自体血小板浓缩物和气体填充与重硅油填充治疗持续性黄斑裂孔手术的结果比较。

Outcome of autologous platelet concentrate and gas tamponade compared to heavy silicone oil tamponade in persistent macular hole surgery.

机构信息

Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

出版信息

Eur J Ophthalmol. 2021 Mar;31(2):664-672. doi: 10.1177/1120672120903704. Epub 2020 Feb 4.

DOI:10.1177/1120672120903704

PMID:32019342

Abstract

PURPOSE

Persistence represents the major reason for failure of primary macular hole repair. A variety of surgical approaches are available for treating persistent macular holes. To compare clinical outcome of re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20% gas tamponade with heavy silicone oil in persistent macular hole.

METHODS

Records of 48 consecutive eyes with persistent macular holes which underwent re-pars plana vitrectomy with either heavy silicone oil (35 eyes, persistent macular-hole minimum linear diameter: 518.8 ± 171.1 µm) or autologous platelet concentrate and sulfur hexafluoride 20% (13 eyes, persistent macular hole-minimum linear diameter: 454.1 ± 211.3 µm) were reviewed retrospectively. All patients underwent measurements of anatomical persistent macular hole characteristics evaluated by optical coherence tomography and visual function. Cases in which anatomical success failed after first re-pars plana vitrectomy were treated with the other surgical techniques, comparable to a cross-over design.

RESULTS

Persistent macular hole closure rate was 57.1% with autologous platelet concentrate and sulfur hexafluoride 20% and 45.7% with heavy silicone oil ( = 0.102). Functional results were comparable when persistent macular hole closure was achieved ( ⩾ 0.741), but significantly better for the autologous platelet concentrate with sulfur hexafluoride 20% group when persistent macular hole closure failed ( = 0.019).

CONCLUSION

Re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20% seems to achieve at least non-inferior persistent macular hole closure rates and comparable functional results when compared to heavy silicone oil, suggesting autologous platelet concentrate and sulfur hexafluoride 20% as a safe surgical alternative in persistent macular hole. Especially when persistent macular hole closure failed, autologous platelet concentrate with sulfur hexafluoride 20% seems to be superior regarding visual outcome.

摘要

目的

持续性是原发性黄斑裂孔修复失败的主要原因。有多种手术方法可用于治疗持续性黄斑裂孔。本研究旨在比较重硅油与自体血小板浓缩物联合六氟化硫 20%气体填充在持续性黄斑裂孔中的临床疗效。

方法

回顾性分析 48 例接受重硅油（35 眼，持续性黄斑裂孔最小线性直径：518.8 ± 171.1 μm）或自体血小板浓缩物联合六氟化硫 20%（13 眼，持续性黄斑裂孔最小线性直径：454.1 ± 211.3 μm）行再次经平坦部玻璃体切割术的持续性黄斑裂孔患者的临床资料。所有患者均接受光学相干断层扫描评估解剖学持续性黄斑裂孔特征和视力功能的测量。首次经平坦部玻璃体切割术治疗失败的病例采用其他手术技术治疗，类似于交叉设计。

结果

自体血小板浓缩物联合六氟化硫 20%组的持续性黄斑裂孔闭合率为 57.1%，重硅油组为 45.7%（ = 0.102）。当达到持续性黄斑裂孔闭合（ ⩾ 0.741）时，功能结果相似，但当持续性黄斑裂孔闭合失败时，自体血小板浓缩物联合六氟化硫 20%组的结果明显更好（ = 0.019）。

结论

与重硅油相比，再次经平坦部玻璃体切割术联合自体血小板浓缩物联合六氟化硫 20%似乎至少能达到非劣效的持续性黄斑裂孔闭合率和相似的功能结果，提示自体血小板浓缩物联合六氟化硫 20%是持续性黄斑裂孔的一种安全替代手术。特别是当持续性黄斑裂孔闭合失败时，自体血小板浓缩物联合六氟化硫 20%在视力结果方面似乎更具优势。