Macular hole surgery with air tamponade and optical coherence tomography-based duration of face-down positioning
Macular hole surgery with air tamponade and optical coherence tomography-based duration of face-down positioning
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DOI：
10.1097/iae.0b013e318185fb5f
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发表时间：
2008-09-01
影响因子：
3.3
通讯作者：
Gesser, Caroline
中科院分区：
文献类型：
--
作者：
Eckardt, Claus;Eckert, Tillmann;Gesser, Caroline
目的：根据术后光学相干断层扫描 (OCT) 评估采用空气填塞和面朝下定位的黄斑裂孔手术后的闭合率。方法：在一项前瞻性研究中，收集了 33 名连续接受黄斑裂孔手术患者的 33 只眼睛的数据。术后，OCT 图像是在面朝下的位置获得的，以尽量减少气泡产生的干扰反射。一旦 OCT 显示孔闭合，面朝下的定位就结束。结果：术后 24 小时，8/33 只眼睛的介质混浊排除了 OCT。 18/33 只眼睛（54.5%）在术后 24 小时通过 OCT 闭合孔，25/33（75.7%）在术后 48 小时闭合孔。 4/33只眼（112.1%）术后24小时OCT判断孔开放。尽管继续面朝下定位，但术后第三天，这四只眼睛中只有一只的孔已经闭合。其余三只眼睛中的两只，可以通过在第一次玻璃体切除术后 5 至 6 天进行的第二次手术来闭合黄斑裂孔。使用 OCT 监测，超过一半 (54%) 的患者可以在 24 小时后退出面朝下姿势，21% 在 48 小时后，24% 在 3 天后退出面朝下姿势。 结论：玻璃体切除术和空气填塞结合 1 至 3 天的面朝下姿势，黄斑裂孔闭合率很高。在术后第一天和第二天，对处于俯卧位的患者进行 OCT，就可以通过气泡监测黄斑裂孔闭合的进展情况。该方法可以根据 OCT 结果有效调整面朝下定位的持续时间。
Purpose: To evaluate the closure rate after macular hole surgery with air tamponade and face-down positioning whose duration is based on postoperative optical coherence tomography (OCT).Methods: In a prospective study, data were gathered on 33 eyes of 33 consecutive patients undergoing macular hole surgery. Postoperatively, OCT images were obtained in a face-down position to minimize the interfering reflections created by the air bubble. The face-down positioning was ended as soon the OCT revealed closure of the hole.Results: Opacity of the media in 8/33 eyes 24 hours postoperatively precluded OCT. In 18/33 eyes (54.5%), the hole was closed on OCT 24 hours postoperatively and in 25/33 (75.7%), 48 hours postoperatively. In 4/33 eyes (112.1%), the hole was judged to be open on OCT 24 hours postoperatively. Despite continued face-down positioning, the hole had closed on the third day postoperatively in only one of these four eyes. In two of the remaining three eyes, the macular hole could be closed by a second surgery which was performed 5 to 6 days after the first vitrectomy. Using OCT monitoring, more than half (54%) of our patients could quit the face-down position after 24 hours, 21% after 48 hours, and 24% after 3 days.Conclusion: Vitrectomy and air tamponade combined with 1- to 3-day face-down positioning produced an excellent rate of macular hole closure. Already on the first and second day postoperatively OCT on patients in a prone position enabled the monitoring of the progress of the macular hole closure through the air bubble. This method allows effective adjustment of the duration of face-down positioning based on OCT findings.