Chan Clement K, Crosson Jason N, Mein Calvin E, Daher Noha
*Southern California Desert Retina Consultants, Palm Desert, California; †Department of Ophthalmology, Loma Linda University, Loma Linda, California; ‡Retina Consultants of Alabama, The University of Alabama at Birmingham, Birmingham, Alabama; §Retinal Consultants of San Antonio, San Antonio, Texas; and ¶Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda California.
Retina. 2017 Oct;37(10):1820-1831. doi: 10.1097/IAE.0000000000001448.
To evaluate the outcome of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT) with or without Stage 2 macular hole (MH).
A retrospective review of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients avoided the supine position until gas resolution. Patients with small MH maintained partial face-down positioning.
Forty-nine consecutive patients (50 eyes) with symptomatic VMT underwent pneumatic vitreolysis between 2010 and 2016. A posterior vitreous detachment developed in 43 eyes (86.0%) after a single gas injection, at a median of 3.0 weeks. Twenty-eight of 35 eyes (80.0%) with VMT only and all 15 eyes (100%) with a small Stage 2 MH developed a posterior vitreous detachment, with MH closure in 10 of 15 eyes (66.7%). Median baseline and last best spectacle-corrected visual acuities were 20/50 and 20/40, respectively (P < 0.001). Mean follow-up time was 11.1 ± 9.9 months. Rate of posterior vitreous detachment was reduced with presence of diabetes mellitus (25%) and with thick cellophane membrane (50%). Univariate analysis showed increased VMT release for eyes with VMT extent within 1 disk area (χ = 13.1, P = 0.002), eyes with absence of diabetes mellitus (χ = 8.8, P = 0.007), and eyes with Stage 2 MH (χ = 5.47, P = 0.019); there was a trend between success and lack of thick cellophane membrane (χ = 3.32, P = 0.068). Results using logistic regression also showed younger age (P = 0.012), followed by better baseline best spectacle-corrected visual acuity (P = 0.044), lack of diabetes mellitus (P = 0.077), and female gender (P = 0.045) to be predictors of increased VMT release. One VMT-only eye formed a MH and another VMT-only eye developed a retinal detachment. Both eyes responded to vitrectomy.
Pneumatic vitreolysis with limited face-down position is a viable option for treating VMT with few adverse events. More studies are needed to elucidate its indications, benefits, and risks.
评估全氟丙烷（C3F8）气体注射治疗有症状的玻璃体黄斑牵引（VMT）伴或不伴2期黄斑裂孔（MH）的疗效。
对接受0.3 mL C3F8气体治疗的VMT患者进行回顾性研究。患者在气体吸收前避免仰卧位。小MH患者保持部分俯卧位。
2010年至2016年期间，49例连续的有症状VMT患者（50只眼）接受了气体性玻璃体溶解术。单次气体注射后，43只眼（86.0%）发生了玻璃体后脱离，中位时间为3.0周。仅VMT的35只眼中的28只（80.0%）和所有15只小2期MH眼（100%）发生了玻璃体后脱离，15只眼中有10只（66.7%）MH闭合。基线和末次最佳矫正视力的中位数分别为20/50和20/40（P < 0.001）。平均随访时间为11.1±9.9个月。糖尿病患者（25%）和存在厚玻璃纸样膜（50%）时玻璃体后脱离发生率降低。单因素分析显示，VMT范围在1个视盘面积内的眼（χ = 13.1，P = 0.002）、无糖尿病的眼（χ = 8.8，P = 0.007）和2期MH眼（χ = 5.47，P = 0.019）的VMT松解增加；成功与不存在厚玻璃纸样膜之间存在趋势（χ = 3.32，P = 0.068）。逻辑回归结果还显示，年龄较小（P = 0.012）、基线最佳矫正视力较好（P = 0.044）、无糖尿病（P = 0.077）和女性（P = 0.045）是VMT松解增加的预测因素。一只仅VMT的眼形成了MH，另一只仅VMT的眼发生了视网膜脱离。两只眼均对玻璃体切除术有反应。
有限俯卧位的气体性玻璃体溶解术是治疗VMT的一种可行选择，不良事件较少。需要更多研究来阐明其适应证、益处和风险。
