García-Arumí J, Corcostegui B, Cavero L, Sararols L
Universidad Autónoma de Barcelona, Hospital Universitario Valle Hebron, Spain.
Retina. 1997;17(5):372-7. doi: 10.1097/00006982-199709000-00003.
To determine if vitreoretinal surgery is successful in closing traumatic macular holes and subsequently improving visual acuity. Blunt trauma may result in a macular hole when it causes traumatic separation of the vitreous from the retina, contusion necrosis, or subfoveal hemorrhage. Like idiopathic macular holes, traumatic macular holes are surrounded by a ring of subretinal fluid and result in severely diminished visual acuity.
Fourteen eyes with full-thickness posttraumatic macular holes were treated. The patients ages ranged from 15 years to 36 years (mean, 22 years). Preoperative best corrected visual acuity ranged from 20/200 to 20/50 (mean, 20/80). A pars plana vitrectomy and posterior hyaloid dissection were performed, followed by complete fluid-gas exchange and instillation of 0.1 mL of platelet concentrate just over the macular hole. A final flushing with 25% sulfur hexafluoride was done. The postoperative follow-up period ranged from 6 months to 28 months (average, 13 months).
Successful anatomic macular hole closure was achieved 6 months after surgery in 13 years (92.86%). Visual acuity improved four or more lines on the Snellen chart within 6 weeks after surgery in every eye with a closed hole; a final visual acuity of 20/20 was achieved in two eyes (15.3%). The mean postoperative visual acuity was 20/30. No intraoperative or postoperative complications were noted, and the lens remained clear in all eyes during the follow up period.
Our results suggest that intraoperative application of platelet concentrate in combination with vitrectomy may be useful in managing posttraumatic full-thickness macular holes, thus improving anatomic and visual outcomes. The greater recovery of visual acuity obtained in this study compared with that obtained in other series of idiopathic macular holes could be related to the young age of the patients with traumatic macular holes and the early diagnosis and treatment.
确定玻璃体视网膜手术能否成功封闭外伤性黄斑裂孔并随后提高视力。钝挫伤导致玻璃体与视网膜外伤性分离、挫伤性坏死或黄斑下出血时，可能会形成黄斑裂孔。与特发性黄斑裂孔一样，外伤性黄斑裂孔被视网膜下液环包围，导致视力严重下降。
对14只患有全层外伤性黄斑裂孔的眼睛进行了治疗。患者年龄在15岁至36岁之间（平均22岁）。术前最佳矫正视力范围为20/200至20/50（平均20/80）。进行了玻璃体切除术和平行于黄斑裂孔的后玻璃体皮质剥离，随后进行了完全的液气交换，并在黄斑裂孔上方注入0.1 mL血小板浓缩液。最后用25%的六氟化硫冲洗。术后随访时间为6个月至28个月（平均13个月）。
13只眼（92.86%）在术后6个月实现了黄斑裂孔的解剖学封闭。每个裂孔封闭的眼睛在术后6周内视力在斯内伦视力表上提高了4行或更多行；两只眼（15.3%）最终视力达到了20/20。术后平均视力为20/30。未观察到术中或术后并发症，随访期间所有眼睛的晶状体均保持清晰。
我们的结果表明，术中应用血小板浓缩液联合玻璃体切除术可能有助于治疗外伤性全层黄斑裂孔，从而改善解剖学和视觉效果。与其他特发性黄斑裂孔系列研究相比，本研究中获得的更好的视力恢复可能与外伤性黄斑裂孔患者的年轻年龄以及早期诊断和治疗有关。
