玻璃体切割联合内界膜剥除和气体填充手术治疗高度近视黄斑劈裂的疗效观察  

The efficacy of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade in the treatment of myopic macular retinosehisis

作　　者：陶继伟 俞雪婷 沈丽君 陈亦棋 张赟 林丽 吴韩飞 

机构地区：[1]温州医科大学附属眼视光医院杭州院区,310020

出　　处：《中华眼底病杂志》2018年第2期111-115,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：浙江省医药卫生科技计划项目（KYB208）

摘　　要：目的 观察玻璃体切割手术（PPV）联合内界膜（ILM）剥除和气体填充治疗高度近视黄斑劈裂（MF）的疗效。 方法 回顾性病例系列研究。接受PPV联合ILM剥除和气体填充治疗的连续高度近视MF患者35例36只眼纳入研究。其中，男性5例5只眼，女性30例31只眼；平均年龄（60.13±10.00）岁。所有患眼均行最佳矫正视力（BCVA）、屈光度、频域光相干断层扫描检查以及眼轴长度（AL）测量。根据患眼MF频域OCT影像特征将其分为单纯MF组（A组）、MF伴中心凹脱离组（B组）、MF伴板层黄斑裂孔（MH）组（C组），分别为10、12、14只眼。3组患者之间年龄、性别构成比、等效球镜度数、AL比较，差异均无统计学意义（F=0.020、0.624、0.009、0.195，P＞0.05）；最小分辨角对数（logMAR）BCVA、黄斑中心凹视网膜厚度（CFT）比较，差异均有统计学意义（F=11.100、41.790，P＜0.05）。采用经睫状体平坦部三切口23G PPV联合ILM剥除，气液交换后，填充12% C3F8或空气。手术后随访时间＞1年。观察末次随访时患眼BCVA和黄斑中心凹结构情况；对比分析不同类型MF之间疗效差异。 结果 末次随访时，36只眼平均logMAR BCVA、CFT分别为0.40±0.44和（213.35±97.58）μm。与手术前比较，差异均有统计学意义（t=5.984、5.113，P＜0.001）。MF愈合33只眼。A、B、C组患眼平均logMAR BCVA分别为0.13±0.10、0.73±0.33、0.38±0.52；平均CFT分别为（222.40±57.16）、（212.50±150.45）、（206.67±55.97）μm；MF愈合分别为10、11、12只眼；黄斑区椭圆体带完整分别为8、2、12只眼。B组患眼logMAR BCVA低于A、C组，差异有统计学意义（F=6.750，P=0.003）；平均CFT比较，组间差异无统计学意义（F=0.068，P=0.935）；MF愈合率比较，组间差异无统计学意义（χ^2=1.558，P=0.459）；B组患眼椭圆体带完整率最低，组间差异有统计学意义（χ^2=18.590，P＜0.001）。C组Objective To observe the ef？cacy of pars plana vitrectomy with internal limiting membrane （ILM） peeling and gas tamponade in the treatment of myopic macular retinoschisis （MF）. Methods This is a retrospective case study. A total of 35 MF patients （36 eyes） were enrolled in this study. There were 5 males （5 eyes） and 30 females （31 eyes）, with an average age of （60.13±10.00） years. All patients were examined for best corrected visual acuity （BCVA）, diopter, optical coherence tomography （OCT） and axial length. The patients were divided into a MF group （group A, 10 eyes）, MF with foveal detachment group （group B, 12 eyes） and MF with lamellar macular hole group （group C, 14 eyes） according to the OCT characteristics. There was no difference of age, gender, spherical equivalent refraction and axial length among 3 groups （F=0.020, 0.624, 0.009, 0.195; P〉0.05）. There were significant differences of the minimum resolution angle logarithm （logMAR） BCVA and central fovea thickness （CFT） （F=11.100, 41.790; P〈0.05）. All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade. The follow-up was more than one year. The BCVA and macular structure at the final follow-up were analyzed. The efficacy between 3 forms of MF was compared. Results At the final follow-up, the BCVA was 0.40±0.44 and CFT was （213.35±97.58） μm, which were significantly improved compared with preoperative measurements （t=5.984, 5.113; P〈0.001）. MF was resolved in 33 eyes. In group A, B and C, the logMAR BCVA were 0.13±0.10, 0.73±0.33 and 0.38±0.52, respectively; CFT was （222.40±57.16）, （212.50±150.45）, （206.67±55.97） μm, respectively; MF was resolved in 10, 11 and 12 eyes, respectively; complete ellipsoid was observe in 8, 2 and 12 eyes. The logMAR BCVA （F=6.750, P=0.003） and the rate of complete ellipsoid （χ^2=18.590, P〈0.001） in group B was lower than group A and C, the differences were significant. There was no difference of

关 键 词：视网膜劈裂症/外科学 近视 退行性/并发症 玻璃体切除术 

分 类 号：R774.5[医药卫生—眼科] R778.11[医药卫生—临床医学]