autologous platelet concentrate is available, high anatomic success rates can be achieved without aggressive membrane removal, which may cause retinal damage. Autologous whole blood cannot be recommended as an alternative adjunct for the treatment of macular holes without membrane removal.
背景
为尽量减少视网膜创伤，在不剥除任何视网膜前膜的情况下，研究了使用玻璃体切除术联合浓缩血小板（PC）或自体全血（WB）治疗黄斑裂孔的解剖和功能结果。
方法
44例II、III和IV期黄斑裂孔患者接受了玻璃体切除术，切除后部皮质玻璃体（II期和III期）并注入C2F6气体进行眼内填充。未进行任何视网膜前膜或内界膜的剥除。14例患者注射了自体全血，30例患者注射了自体浓缩血小板。平均随访时间为9.3个月。
结果
WB组36.4%的患者实现了解剖学上的闭合，PC组为93.9%。扫描激光眼底微视野检查显示，WB组80%的患者和PC组75%的患者绝对暗点减少。WB组发生了1例视网膜脱离和1例分支静脉阻塞；PC组观察到3例视网膜脱离、1例中央动脉阻塞、1例黄斑皱襞、1例黄斑囊样水肿、1例晚期裂孔重新开放和1例继发性青光眼。两组均未发生眼内炎。
结论
如果有自体浓缩血小板，在不进行可能导致视网膜损伤的积极膜剥除的情况下，可以获得较高的解剖学成功率。不建议将自体全血作为不剥除膜治疗黄斑裂孔的替代辅助方法。
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