后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离  

Posterior scleral reinforcement for recurrent macular hole retinal detachment with silicone oil tamponade in severe highly myopic eyes

作　　者：刘琼[1,2] 淦强 叶波[2] 邱新文[2] 黄银花[2] 薛安全[4] 

机构地区：[1]中南大学爱尔眼科学院,湖南省长沙市410000 [2]南昌爱尔眼科医院,江西省南昌市330000 [3]南昌大学研究生院医学部,江西省南昌市330000 [4]温州医科大学附属眼视光医院,浙江省温州市325000

出　　处：《眼科新进展》2016年第8期773-776,共4页Recent Advances in Ophthalmology

摘　　要：目的探讨后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离(macular hole retinal detachment,MHRD)的可行性及疗效。方法选取2011年6月至2014年6月硅油填充术后的复发性超高度近视性MHRD患者36例(36眼),所有患者均由同一术者行黄斑区改良后巩膜加固术,术后3个月取出硅油。术后随访12个月,观察记录术后并发症、视网膜脱离复位情况、黄斑裂孔闭合情况、术后视力、眼轴长度等指标。结果 36眼视网膜完全复位,视网膜复位率为100%;末次随访SD-OCT示22眼黄斑裂孔完全闭合,占61.1%,11眼黄斑部分闭合,占30.6%,3眼仍未闭合,占8.3%;31眼术后最佳矫正视力(best correct visual acuity,BCVA)较术前提高,占86.1%,5眼BCVA较术前无明显改变,占13.9%;术前患者BCVA为(1.48±0.92)log MAR,术后BCVA为(0.93±0.38)log MAR,差异有统计学意义(P<0.05);术前患者眼轴长度为(30.95±1.16)mm,术后为(28.46±1.34)mm,差异有统计学意义(P<0.001)。所有患眼均未发生眼底出血、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。结论改良后巩膜加固术是治疗硅油填充术后复发性超高度近视MHRD安全有效的手术方法,能提高视网膜解剖复位率、黄斑裂孔闭合率、视力及减少并发症。Objective To investigate the efficacy and feasibility of posterior scleral reinforcement for recurrent macular hole retinal detachment with silicone oil tamponade in severe highly myopic eyes. Methods A retrospective study of 36 patients（ 36 eyes） with recurrent macular hole retinal detachment with silicone oil tamponade in severe highly myopic eyes from June 2011 to June 2014 was performed. All patients were treated with modified posterior scleral reinforcement. All patients underw ent silicone oil removal at 3 months after the surgery,and were continuously follow ed for 12 months. The postoperative complication,macular hole heeling,anatomic retinal reattachment,best corrected visual acuity（ BC VA） and ocular axis length were observed. Results R etinal reattached completely in 36 eyes（ 100%）. SD-O C Trevealed that the macular holes in 22 eyes（ 61. 1%） were completely closed,11 eyes（ 30. 6%） were partly closed and 3 eyes（ 8. 3%） was not closed in the last visit. Postoperative BC VA improved in 31 eyes（ 86. 1%）,stabled in 5 eyes（ 13. 9%）; The mean preoperative BC VA was（ 1. 48 ±0. 92） log MAR,whereas mean postoperative BC VA was（ 0. 93 ± 0. 38） log MAR,the difference was statistically significant（ P 〈0. 05）. Preoperative ocular axis length was（ 30. 95 ± 1. 16） mm,whereas postoperative ocular axis length was（ 28. 46 ± 1. 34） mm,the difference was statistically significant（ P 〈0. 001）. There was no complications such as subretinal hemorrhage,vortex vein circumfluence obstacle and anterior ocular ischemia syndrome after surgery. Conclusion Posterior scleral reinforcement is a safe and effective operative method to treat recurrent macular hole retinal detachment with silicone oil tamponade in severe highly myopic eyes,can improve visual acuity,rate of the retinal anatomical reattachment and macular hole closure,and reduce the complications.

关 键 词：硅油填充 后巩膜加固术 超高度近视黄斑裂孔性视网膜脱离 

分 类 号：R774[医药卫生—眼科]