内界膜翻转填塞治疗高度近视黄斑裂孔性视网膜脱离的初步疗效分析  

The clinic outcomes of inverted internal limiting membrane flap for macular hole retinal detachment in highly myopic eyes

作　　者：孙光丽[1] 徐向忠[1] 沈轶[1] 姚进[1] 

机构地区：[1]南京医科大学附属医院眼科,210029

出　　处：《临床眼科杂志》2017年第3期231-234,共4页Journal of Clinical Ophthalmology

摘　　要：目的观察内界膜翻转填塞治疗高度近视黄斑裂孔视网膜脱离的初步疗效。方法接受23G微创玻璃体切除联合内界膜剥除的高度近视黄斑裂孔视网膜脱离的患者37例(38只眼)纳入研究。其中,成功施行玻璃体切除联合内界膜剥除及内界膜翻转填塞16只眼(内界膜填塞组),其余21例(22只眼)行常规玻璃体切除联合内界膜剥除手术(内界膜剥除组)。两组患者均行硅油填充。手术后随访时间3~6个月,平均随访时间4个月。对比分析两组患眼黄斑裂孔闭合率、最佳矫正视力(Log MAR视力)、视网膜复位情况。结果内界膜剥除组,术后3个月视网膜复位者20只眼占90.91%,黄斑裂孔闭合者7只眼占31.82%。内界膜填塞组,术后3个月视网膜复位者16只眼占100%,黄斑裂孔闭合者16只眼占100%;内界膜剥除组术眼Log MAR视力由术前的1.95±0.44增加到术后的1.57±0.46,内界膜填塞组由术前的1.98±0.39增加到术后的1.48±0.33。两组术后视网膜复位率比较,差异有统计学意义(χ~2=7.06,P<0.05)。两组裂孔闭合率比较,差异有统计学意义(χ~2=6.31,P<0.05)。内界膜剥除组及内界膜填塞组手术后Log MAR视力均较手术前明显提高,差异有统计学意义(t=4.02、4.43,P<0.05)。两组手术后Log MAR视力比较,差异无统计学意义(t=0.17,P>0.05)。结论高度近视黄斑裂孔视网膜脱离行内界膜反转填塞手术较单纯内界膜剥除,黄斑裂孔闭合率及视网膜复位率均高,但术后两组视力恢复无明显差异。Objective To assess the clinic outcomes of inverted internal limiting membrane （ ILM ） flap for macu- lar hole retinal detachment （MHRD） in highly myopic eyes. Methods A retrospective case series of 37 patients （ 38 eyes } with MHRD in highly myopic eyes who underwent 23G vitrectomy combined with internal limiting membrane peeling （ILMP） were included. 21patients （22 eyes） were performed PPV combined with ILM peeling （ILM peeling group）, the other 16patients （16eyes） were performed PPV combined with ILM peeling and ILM flap inverting （ILM inverting group）. The fallow-up was ranged from 3 to 6 months with an average of g months. The principal outcome measures were postopera- tive LogMAR vision, and the primary retinal reattachment rate and macular closure rate. Results In 3 months after sur- gery, the retinal reattachment rate was 90. 91% （20/22） in the ILM peeling group, and 100% （ 16/16 ） in the ILM inverting group. The macular hole closure rate was 31.82% （7/22） in the ILM peeling group, and 100% （16/16） in the ILM inverting group. The logMAR vision （ mean ± SD） improved from 1.95 ± 0.44 preoperatively to 1.57± 0. 46 postoperatively in the ILM peeling group, and 1.98 ± 0. 39 preoperatively tol. 48 ±0. 33 postoperatively in the ILM inverting group. Both groups had improved postoperative LogMAR vision compared with preoperation （ t =4.02,4.43, P 〈 0. 05 }. The difference of macular closure and retinal reattachment between these two groups was significant （χ^2 = 6.31,7.06, P 〈 0.05）. There was no significant difference about the postoperative LogMAR vision between the two groups （t = 0. 17, P 〉 0. 05）. Conclusion Vitrectomy combined with ILM Inverting group for highly myopic MHRD had a higher rate of both retinal reat- tachment and macular hole closure than vitrectomy combined with ILM peeling group, but the vision outcome had no signifi- cance.

关 键 词：玻璃体切除 高度近视 视网膜脱离 黄斑裂孔 

分 类 号：R779.6[医药卫生—眼科]