[摘要] 目的 追踪观察外伤性黄斑裂孔自发性愈合与未愈合病例的临床特点、组织形态及视功能转归结果,为该病治疗方法的选择提供依据。 方法 对连续收治的21例(21眼)外伤性黄斑裂孔进行国际标准视力、压平眼压测量,眼底三面镜检查,光学相干断层扫描仪(optical coherence tomography, OCT)对裂孔组织形态检测;部分病例进行多焦ERG、VEP检测,伤后初期就诊者,一般常规眼部挫伤对症和神经营养药物治疗,随访4~12个月。结果 21例均为顿挫伤,受伤年龄10~31岁,平均19.5岁。就诊时,OCT检测裂孔直径60~1207um,平均468 um,视力:0.01至0.3。18例在受伤后2个月内就诊,7例(7眼)单纯黄斑裂孔,均自发性愈合,视力均有提高,达0.4~0.9。4例mf-ERG检测,对应区域平均光感受器振幅密度由初次检测30.8 nv/deg2提高到52.6 nv/deg2。14例(14眼)合并不同程度玻璃体腔及后极部视网膜脉络膜下积血,视网膜平伏,黄斑裂孔未闭合,部分患眼后极部视网膜色素上皮呈萎缩样变。3例为受伤后诊断为黄斑裂孔10、13、20年者,裂孔解剖、视功能无明显改变,后极部视网膜前、下有不规则白色机化条索及视网膜脉络膜萎缩灶。结论 外伤性黄斑裂孔主要发生在年轻人,伤后低视力,不易发生视网膜脱离,单纯外伤性黄斑裂孔自愈率高,视觉功能提高,早期密切随访为其首选疗法。合并视网膜脉络膜严重挫伤、眼内出血影响裂孔自发愈合。非自愈病例手术治疗时机与疗效尚需进一步观察。
[Abstract] Objective Retrospectively analyze the clinical characteristics of 11 cases of traumatic macular hole to provide the different ways to treating it. Methods In a consecutive series of 21 patients (21 eyes) with traumatic macular holes, visual acuity in international standard, flatten intraocular pressure and fundus examination were checked; Optical coherence tomography (OCT) was used to check the structure of macular holes; Mutifocal ERG and P-VEP in some cases were also detected. Following-up time was4~12 months. Results At the first consultation of the 21 cases, the detected hole diameters of OCT were from 60 to 1207 um (average 468 um). Visual acuity was from 0.1 to 0.3. 18 patients first visited to a doctor among 2 month after traumatized. Among of them, 7 cases (7 eyes) were pure macular holes, and all spontaneously closured. Their vision increased up to 0.4~0.9. 14 cases (14 eyes) combined the different vitreous hemorrhage and choroidal-retinal hemorrhage. The open clear-edged macular hole weren’t closured, and retina was not detachment. The retinal pigment epithelium (RPE) of fundus was atrophy. 3 cases were diagnosed macular hole 10 and 20 years respectively, their visual function and anatomical structure of macular weren’t changed obviously. There were irregular organized cords under and above the retina of fundus. Conclusion Traumatic macular hole mainly occur among the young, their vision and the rate of retina detachment was low. The tissue regeneration of young is strong and purely traumatic macular hole really has a high spontaneous cure rate. The close follow-up were the first choice of treatment for this disease. The spontaneous cure rate of macular hole was influenced by the retinal hemorrhage and severe choroidal-retinal contusion. The medical usefulness and vitreous retinal surgery of the treatment and the above standpoint needs the big sample to be further researched. |