内界膜剥除联合硅油填充治疗高度近视黄斑裂孔视网膜脱离的临床观察  

Efficacy of internal limiting membrane peeling and silicone oil tamponade for highly myopic macular hole retinal detachment

作　　者：楚艳华[1] 刘蓓[1] 王莹[1] 韩泉洪[1] 

机构地区：[1]天津市眼科医院天津市眼科学与视觉科学重点实验室天津市眼科研究所天津医科大学眼科临床学院,300020

出　　处：《中华眼底病杂志》2013年第2期146-150,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：天津市卫生局科技基金（2011KY32）

摘　　要：目的观察玻璃体切割联合视网膜前膜剥除（ERMP）和（或）内界膜剥除（ILMP）及硅油填充治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔视网膜脱离（MHRD）的疗效。方法高度近视MHRD患者85例85只眼纳入研究。所有患者均采用国际标准视力表行矫正视力检查以及裂隙灯显微镜加前置镜、间接检眼镜、A／B型超声、光相干断层扫描（OCT）、眼压检查。患者平均眼轴长度（29．1±1．8）mm。后极部脉络膜弥漫性萎缩24只眼；部分性萎缩61只眼。将小数视力换算成最小分辨角对数（10gMAR）视力进行统计学处理。平均logMAR矫正视力为1．93±0．37。均行玻璃体切割曲安奈德（TA）或吲哚青绿（ICG）辅助的ILMP和（或）ERMP以及硅油填充手术。85只眼均联合TA辅助行ERMP。其中，单纯TA辅助行ERMP21只眼；ICG辅助行ILMP56只眼；TA辅助行ILMP8只眼。平均硅油填充时间（6．2±1．6）个月。观察患眼手术后矫正视力、视网膜复位、黄斑裂孔闭合情况以及手术后并发症。手术前后视力行t检验；对影响手术后视力的相关因素行相关性分析；视网膜脱离复发行logistic多元回归分析，黄斑区视网膜劈裂对裂孔闭合的影响行χ2检验。结果患眼手术后平均logMAR矫正视力为1．34±0．48。与手术前平均logMAR矫正视力比较，差异有统计学意义（t=39．38，P〈0．01）。手术后矫正视力与患眼眼轴长度（r=0．142）、后极部脉络膜萎缩程度（t=0．23、-0．165）、黄斑裂孔是否闭合（t-0．12、0．005）均无相关性（P〉0．05）。首次手术后视网膜复位79只眼，占92．9％。视网膜脱离复发6只眼，占7．1％。Logistic多元回归分析结果显示，视网膜脱离复发与患眼手术前脉络膜是否脱离、增生型玻璃体视网膜病变程度、眼轴长度、后极部脉络膜萎缩程度以及是否行ILMP均无相关性（比值比-1．428、5．039、0．815、2�Objective To observe the effect of pars plana vitrectomy （PPV） with epiretinal membrane peeling （ERMP） and （or） internal limiting membrane peeling （ILMP） and silicone oil tamponade for highly myopic macular hole retinal detachment （MHRD） with posterior staphyloma. Methods Eighty five highly myopic MHRD patients （85 eyes） were enrolled in this study. All the patients were examined for corrected visual acuity （CVA）, slit lamp microscope and preset lens, indirect ophthalmoscope, A/B ultrasound, optical coherence tomography （OCT） and intraocular pressure examination. The average axial length was （29. 1±1.8） mm. There were 24 eyes with diffuse choroid atrophy and 61 eyes with partial choroid atrophy. The CVA was converted into a logarithm of the minimal angle of resolution （logMAR） for statistical analysis. The average logMAR CVA was 1.93 ± 0.37. All the patients were treated with PPV and triamcinolone acetonide （TA） or indocyanine green （ICG） assisted ILMP and （or） ERMP and siliconeoil tamponade. TA assisted ERMP was performed in 21 eyes; with ICG assisted ILMP in 56 eyes and TA assisted ILMP in eight eyes. The duration of silicone oil tamponade was （6.2±1.6） months. CVA, retina and macular hole status and complications were observed postoperatively. Differences between preoperative and postoperative CVA were evaluated by the t test and correlation analysis. Multiple logistic regression analysis was performed to assess the influence of individual preoperative factors on the initial anatomical success. Differences in the macular hole closure rate between eyes with or without macular schisis were evaluated for statistical significance using corrected chi-square. Results The mean logMAR CVA was 1.34±0.48 after surgery, which significantly improved compared to that before surgery （t=39.38, P〈 0.01）. The CVA after surgery was independent of axial length （r=0. 142, P〉0.05）, choroid atrophy （t= 0.23,-0.165, P〉0.05） and macular hole closure （t=0.

关 键 词：近视 退行性 外科学 视网膜脱离 外科学 视网膜穿孔 外科学 玻璃体切除术 硅油类 治疗应用 

分 类 号：R77[医药卫生—眼科]