Spontaneous closure of traumatic macular hole.
Spontaneous closure of traumatic macular hole.
复制标题
外伤性黄斑裂孔自发闭合。
DOI：
10.1097/00006982-200108000-00020
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
S. Takeuchi
中科院分区：
文献类型：
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作者：
Y. Mitamura;W. Saito;M. Ishida;S. Yamamoto;S. Takeuchi
方法在我科，我们主要观察了外伤性黄斑裂孔，但没有进行平坦部玻璃体切除术（PPV），观察时间约为3-4个月，因为有报道称外伤性黄斑裂孔可以自行消退。2，3 1994年9月至2000年10月，在日本千叶东邦大学樱花医院连续观察了11例（11只眼）外伤性黄斑裂孔患者。使用Goldmann黄斑接触透镜对每例患者进行生物显微镜检查。生物显微镜诊断黄斑裂孔的标准如下：聚焦在黄斑上的细狭缝光束在裂孔位置向旁边偏移，并且在裂孔内没有观察到视网膜组织。黄斑裂孔周围的视网膜下液囊有利于诊断。所有病例在黄斑裂孔开放时的50 μm激光瞄准光束试验均为阳性。11只眼中6只眼行血管造影。在所有六只眼睛中发现了对应于黄斑裂孔底部的中央高荧光窗缺损。通过检眼镜检查观察到所有眼睛的黄斑裂孔闭合，并在11只眼睛中的9只眼睛中使用OCT进行确认。黄斑裂孔闭合的临床诊断标准定义为黄斑裂孔边缘变平，周围视网膜下液囊消退，且黄斑裂孔边缘不可见。黄斑裂孔闭合后，50 μm激光瞄准光束试验和Watzke-Allen试验均为阴性。11只眼的临床数据总结见表1。11例中7例黄斑裂孔自行消失。这7例患者的共同特点是年龄小（8 ~ 17岁，平均13.6岁），黄斑裂孔小（0.1-0.2个盘直径），无玻璃体后脱离，末次访视视力较好。在所有7例病例中，视力提高了两行或更多行。黄斑裂孔开放时间为1 ~ 4个月，2只眼除外（这2例患者拒绝接受手术）。在其他四个病例中，黄斑裂孔在观察期间没有自发闭合。由于黄斑裂孔扩大（例8、9和11）或中度玻璃体积血（例10），患者接受了PPV联合膜（后玻璃体、视网膜前膜和内界膜）去除和六氟化硫填充，术后黄斑裂孔获得解剖闭合。这4例患者的年龄范围为11 - 33岁，平均24.8岁，黄斑裂孔相对较大（0.2-0.4盘直径）。
MethodsIn our unit, we principally observed traumatic macular hole without pars plana vitrectomy (PPV) for about 3–4 months, because it was reported that traumatic macular hole might resolve spontaneously. 2, 3 Eleven consecutive patients (11 eyes) with traumatic macular hole were observed at Toho University Sakura Hospital in Chiba, Japan, between September 1994 and October 2000. Biomicroscopic examination using a Goldmann macula contact lens was performed on each patient. Biomicroscopic criteria for diagnosis of macular hole were defined as follows: the fine slit beam focused over the macula shifted aside at the location of the hole, and no retinal tissue was observed within the hole. The surrounding subretinal fluid cuff strongly favored the diagnosis of macular hole. A 50-μm laser aiming beam test was positive in all cases at the time of macular hole opening. Fluorescein angiography was performed in 6 of the 11 eyes. A central hyperfluorescent window defect corresponding to the base of the macular hole was found in all six eyes. Macular hole closure was observed by ophthalmoscopic examination in all eyes and was also confirmed by use of OCT in 9 of the 11 eyes. The clinical diagnostic criteria for macular hole closure were defined as flattening of the edges of the macular hole with resolution of the surrounding subretinal fluid cuff and no visible edge of the macular hole. After macular hole closure, the 50-μm laser aiming beam test and Watzke–Allen test became negative in all eyes. The clinical data of the 11 eyes are summarized in Table 1. In 7 of the 11 cases, the macular hole disappeared spontaneously. Common features of these seven cases are young age (ranging from 8 to 17 years, mean 13.6 years), small size of macular hole (0.1–0.2 disk diameter), no posterior vitreous detachment, and relatively good visual acuity on final visit. Visual acuity improved two or more lines in all seven cases. Duration of macular hole opening ranged from 1 to 4 months except in two eyes (these two patients refused to undergo operations). In the other four cases, the macular hole did not close spontaneously during the observation period. Because of macular hole enlargement (Cases 8, 9, and 11) or moderate vitreous hemorrhage (Case 10), patients underwent PPV combined with removal of the membrane (posterior hyaloid, epiretinal membrane, and internal limiting membrane) and sulfur hexafluoride tamponade, and anatomic closure of macular hole was obtained after the operation. These four patients ranged in age from 11 to 33 years, mean 24.8 years, and had relatively large macular holes (0.2–0.4 disk diameter).