方法：对特发性黄斑裂孔患者22例23眼的临床资料进行回顾分析。患眼术前术后除常规检查外最后由光学相干断层扫描(OCT)确诊及测量黄斑裂孔形态。所有患眼均行玻璃体切割、内界膜剥除联合玻璃体腔气体(空气或惰性气体)填充术。观察患者术后视力和黄斑裂孔闭合率及手术并发症的发生情况。用SPSS 13.0统计软件分析患者年龄、病程、术前最佳矫正视力(BCVA)、黄斑裂孔直径、玻璃体腔填充气体种类与术后BCVA和黄斑裂孔闭合率的相关性。

结果：术后OCT检查结果显示患者黄斑裂孔闭合率100%。其中术中使用空气进行玻璃体腔填充的14眼，一期黄斑裂孔闭合11眼(79%)； 术中使用惰性气体(100mL/L C₃F₈)进行玻璃体腔填充的9眼，一期黄斑裂孔全部闭合，闭合率100%，二者比较，差异无统计学意义(χ²=2.1214，P>0.05)。术后平均矫正视力0.23±0.12，与术前平均矫正视力0.11±0.05相比较，差异有统计学意义(t=4.023，P<0.05)。术后视力提高者术前黄斑裂孔直径小于术后视力不提高者，差异有统计学意义(t=3.92，P<0.05)。术后BCVA与患者年龄(r=-0.415，P= 0.256)、病程(r=0.193 ，P= 0.498)、术前BCVA(r=0.152，P=0.673)无相关性。

结论：玻璃体切割、内界膜剥除联合玻璃体腔气体填充术治疗特发性黄斑裂孔疗效确切； 黄斑裂孔直径是影响特发性黄斑裂孔术后闭合和视力预后的主要因素； 而术前视力、年龄、病程对特发性黄斑裂孔术后闭合和视力预后的影响无相关性。

METHODS: The clinical data of 22 IMH patients(23 eyes)were retrospectively analyzed. All the patients were diagnosed with IMH by optical coherence tomography(OCT)and their macular hole patterns were measured before and after surgery by OCT in addition to the routine examinations. All patients were treated with vitrectomy, internal limiting membrane peeling combined with gas injection(air or inert gas). The postoperative visual acuity, macular hole closure rate and the incidence of surgical complications were observed. The correlation between the patients' age, course of disease, preoperative best corrected visual acuity(BCVA), macular hole diameter, the type of vitreous cavity filling gas, the postoperative BCVA, and the macular hole closure rate was analyzed with SPSS 13.0 statistical software.

RESULTS: Postoperative OCT examination results showed that the macular hole closure rate was 100%. The macular hole closure rate was 79%(11 eyes of 14 eyes)after the first intravitreal air injection and 100%(9 eyes)after fist intravitreal inert gas injection(100mL/L C₃F₈). There was no significant difference between the air injection and inert gas injection(χ²=2.1214, P>0.05). The mean preoperational BCVA was 0.11±0.05 and the mean postoperative BCVA 0.23±0.12; there was a statistically significant difference between them(t=4.023,P<0.05). Compared with the patients without visual acuity improvement after surgery, the diameters of the hole were smaller in the patients whose postoperative visual acuity got improved(t=3.92, P<0.05). There was a significant difference in the visual acuity before and after the surgery(P<0.05). The age of the patients(r=-0.415, P=0.256), duration of disease(r=0.193, P= 0.498), preoperative VA(r=0.152, P=0.673)had no significant influence on IMH visual outcomes.

CONCLUSION: The vitrectomy combined with internal limiting membrane peeling and intravitreal gas tamponade is an effective treatment for IMH; the macular hole diameter is the major influence factor in the postoperative closure and visual prognosis of IMH; while the preoperative visual acuity, age, duration and the type of gas filled in the visual cavity have no effects on the postoperative closure and visual prognosis in IMH.