自体视网膜神经上皮层移植术治疗难治性高度近视黄斑裂孔性视网膜脱离的效果  

Therapeutic Effectiveness of Autologous Neurosensory Retinal Transplantation for Refractory Macular Hole Retinal Detachment in Highly Myopic Eyes

作　　者：胡耀 余川 王玉倩 段淯平 程荣 Yao Hu;Chuan Yu;Yuqian Wang;Yuping Duan;Rong Cheng(Eyegood Ophthalmic Hospital,Wuhan 430064,China;Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Jinan Huashi Eye Hospital,Jinan 250000,China)

机构地区：[1]武汉艾格眼科医院,武汉430064 [2]郑州大学第一附属医院眼科,郑州450052 [3]济南华视眼科医院,济南250000

出　　处：《中华眼视光学与视觉科学杂志》2024年第8期612-618,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：武汉市重点医学科研基金项目(WX20B27)

摘　　要：目的:观察自体视网膜神经上皮层移植术在难治性高度近视黄斑裂孔性视网膜脱离(MHRD)患者中的治疗效果。方法:回顾性临床研究。连续纳入2021年5月至2023年3月就诊于武汉艾格眼科医院的难治性高度近视MHRD患者5例(5眼)。5眼均由同一位医师主刀,手术方式为自体视网膜神经上皮层移植及硅油填充术,术后3个月行硅油取出术。硅油取出术后随访至少6个月。记录患眼自体视网膜移植术前和术后9个月的最佳矫正视力(BCVA)。根据术后光学相干断层扫描(OCT)评估患眼视网膜复位及黄斑裂孔闭合情况;根据术后眼底荧光素血管造影(FFA)和光学相干断层扫描血管成像(OCTA)评估黄斑区视网膜移植片的血供情况。记录并分析患眼术中及术后的并发症。结果:纳入的患者中,男4例(4眼),女1例(1眼),年龄49~71岁,眼轴长度29.86~34.66 mm。术后9个月的BCVA与术前相比,1眼BCVA无改变,其余4眼均较术前有不同程度的提高。术后9个月5眼黄斑区OCT示视网膜均复位,黄斑裂孔均闭合。术后9个月的FFA和OCTA示5眼移植片存活,但未见视网膜浅层新生的毛细血管网络。术中及术后均无并发症。结论:自体视网膜神经上皮层移植术能有效治疗难治性高度近视MHRD,且术中及术后随访期间未见并发症。Objective:To determine the therapeutic effectiveness of autologous neurosensory retinal transplantation for refractory macular hole retinal detachment(MHRD)in highly myopic eyes.Methods:This was a retrospective clinical study.From May 2021 to March 2023,totally 5 patients(5 eyes)who admitted to Wuhan Eyegood Ophthalmic Hospital due to MHRD with high myopia were included in this study.All surgeries were performed by the same surgeon,involving autologous neurosensory retinal transplantation and silicone oil tamponade,followed by silicone oil removal after 3 months.Follow-up was conducted for at least 6 months after the second surgery.The best corrected visual acuity(BCVA)preoperatively and 9 months postoperatively were recorded.The retinal reattachment and macular hole closure were assessed based on optical coherence tomography(OCT).Fundus fluorescein angiography(FFA)and optical coherence tomography angiography(OCTA)were used to observe the macular microvasculature.Complications during and after surgery were recorded.Results:Four males(4 eyes)and one female(1 eye)were included in this study,aged 49 to 71 years,with axial length ranging from 29.86 to 34.66 mm.There was no change of BCVA in one eye before and after surgery at 9 months postoperatively,while the vision improved with varying degrees in 4 eyes.OCT showed the retinal reattachment and macular hole closure in five eyes 9 months after surgery,and FFA and OCTA showed that there had no neovascularization.There were no complications during or after surgery.Conclusion:Autologous neurosensory retinal transplantation is effective in treating refractory MHRD in high-myopia.No complications during surgery and the follow-up period after surgery are found.

关 键 词：自体移植 难治性高度近视黄斑裂孔性视网膜脱离 高度近视 视网膜神经上皮层 玻璃体视网膜手术 

分 类 号：R779.6[医药卫生—眼科]