玻璃体切割术治疗高度近视性黄斑劈裂及黄斑裂孔的疗效观察  

Clinical effects of vitrectomy for macular retinoschisis and macular hole in high myopic eyes

作　　者：彭娇玲[1] 朱小华[2] 谭钢[1] 邵毅[3] 

机构地区：[1]南华大学附属第一医院眼科,湖南省衡阳市421001 [2]中南大学湘雅二医院眼科,湖南省长沙市410011 [3]南昌大学第一附属医院眼科,江西省南昌市330006

出　　处：《眼科新进展》2014年第6期533-537,共5页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:81100648;81160118);全国临床医药研究专项基金(编号:L2012052);江西省自然科学基金(编号:20114BAB215029);湖南省科技计划项目(编号:2010FJ4135);江西省科技支撑计划项目(编号:20111BBG70026-2);江西省卫生厅中医药科研项目(编号:2012A087)~~

摘　　要：目的观察并分析高度近视黄斑劈裂及黄斑裂孔玻璃体切割术前、术后的光学相干断层扫描(optical coherence tomography,OCT)、视力及多焦视网膜电图(multifocal electroretinogram,mfERG)的变化特征,评估手术疗效,并探讨手术时机。方法收集2011年8月至2013年3月在我院行标准三通道经睫状体平坦部玻璃体切割术联合内界膜剥离术治疗高度近视性黄斑劈裂及黄斑裂孔不伴视网膜脱离患者38例(44眼),并将其分成两组,即黄斑劈裂组(24眼)和黄斑裂孔组(20眼),术后随访6个月,观察患眼术前及术后视力、OCT及mfERG情况。结果两组患者术后视力较术前均有提高(均为P<0.05),黄斑劈裂组患者术后视力提高幅度大于黄斑裂孔组(P<0.05)。视力进步者黄斑劈裂组为91.7%,黄斑裂孔组为50.0%,两组相比差异有统计学意义(P<0.05)。OCT示黄斑劈裂组24眼中22眼(91.7%)黄斑区完全愈合,2眼(8.3%)好转;黄斑裂孔组20眼中8眼(40.0%)完全愈合,6眼(30.0%)好转,6眼(30.0%)未愈合;两组黄斑区完全愈合率相比,差异有统计学意义(P<0.01)。mfERG示术后6个月时,黄斑劈裂组1环P1波潜伏期为(37.50±3.62)ms,与术前的(44.23±4.35)ms相比明显缩短(P<0.05),而黄斑裂孔组为(38.54±4.75)ms,与术前的(40.31±2.80)ms相比差异无统计学意义(P>0.05)。两组患者P1波振幅密度在术后2个月、3个月、6个月时均逐渐提高,但仍略低于术前(均为P<0.05)。术前mfERG的三维地形图表现为中央峰缺如或低平,旁中心凹区域有多处不规则低反应区。术后愈合患者mfERG的三维地形图的中央峰逐渐恢复,旁中心凹区域不规则反应区减少或消失。两组术中未见医源性裂孔形成,术后无眼内出血或眼内炎等严重并发症发生。结论玻璃体切割联合内界膜剥离术是治疗高度近视性黄斑劈裂及黄斑裂孔安全有效的手术方法。在高度近视黄斑劈裂形成伴有视力受损之后、裂孔形成之前及时行玻璃体Objective To observe and analyze the changes of optical coherence tomography（OCT） ,visual acuity and muitifocal electroretinogram（mfERG） before and after successful vitrectomy for macuiar retinoschisis and macular hole in high myopic eyes, evaluate the efficiency of the surgery, and approach the surgical indication. Methods A total of 44 eyes of 38 high myopic patients with macuiar retinoschisis and macuiar hole without retinal detachment underwent standard 3-port pars plana vitrectomy combined with internal limiting membrane peeling during August 2011 and March 2013 in our hospital were collected. The cases were assigned to 2 groups, macuiar retinoschisis group （ 24 eyes） and macular hole group （ 20 eyes）. OCT, best corrected visual acuity and mfERG were examined preoperatively and 2 months, 3 months and 6 months postoperatively, respectively. Results Postoperative visual acuity in two groups were better than pre-operation（P 〈 0.05 ）, and the macuiar retinoschisis group was better than macular hole group（P 〈 0.05 ）. Visual acuity improved in 91.7% of macular retinoschisis group and 50.0% of macuiar hole group, there was statistical difference between two groups （P 〈 0. 05 ）. OCT showed that the retinoschisis completely resolved in 22 eyes（gl. 7% ）and partially resolved in 2 eyes （8.3%）in macular retinoschisis group, which in macular hole group were 8 eyes （40.0%） and 6 eyes （30.0%）, there was statistical difference in resolved rate between two groups（P 〈0.01 ）. The mfERG showed that the latency of wave P1 of ring 1 at postoperative 5 months in macuiar retinoschisis group was（ 37.5 ± 3.62 ） ms, which was shorter than preoperatively （ 44.23 ±4.35 ） ms （ P 〈 0. 05 ） ;While there was no statistical difference between pre-operation（40.31 ±2.80）ins and post-operation（38.54 ±4.75 ） ms in macular hole group （P 〉 0.05 ）. The amplitude densities of wave P1 of ring 1 got higher and higher at postoperative 2 months ,3 months and 6 months

关 键 词：高度近视 黄斑劈裂 黄斑裂孔 玻璃体切割术 多焦视网膜电图 

分 类 号：R779.6[医药卫生—眼科]