玻璃体切除联合内界膜剥离术治疗高度近视黄斑裂孔的疗效  

Vitrectomy with internal limiting membrane peeling for macular hole in high myopia eyes

作　　者：邓春梅[1] 艾明[1] 江双红[1] 郑文敏[1] 

机构地区：[1]武汉大学人民医院眼科中心,中国湖北省武汉市430060

出　　处：《国际眼科杂志》2015年第8期1398-1401,共4页International Eye Science

摘　　要：目的：比较经睫状体平坦部玻璃体切除术（pars plana vitrectomy,PPV）与PPV联合内界膜剥离术（internal limiting membrane peeling,ILMP）治疗高度近视黄斑裂孔的临床效果。方法：回顾性分析高度近视黄斑裂孔患者（伴或不伴黄斑裂孔性视网膜脱离）33例36眼的病例资料。根据手术方式不同,分为Ⅰ组和Ⅱ组。Ⅰ组15眼行玻璃体切除术（不剥离内界膜）;Ⅱ组21眼行玻璃体切除联合内界膜剥离术,术中根据患者病情不同,给予不同的辅助方式,如行硅油填充、C3F8填充、光凝、冷凝等。术后随访3-12mo,以术后最佳矫正视力（best corrected visual acuity,BCVA）、裂孔闭合及视网膜复位情况作为疗效观察指标,并将两组数据进行统计学分析。结果：Ⅰ组15眼术后最佳矫正视力（Log MAR）较术前平均提高0.167,差异有统计学意义（t=2.46,P=0.027）;Ⅱ组术后最佳矫正视力（Log MAR）较术前平均提高0.456,差异有统计学意义（t=6.753,P=0.000）;两组间术后视力提高程度比较,差异有统计学意义（t=-2.943,P=0.006）。Ⅰ组患者黄斑裂孔闭合率46.67%;Ⅱ组患者黄斑裂孔闭合率85.71%;比较两组术后裂孔闭合率,差异有统计学意义（χ^2=6.287,P=0.025）。Ⅰ组视网膜最终复位率91.67%。Ⅱ组视网膜最终复位率94.73%,比较两组患者视网膜复位情况,差异无统计学意义（χ^2=0.856,P=0.418）。结论：玻璃体切除联合内界膜剥离术可以显著提高高度近视黄斑裂孔的闭合率和术后视力,但对于视网膜的复位率较不剥膜者无明显区别。AIM：To compare the clinical effects between pars plana vitrectomy（PPV） and PPV with internal limiting membrane peeling（ILMP） for macular hole in high myopia eyes.METHODS：The clinical data of 33 high myopia with macular hole patients（36 eyes） with or without retinal detachment caused by macular hole were retrospectively analyzed.The patients were divided into two groups according to different operation methods：15 eyes in group I had undergone PPV;21 eyes in group Ⅱ had undergone PPV with ILMPP peeling.According to different conditions of patients,different auxiliary methods were accepted,such as silicone oil tamponade,C_3F_8tamponade,photocoagulation,condensation,etc.The follow- up period was 3 - 12 mo.Best corrected visual acuity（BCVA）,macular hole closure rate and retinal reattachment rate were continuous checked after operation.Then we evaluated the outcome in the two groups by statistical analysis.RESULTS：The postoperative mean BCVA increased by0.167 in group I and 0.456 in group I than preoperative,the difference was significant（t = 2.46,6.753;P = 0.027,0.000）.And the difference of BCVA improvement was significant between those two groups（t =- 2.943,P =0.006）.The macular hole closed in 7 eyes（46.67%） in group Ⅰ,and 18 eyes（85.71%） in group Ⅱ;The difference was significant between those two groups（χ^2 =6.287,P =0.025）.Retinal reattachment was found in 11 eyes（91.67%） in group Ⅰ and 19 eyes（94.73%） in group Ⅱ.The difference was not significant between the two groups（χ^2 =0.856,P=0.418）..CONCLUSION：PPV with ILMPP peeling for macular hole in high myopia eyes can obviously improve closure of macular hole and postoperative visual acuity.But the difference of retinal reattachment rate was not significant between peeling and unpeeling of ILMP.

关 键 词：高度近视 黄斑裂孔 玻璃体切除术 内界膜剥除术 临床疗效 

分 类 号：R779.6[医药卫生—眼科]