不同程度高度近视黄斑裂孔性视网膜脱离玻璃体切割手术后疗效比较  

Efficacy of vitrectomy for moderate and extreme highly myopic macular hole retinal detachment

作　　者：魏勇 王润生[1] 朱忠桥 毕春潮 王勇[1] 杨新光[1] 

机构地区：[1]陕西省眼科医疗中心西安市第四医院眼科西安交通大学医学院附属广仁医院眼科,710004

出　　处：《中华眼底病杂志》2013年第2期142-145,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：西安市科委社会发展引导计划一医疗卫生研究项目[SFL022（5）]

摘　　要：目的比较适度与极端高度近视黄斑裂孔性视网膜脱离（MHRD）曲安奈德（TA）染色辅助玻璃体切割及内界膜剥除联合长效气体眼内填充手术后的疗效。方法41例高度近视MHRD住院患者41只眼纳入研究。其中，眼轴长度〈29mm，视网膜色素上皮（RPE）及脉络膜萎缩轻，0～1级且深度≤2mm的巩膜后葡萄肿者24只眼（适度组）；眼轴长度≥29mm，RPE及脉络膜明显萎缩，2～3级且深度〉2mm的巩膜后葡萄肿者17只眼（极端组）。两组患者均行TA染色辅助玻璃体切割手术联合内界膜剥除手术治疗，手术完毕时行C3F8眼内填充。对手术后发生视网膜再脱离者行再次手术。以手术后12个月为疗效判定时间点，比较两组患者视网膜复位率、黄斑裂孔闭合率及视力情况。结果第1次手术后，适度组、极端组视网膜复位率分别为91．67％、64．71％，黄斑裂孔闭合率分别为58．33％、17．65％。两组第1次手术后视网膜复位率（P=0．049）、黄斑裂孔闭合率（χ2=6．787，P=0．009）比较，差异均有统计学意义。第2次手术后，适度组、极端组视网膜复位率分别为95．83％、88．24％，黄斑裂孔闭合率分别为58．33％、23．53％。两组比较，视网膜复位率间差异无统计学意义（P=0．560），黄斑裂孔闭合率间差异有统计学意义（χ2=4．894，P=0．027）。手术后12个月，适度组视力提高14只眼，视力不变9只眼，视力下降1只眼；极端组视力提高6只眼，视力不变8只眼，视力下降3只眼。两组视力情况比较，差异无统计学意义（χ2=0．209，P=0．647）。结论TA染色辅助玻璃体切割及内界膜剥除联合长效气体眼内填充手术后，适度高度近视MHRD患者视网膜复位率及黄斑孔闭合率较极端高度近视MHRD患者更高，但视力预后无明显差异。Objective To compare the outcome of pars plana vitrectomy （PPV） with triamcinolone （TA） assistance and internal limiting membrane （ILM） peeling for the treatment of moderate and extreme highly myopic macular hole retinal detachment （MHRD）. Methods Forty-one highly myopic MHRD patients （41 eyes） who underwent PPV with TA assistance and ILM peeling were enrolled in this study. These eyes were divided into two groups according to different anatomic features： group A （24 eyes） had a consistent moderate long axial lengths （〈 29 mm）, ＂ mild＂ retinal pigment epithelium （RPE） and chorioretinal atrophy, and posterior staphyloma （level 0-1 and depth ≤2 mm） ; while group B （17 eyes） had a consistent extreme long axial lengths （≥929 mm）, ＂severe＂ RPE and chorioretinal atrophy, and posterior staphyloma （level 2-3 and depth〉2 mm）. All the patients underwent C3F8 tamponade at the end of PPV. The anatomic reattachment of the retina, macular hole closure, and visual acuity were observed at 12 months after surgery. Results The rates of retinal reattachment and macular hole closure were 91.67% and 58.33% in group A, 64.71% and 17.65 % in group B in the first time of surgery. The differences of rates of retinal reattachment （P=0. 049） and macular hole closure （χ2=6. 787, P=0. 009） between two groups were statistically significant. The rates of retinal reattaehment and macular hole closure were 95.83 % and 58.33% in group A, 88.23% and 29.53% in group B in the second time of surgery. The difference of retinal reattachment rate between two groups was not statistically significant （P=0. 560）. The difference ofmacular hole closure rate between two groups was statistically significant （ χ2=4. 894, P=0.027）. Twelve months after surgery, the vision acuity improved in 14 eyes, unchanged in nine eyes, and decreased in one eye in group A; the vision acuity improved in six eyes, unchanged in eight eyes, and decreased in three eyes in group B. The differences of

关 键 词：近视 退行性j外科学 视网膜脱离 外科学 视网膜穿孔j外科学 玻璃体切除术 

分 类 号：R77[医药卫生—眼科]