目的：应用频域光学相干断层成像(SD-OCT)评估玻璃体切割联合内界膜(ILM)填塞手术治疗难治性黄斑裂孔(MH)的疗效。

方法：回顾性分析2019-07/2020-12在我院诊断为难治性MH并接受玻璃体切割联合ILM填塞手术治疗的患者17眼。比较手术前后最佳矫正视力(BCVA)，使用SD-OCT量化评估术后MH修复情况。

结果：术前椭圆体带中断宽度为839.00～1577.50(平均1 182.90±226.68)μm。术后随访3～12mo，17眼(100%)MH完全闭合且未见复发。术后BCVA较术前提高(P<0.01)。术后1wk，3mo外界膜中断宽度、椭圆体带中断宽度较术前逐渐缩小(均P<0.01)，但仍未恢复延续性，中心子区厚度(直径1mm范围)较术前明显下降(均P<0.01)。

结论：玻璃体切割联合ILM填塞手术治疗难治性MH安全有效。SD-OCT对难治性MH的诊断及术后随访评估具有重要的临床价值。

METHODS: Retrospective analysis was conducted in 17 patients(17 eyes)with refractory MH from July 2019 to December 2020. All patients were treated with pars plana vitrectomy combined with ILM insertion. Preoperative and postoperative best corrected visual acuity(BCVA)were compared. Quantified evaluation of the postoperative macular restoration was performed by SD-OCT.

RESULTS: The widths of ellipsoid zone disruption were 839.00-1577.50μm, with an average of 1182.90±226.68μm. During the follow-up period(3-12mo), 17 cases achieved successful closure(100%), and no recurrence was seen. Postoperative BCVA was significantly improved compared with preoperative(P<0.01). The widths of external limiting membrane disruption and ellipsoid zone disruption were smaller gradually at 1wk and 3mo after surgery compared with preoperative(all P<0.01). But the continuity was still not restored. The thickness of the central fovea of macula(within 1mm diameter range)at 1wk and 3mo after surgery decreased significantly compared with preoperative(all P<0.01).

CONCLUSION: Pars plana vitrectomy combined with ILM insertion proves to be effective to achieve anatomical and functional improvement in the treatment of refractory MH. SD-OCT has important clinical value in the diagnosis and postoperative follow-up evaluation of refractory MH.