玻璃体切除联合内界膜剥除术治疗高度近视黄斑劈裂临床研究  

Clinical study on the treatment of vitrectomy with internal limiting membrane peeling for macular retinoschisis in highly myopic eyes

作　　者：殷志博[1] 闵思[1] 魏玉华[1] 郝玉华[1] 叶存喜[1] 

机构地区：[1]河北医科大学第二医院,河北省石家庄市050000

出　　处：《中国实用眼科杂志》2016年第10期1043-1048,共6页Chinese Journal of Practical Ophthalmology

摘　　要：【摘要】目的观察玻璃体切除联合内界膜剥除术治疗高度近视黄斑劈裂的治疗效果，比较手术前、后黄斑结构和功能变化。方法临床病例对照研究。收集2009年10月至2013年6月就诊于河北医科大学第二医院的高度近视黄斑劈裂患者24例31只眼，并将其分为2组：同意接受手术治疗的设为手术组（17只眼）；不同意接受手术治疗，接受定期随访观察的设为对照组（14只眼）。其中手术组的患者接受标准三通道经睫状体平坦部玻璃体切除术联合内界膜剥除术。分别比较手术组术前术后、对照组观察至少3个月后的最佳矫正视力、黄斑区视网膜劈裂的最高值、多焦视网膜电图的b波振幅和三维地形图的变化。手术组术前术后及对照组随访期前后的BCVA的比较采用配对t检验，MxFT、b波振幅的比较采用Wilcoxon符号秩检验。结果最佳矫正LogMAR视力：手术组术后较术前明显改善，对照组末次随访与初诊时比较视力下降。黄斑区视网膜劈裂最高值：手术组术后视网膜劈裂高度较术前显著下降，对照组末次随访与初诊时比较视网膜劈裂高度增加。mfERG：手术组术后b波振幅较术前明显提高，术后大部分患者三维地形图示中央峰较术前逐渐增高，位于旁中心凹区域的低反应区变少或消失。对照组末次随访与初诊时比较b波振幅明显下降，三维地形图显示大部分患者末次随访较初诊时中央峰减低，旁中心凹区域不规则低反应区增加。并发症：手术组术中未造成医源性裂孔，术后均未发生眼内炎或眼内出血等严重并发症，术后有1只眼发生了周边视网膜裂孔，导致视网膜脱离，遂行玻璃体切除联合硅油填充术，半年后行眼内硅油取出术，视网膜在位。对照组中有2只眼在随访过程中出现黄斑裂孔。结论玻璃体切除联合内界膜剥除术治疗高度近视黄斑劈裂，能够使劈裂的�Objective To survey the efficacy of vitrectomy with internal limiting membrane peel- ing for macular retinoschisis in highly myopic eyes, to compare the changes of the macular struc- ture and function before and after the vitrectomy. Methods From October 2009 to June 2013, a to- tal of 24 highly myopic patients （31 eyes） who were diagnosed as macular retinoschisis were collect- ed. The cases were divided into 2 groups： 17 eyes received surgical treatment （operation group） and 14 eyes did not receive surgical treatment, just received regular follow-up observation （control group）. Patients in operation group underwent standard 3-port pars planavitrectomy （PPV） combined with internal limiting membrane peeling （ILMP）. Before and after the surgery and the follow-up, the best corrected visual acuity （BCVA） were obtained and compared by the paired t-test, while the max- imum foveal thickness （MxFT） and the respond densities of wave b of multifocal electroretinogram （mIERG） were compared by the Wilcoxon signed-rank test. Results Best Corrected Visual Acuity： Postoperative BCVA was better than the preoperative significantly in the operation group while the BCVA of the last follow-up was worse than the first visit in the control group. Maximum Foveal Thickness： The MxFT was significantly decreased after surgery in the operation group while that of the last follow-up was increased compared with the first visit in the control group, mfERG： The postoperative respond densities of wave b was higher than the preoperative in the operation group. After the surgery, the central peaks of topographies recoveredgradually, and the irregular low reac- tion regions which in the parafoveal were decreased or disappeared. The respond densities of wave b of the last follow-up were lower than the first visit in the control group. The central peaks of to- pographies of the last follow-up were decreased and the irregular low reaction regions in the parafo- veal were increased. Complications： In the oper

关 键 词：高度近视 黄斑劈裂 玻璃体切除术 内界膜剥除 多焦视网膜电图 

分 类 号：R779.6[医药卫生—眼科]