目的：观察玻璃体切割术(PPV)联合内界膜(ILM)填塞及鼠神经生长因子(NGF)注射治疗大直径特发性黄斑裂孔(IMH)的临床疗效。

方法：回顾性病例研究。选取2018-05/2020-05在南京医科大学眼科医院检查确诊并行PPV联合ILM填塞及鼠NGF注射的大直径IMH患者16例16眼纳入研究。所有入组患者均接受经睫状体扁平部三通道23G PPV联合ILM填塞及鼠NGF注射治疗。观察术后最佳矫正视力\〖BCVA(LogMAR)\〗、裂孔闭合率、分析黄斑裂孔闭合的OCT分型、中心凹外层结构包括椭圆体带(EZ)、外界膜(ELM)的连续性及术后并发症等。

结果：患者术前BCVA为1.15±0.21，术后3、6mo BCVA分别为1.02±0.19、0.87±0.24(F=34.966，P<0.01)； 术后3、6mo BCVA较术前均有改善(P<0.01)，且术后6mo BCVA较术后3mo改善(P<0.01)。术后患者裂孔闭合率为100%，OCT所显示的闭合形态中，11眼为U型闭合(69%)； 3眼为V型闭合(19%)； 2眼为不规则闭合(13%)。术后6mo，U型、V型及不规则闭合组眼的BCVA分别为0.75±0.18、1.1±0.19、1.20±0.00(F=6.937， P<0.01)，其中U型闭合组的BCVA恢复明显优于V型闭合组和不规则闭合组(P=0.027、0.007)。术后6mo，U形闭合组中有10眼(91%)ELM恢复连续性、7眼(64%)EZ恢复连续性，V型闭合组中有2眼(67%)ELM恢复连续性、1眼(33%)EZ恢复连续性，不规则闭合眼中未见ELM、EZ连续性恢复(P<0.05)。随访期间未发现眼部及全身并发症。

结论：PPV联合ILM填塞及鼠NGF注射治疗对大直径IMH安全有效，NGF与ILM的协同作用可促进裂孔的闭合，有利于视网膜光感受器细胞的完整性恢复及术后视功能的改善。

METHODS: This was a retrospective clinical study which included 16 patients(16 eyes)with large IMH diagnosed in the Affiliated Eye Hospital of Nanjing Medical University from May 2018 to May 2020. All patients were treated with PPV combined with ILM insertion and NGF injection and the follow-up period was at least 6mo. Macular hole closure rates, best-corrected visual acuity(BCVA)(LogMAR), and optical coherence tomography(OCT)findings including ellipsoid zone(EZ)and external limiting membrane(ELM)were analyzed, the complications were also observed postoperatively.

RESULTS: The BCVA was 1.15±0.21 before operation, and the follow-up of BCVA was 1.02±0.19 and 0.87±0.24 respectively at 3 and 6mo after operation(F=34.966, P<0.01); The BCVA was improved 3 and 6mo after operation(P<0.01), and the BCVA at 6mo after operation was better than that at 3mo(P<0.01). The closure rate of the MH was 100% and 11 eyes showed U-shaped closure in OCT(69%), 3 eyes were V-shaped closure(19%)and 2 eyes were irregular closure(13%). The BCVA of U-shaped closure group, V-shaped closure group and irregular closure group were 0.75±0.18, 1.1±0.19, and 1.20±0.00 respectively(F=6.937, P<0.01). The recovery of BCVA in U-shaped closure group was significantly better than that in V-shaped closure group and irregular closure group(P=0.027, 0.007). Six months after operation, 10 eyes(91%)of ELM and 7 eyes(64%)of ellipsoid zone resumed continuity in U-shaped closure group, 2 eyes(67%)of ELM and 1 eye(33%)of resumed continuity in V-shaped closure group. ELM and ellipsoidal zone were not recovered continuously in irregular closure group(P<0.05). During the follow-up period, we found no ocular or systemic complications.

CONCLUSION: PPV combined with ILM insertion and NGF injection is safe and effective in treating large IMH. The synergetic effect of NGF and ILM can obviously promote the closure of IMH, which is beneficial to the recovery of photoreceptor layer integrity and the improvement of visual function after operation.