Goldbaum M H, McCuen B W, Hanneken A M, Burgess S K, Chen H H
Department of Ophthalmology, Shiley Eye Center, University of California, Veterans Administration Medical Center, San Diego, USA.
Ophthalmology. 1998 Nov;105(11):2140-7; discussion 2147-8. doi: 10.1016/S0161-6420(98)91140-X.
The authors performed a study to determine the effectiveness and safety of silicone oil as a substitute for gas to fill the vitreous cavity to treat macular holes.
Multicenter, nonrandomized, interventional trial.
Thirty-seven consecutive patients chose vitrectomy with silicone tamponade instead of gas to treat 40 eyes with stage-2 to stage-4 idiopathic age-related macular holes. Stage-2 holes constituted 40% of the holes, and stage-3 and stage-4 holes made up 60%.
All eyes were treated with vitrectomy, manual detachment of the posterior vitreous face (not done for stage-4 holes), autologous serum instillation, and silicone fill of the vitreous cavity. After insertion of the oil, the patients resumed normal activity with no restriction of head or eye position except to avoid faceup position. The oil was removed after approximately 6 weeks.
The authors considered the seal of the macular hole and the preoperative and postoperative logarithm of the minimum angle of resolution (logMAR) visions the most significant measures for comparison to other studies.
Eighty percent of all holes and 86% of holes not treated previously were sealed with a single silicone tamponade of the vitreous cavity. The logMAR value of visual acuity improved an average of 0.26 (2.6 lines) to 0.61 (20/81) for all eyes and 0.34 (3.4 lines) to 0.52 (20/66) when the macular hole sealed. Completeness of fill of the vitreous cavity with silicone affected seal of the macular hole. Three of eight eyes in which open holes developed after oil removal had less than 90% fill of the vitreous cavity by silicone. Sixty-nine percent of lenses increased opacity one grade or were removed after silicone tamponade. There were no significant adverse effects arising from silicone tamponade.
Silicone oil tamponade of macular holes is effective and safe. Silicone may be optimal for the treatment of macular holes in persons who must travel, who cannot maintain facedown positioning, or who have monocular vision. The most important factor in the successful closure of the macular hole was the completeness of fill of the vitreous cavity with silicone oil.
作者开展一项研究以确定硅油作为气体替代物填充玻璃体腔治疗黄斑裂孔的有效性和安全性。
多中心、非随机、干预性试验。
37例连续患者选择玻璃体切除联合硅油填塞而非气体来治疗40只患有2期至4期特发性年龄相关性黄斑裂孔的眼睛。2期裂孔占所有裂孔的40%，3期和4期裂孔占60%。
所有眼睛均接受玻璃体切除术、玻璃体后皮质手动分离（4期裂孔不进行）、自体血清滴注以及玻璃体腔硅油填充。注入硅油后，患者恢复正常活动，除避免面朝上体位外，头部和眼部位置无限制。大约6周后取出硅油。
作者认为黄斑裂孔的封闭以及术前和术后最小分辨角对数视力（logMAR）是与其他研究进行比较的最重要指标。
所有裂孔的80%以及既往未治疗裂孔的86%通过单次玻璃体腔硅油填塞得以封闭。所有眼睛的视力logMAR值平均从0.26（2.6行）提高到0.61（20/81），黄斑裂孔封闭时则从0.34（3.4行）提高到0.52（20/66）。硅油填充玻璃体腔的完全程度影响黄斑裂孔的封闭。8只在取出硅油后出现开放裂孔的眼睛中，有3只硅油对玻璃体腔的填充不足90%。69%的晶状体在硅油填塞后混浊程度增加一级或被摘除。硅油填塞未产生显著不良反应。
硅油填塞黄斑裂孔有效且安全。对于必须旅行、无法保持面朝下体位或单眼视力的患者，硅油可能是治疗黄斑裂孔的最佳选择。黄斑裂孔成功封闭的最重要因素是硅油对玻璃体腔填充的完全程度。
