非内界膜剥离的玻璃体切除术联合长效气体填充治疗病理性近视继发黄斑劈裂  

Vitrectomy without internal limiting membrane peeling associated with gas tamponade for treatment of foveoschisis in pathologic myopia

作　　者：张娅萍[1] 薛安全[1] 王毓琴[1] 彦文涛[1] 宋宗明[1] 

机构地区：[1]温州医学院附属眼视光学医院,325027

出　　处：《中华眼科杂志》2011年第6期497-503,共7页Chinese Journal of Ophthalmology

摘　　要：目的探讨非内界膜剥离的玻璃体切除术联合长效气体填充治疗病理性近视继发黄斑劈裂的临床疗效。方法前瞻陛临床研究。对49例（52只眼）病理性近视继发黄斑劈裂患者采用随机数字表法分组，非注气组（接受非内界膜剥离的玻璃体切除术）22例（24只眼）；注气组（接受非内界膜剥离的玻璃体切除联合玻璃体腔内长效气体填充）15例（16只眼）；对照组（非手术组，接受定期随访观察治疗）12例（12只眼）。分别比较各组患者首次诊疗及术后第3、6、9个月的最佳矫正视力及光相干断层扫描（OCT）显示的视网膜劈裂高度变化。3组间不同随访时段的最佳矫正视力、黄斑中心凹厚度、黄斑区视网膜劈裂高度的比较采用Wilcoxon秩和检验，组内手术前后上述3个指标的比较采用配对符号秩和检验。结果患者术后随访9个月，最佳矫正logMAR视力（四分位数间距）中位数（Q1，Q3）：非注气组为0．5（0．3，0．8），较术前的0．7（0．4，1．1）有明显改善（t=2．57，P〈0．05）；注气组为0．5（0．3，0．7），较术前的0．8（0．5，1．0）有显著改善（t=3．58，P〈0．05）；对照组为0．5（0．3，1．3），与术前的0．4（0．1，0．6）比较，差异无统计学意义（t=1．84，P〉0．05）；术后3组间最佳矫正视力比较，差异无统计学意义（）c2=0．24，P〉0．05）。术后9个月OCT检测：非注气组和注气组患者平均视网膜劈裂高度均较术前显著下降。术后9个月视网膜完全复位率：对照组0．0％（0／12）、非注气组66．7％（16／24）、注气组81．3％（13／16），组间差异有统计学意义（X2=20．50，P〈0.05），表明非内界膜剥离的玻璃体切除术可显著促进病理性近视继发黄斑劈裂的视网膜复位。并发症：对照组中有2只眼分别在随访的6个月和8个月出现黄斑裂孔性视网膜脱离，另10只眼随Objective To evaluate the efficacy of vitrectomy without internal limiting membrane （ILM） peeling associated with gas tamponade in eyes with myopic foveoschisis. Methods A prospective study was conducted, in which 49 pathological myopia patients （52 eyes） with myopic foveoschisis were enrolled and divided into three groups according to the different therapeutic procedures： 22 patients （24 eyes） underwent vitrectomy without internal limiting membrane （non-gas tamponade group）, 15 patients （16 eyes） received vitrectomy without internal limiting membrane peeling but combined with gas tamponade （gas tamponade group） and 12 patients （12 eyes） did not receive surgical treatments （control group） . SAS 9. 13 was used for the statistic analysis. Best-corrected visual acuity （BCVA） and optical coherence tomographic （OCT） findings of the foveal thickness before and after the operation （the 3rd, 6th, and 9th month postoperatively ） were obtained and compared by the Wilcoxon Rank-Sum test. Non- parameters Wilcoxon symbols test was used to compare the BCVA, the central foveal thickness （CFT） and maximum foveal thickness （MxFr） of each group before and after the surgery. Results Postoperative visual acuity was significantly increased in the two operation groups （ t = 2. 57, P 〈 0. 05 ; t = 3.58, P 〈 0. 05 ） but not increased in the control group （t = 1.84 ;P 〉 0. 05）. The difference of BCVA between these three groups was not significant （X2 = 0. 24, P 〉 0. 05 ）. OCT showed the mean foveal thickness was significantly decreased postoperatively. Vitrectomy without peeling of the ILM significantly promoted the retinal reattachment in eyes with myopic foveoschisis. No retinal reattachments was found in the control group while 16 and 13 retinal reattachments were found in the non-gas tamponade （66.7%） and gas tamponade group （81.3%）, the difference between these two operation groups and the control was statistically significant （ X^2 = 20. 50, P 〈 0

关 键 词：近视 退行性 视网膜劈裂症 玻璃体切除术 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]