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目的 探讨黄斑区内表面增生性病变玻璃体手术治疗效果和并发症的防治。方法 对各种原因所致的黄斑区牵引和皱褶共 41例 (4 1只眼 )行玻璃体手术治疗。包括特发性黄斑前膜 12例 ,黄斑裂孔合并黄斑前膜形成 10例 ,外伤或视网膜脱离复位术后黄斑皱褶 19例 (不包括糖尿病性眼底病变或视网膜脱离患者 )。术中寻找前膜与视网膜之间的潜在性间隙 (桥底 )或粘连薄弱部位 ,应用笛形针、视网膜钩、铲、镊等眼内器械 ,将增生膜和玻璃体后界膜剥离干净。结果 41例术中均顺利剥除黄斑区的视网膜前膜 ,恢复黄斑区的解剖形态。除 4例术中、术后发生少量视网膜浅层出血外 ,未见视网膜撕裂、脱离等并发症。术后视力提高者共 38例 ,3例视力保持原有水平 ,所有患者视物变形均有明显改善甚至消失。随访时间为 3个月至 4年。结论 玻璃体手术治疗各种增生性黄斑病变疗效可靠 ,术后可使患者视力提高 ,症状缓解 ,并发症得到有效控制 ,术前、术后应用光学相干断层成像术检查 ,有助于了解黄斑区及增生膜的情况 ,并进行疗效的客观评价。
Objective To investigate the effect and complications of vitreous surgery on macular surface hyperplasia lesions. Methods A total of 41 cases (41 eyes) of macular traction and folds caused by various causes were treated with vitrectomy. Including idiopathic macular degeneration in 12 cases, macular hole combined with macular membrane formation in 10 cases, traumatic or retinal detachment after macular fold in 19 cases (excluding diabetic retinopathy or retinal detachment patients). Surgery to find the potential gap between the anterior membrane and the retina (bridge) or adhesion sites, the use of the flute needle, hook, shovel, tweezers and other intraocular devices, the proliferative membrane and vitreous hindbrain dissection clean. Results All the 41 cases were successfully stripped of the retina of the macula and restored the anatomy of the macula. In addition to 4 cases of surgery, a small amount of postoperative retinal superficial hemorrhage, no retinal tears, detachment and other complications. Postoperative visual acuity in 38 cases, 3 cases of visual acuity to maintain the original level, all patients with visual distortion have significantly improved or even disappear. Follow-up time was 3 months to 4 years. Conclusion Vitreous surgery for the treatment of various proliferative macular degeneration is reliable and effective. After the operation, the patients’ vision can be improved and the symptoms can be relieved. The complications can be effectively controlled. Preoperative and postoperative optical coherence tomography can help to understand the macular area and Proliferative membrane situation, and the objective evaluation of the curative effect.