内界膜剥除对适度高度近视黄斑裂孔性视网膜脱离视网膜复位及裂孔闭合的影响  

Efficacy of internal limiting membrane peeling for retinal reattachment and macular hole closure of moderate highly myopic macular hole retinal detachment

作　　者：魏勇 王润生[1] 朱忠桥 毕春潮 雷春灵[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151-154,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[SF1022（5）]

摘　　要：目的比较曲安奈德（TA）玻璃体染色辅助玻璃体切割（PPV）联合与不联合内界膜剥除对适度高度近视黄斑裂孔性视网膜脱离（MHRD）视网膜复位及黄斑裂孔闭合的影响。方法屈光度≥6D，增生型玻璃体视网膜病变分级A、B级，眼轴长度≥26mm但〈29mm，视网膜色素上皮及脉络膜萎缩轻或不明显，0～1级且深度≤2mm巩膜后葡萄肿的适度高度近视MHRD患者43例43只眼纳入观察。将43只眼随机分为内界膜剥除组和内界膜保留组。其中，内界膜剥除组24只眼，内界膜保留组19只眼。TA玻璃体染色辅助PPV后，内界膜剥除组行内界膜剥除，内界膜保留组不行内界膜剥除。手术后1周，1、3、6、12个月时随访，比较两组间矫正视力、视网膜复位及黄斑裂孔闭合率的差异。结果手术后12个月，内界膜剥除组视网膜复位22只眼，视网膜复位率91．67％；内界膜保留组视网膜复位18只眼，视网膜复位率94．74％；两组患者的视网膜复位率比较，差异无统计学意义（Fisher确切概率法，P＝1．000）。内界膜剥除组黄斑裂孔闭合14只眼，黄斑裂孔闭合率58．33％；内界膜保留组黄斑裂孔闭合11只眼，黄斑裂孔闭合57．89％；两组患者的黄斑裂孔闭合率比较，差异无统计学意义（χ2＝0．049，P＝0．824）。两组患者手术后视力比较，差异无统计学意义（χ2＝0．001，P＝0．977）。结论采用TA辅助PPV治疗适度高度近视MHRD眼，其视网膜复位、裂孔闭合及视力改变与内界膜是否剥除无明显关系。Objective To compare the outcome of pars plana vitrectomy （PPV） with triamcinolone （TA） assistance and with or without internal limiting membrane （ILM） peeling for retinal reattaehment and macular hole closure of moderate highly myopic macular hole retinal detachment （MHRD）. Methods Forty- three moderate highly myopic MHRD patients （43 eyes） with proliferative vitroretinopathy in class A or B, moderate long axial lengths （≥26 mm but 〈29 mm）, mild retina pigment epithelium and chorioretinal atrophy, and posterior staphyloma （0 - 1 level and ≤2 mm） were enrolled in this study. The patients were divided into two groups according to surgical options： TA-assisted PPV with ILM peeling （group A, 24 eyes）, TA-assisted PPV without ILM peeling （group B, 19 eyes）. The anatomic reattachment of the retina, maeular hole closure, and corrected visual acuity （CVA） were observed at one week, one, three, six and 12 months after surgery. Results Twelve months after surgery, retinal reattachment was achieved in 22 eyes （91.67%） and 18 eyes （94. 74%） in group A and B, respectively. The difference of retinal reattachment rate between two groups was not statistically significant （Fisher＇s exact test, P= 1. 000）. Macular hole closure was in 14 eyes （58. 33%） and 11 eyes （57.89%） in group A and B, respectively. The difference of macular hole closure rate between two groups was not statistically significant （χ2 =0. 049,P=0. 824）. The differences of CVA between two groups was not statistically significant （χ2= 0. 001, P= 0. 977）. Conclusion ILM peeling may not be necessary in the surgery of TA-assisted PPV for moderate highly myopic MHRD.

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 

分 类 号：R77[医药卫生—眼科]