玻璃体切割联合内界膜填塞手术治疗高度近视黄斑裂孔性视网膜脱离疗效观察  

Clinical efficacy of vitrectomy combined with internal limiting membrane tamping on macular hole and retinal detachment in high myopia

作　　者：黄志坚 陈晓 洪玲 晏颖 曾苗 

机构地区：[1]解放军武汉总医院全军眼科中心,430070

出　　处：《中华眼底病杂志》2017年第4期350-353,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察玻璃体切割（PPV）联合内界膜（ILM）填塞手术治疗高度近视黄斑裂孔性视网膜脱离（MHRD）的疗效和安全性。方法回顾性非随机临床研究。经眼底、眼底彩色照相、光相干断层扫描、B型超声检查确诊的高度近视MHRD患者23例23只眼纳入研究。其中，男性5例5只眼，女性18例18只眼。平均年龄（62.35±8.28）岁。平均病程1.1个月。平均最小分辨角对数（logMAR）最佳矫正视力（BCVA）2.31±0.72。平均眼轴长度（28.66±1.99）mm。均接受标准经睫状体平坦部三通道23G PPV。手术中切除玻璃体后皮质膜后，吲哚青绿辅助染色黄斑区ILM，将裂孔周围部分ILM反折填塞至裂孔中，手术完毕时C3F8或硅油眼内填充。其中，C3F8填充5只眼；硅油填充18只眼。硅油填充者手术后3个月取出硅油。手术后随访6个月，观察手术后BCVA变化、裂孔闭合、视网膜复位情况。以手术中和手术后眼部及全身不良反应作为安全性评价指标，观察相应并发症发生情况。结果手术后6个月，患眼logMAR BCVA为1.13±0.38；与手术前logMAR BCVA比较，差异有统计学意义（t=15.33，P=0.00）。所有患眼裂孔均闭合，视网膜解剖复位；裂孔闭合、视网膜脱离复位率均为100.0%。所有患者手术中及手术后均未见明显眼部或全身不良反应。结论PPV联合ILM填塞手术治疗MHRD可提高患眼裂孔闭合率，改善视力；治疗高度近视MHRD安全有效。ObjectiveTo evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane （ILM） tamping on macular hole and retinal detachment （MHRD） in highly myopic eyes.Methods23 patients （23 eyes） were retrospectively reviewed, who were diagnosed as MHRD through examination of the ocular fundus, optic coherence tomography （OCT） and B-mode ultrasonography. There were 5 males （5 eyes） and 18 females （18 eyes）. The mean age was （62.35±8.28） years. The mean course of disease was 1.1 months. The logarithm of the minimum angle of resolution （logMAR） best-corrected visual acuity （BCVA） was 2.31±0.72. The mean axial length was （28.66±1.99） mm. All patients underwent 23G micro-incision vitrectomy. After vitreous gel and cortex were gently resected, the ILM around the edges of the macular hole was stained with indocyanine green, and was folded and pushed to fill the macular hole gently. Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes, respectively. The silicone oil was removed after 3 months. The follow-up was 6 months. The BCVA, macular hole closure, retinal anatomical reattachment were retrospectively observed, and were used to evaluate the safety and effectiveness of the surgery.ResultsAt the 6 months after surgery, the logMAR BCVA was improved to 1.13±0.38, the difference was significant （t=15.33, P=0.00）. The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100%. There were no ocular or systemic adverse events observed in all patients.ConclusionVitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.

关 键 词：视网膜穿孔/外科学 视网膜脱离/外科学 近视  退行性/并发症 玻璃体视网膜手术 

分 类 号：R779.6[医药卫生—眼科]