玻璃体切割联合内界膜覆盖与剥除手术治疗高度近视黄斑裂孔性视网膜脱离的疗效比较  

Inverted internal limiting membrane versus internal limiting membrane peeling for macular hole retinal detachment in high myopia

作　　者：侯亚南 刘磊 王刚 刘勇 王一 Hou Yanan;Liu Lei;Wang Gang;Liu Yong;Wang Yi(Chongqing Aier Eye Hospital,Aier School of Ophthalmology,Central South University,Chongqing 400038,China)

机构地区：[1]中南大学爱尔眼科学院,重庆爱尔眼科医院,400038

出　　处：《中华眼底病杂志》2020年第12期943-947,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的对比观察玻璃体切割(PPV)联合内界膜(ILM)剥除和ILM覆盖手术治疗高度近视黄斑裂孔性视网膜脱离的疗效。方法回顾性临床研究。2012年10月至2019年1月于重庆爱尔眼科医院和合肥爱尔眼科医院检查确诊的高度近视黄斑裂孔性视网膜脱离患者78例78只眼纳入研究。其中,男性11例11只眼,女性67例67只眼;平均年龄(55.6±9.6)岁。患者均行BCVA、屈光度、OCT检查以及眼轴长度(AL)测量。采用标准对数视力表行BCVA检查,记录时换算为logMAR视力。根据手术方式将患者分为PPV联合ILM剥除组(ILM剥除组)和PPV联合ILM覆盖组(ILM覆盖组),分别为51例51只眼、27例27只眼。两组患者平均年龄(t=-1.170)、屈光度(t=0.504)、AL(t=0.474)、logMAR BCVA(t=0.935)、裂孔直径(t=-0.334)比较,差异均无统计学意义(P>0.05)。2个组患眼手术前后BCVA、RPE裸露距离比较采用两独立样本t检验;2个组间率的比较采用χ^2检验。结果末次随访时,ILM覆盖组、ILM剥除组患眼logMAR BCVA分别为0.87±0.27、1.45±0.39。与手术前比较,两组患眼BCVA均明显提高,差异有统计学意义(t=8.790、4.640,P<0.001、<0.001);两组患眼间logMAR BCVA比较,差异有统计学意义(t=6.830,P<0.001)。ILM覆盖组、ILM剥除组患眼RPE裸露距离分别为(31.81±23.52)、(681.80±466.61)μm;2个组患眼RPE裸露距离比较,差异有统计学意义(t=7.180,P<0.001)。ILM覆盖组27只眼裂孔均愈合(100%,27/27);均未发生视网膜再次脱离。ILM剥除组51只眼中,裂孔愈合45只眼(88.2%,45/51),视网膜再脱离6只眼(11.8%,6/51)。2个组患眼视网膜再脱离发生率比较,差异有统计学意义(χ^2=45.440,P=0.000)。结论与PPV联合ILM剥除比较,ILM覆盖手术患眼BCVA提高更多,视网膜再脱离发生率更低以及更好地保护RPE。Objective To compare the efficacy of pars plana vitrectomy(PPV)combined inverted internal limiting membrane(ILM)with PPV combined ILM peeling for macular hole retinal detachment(MHRD)in high myopia.Methods A retrospective clinical study.From October 2012 to January 2019,78 patients(78 eyes)with high myopia macular hole retinal detachment diagnosed from Chongqing Aier Eye Hospital and Hefei Aier Eye Hospital were included in the study.Among them,there were 11 males(11 eyes)and 67 females(67 eyes)with the average age of 55.6±9.6 years.All patients underwent BCVA,diopter,OCT examination and axial length(AL)measurement.The standard logarithmic visual acuity chart was used for BCVA examination,and the visual acuity was converted to logMAR when recorded.Patients were divided into PPV combined with ILM peeling group(ILM peeling group)and PPV combined with ILM inverted group(ILM inverted group)according to the surgical method,with 51 patients(51 eyes)and 27 patients(27 eyes),respectively.The average age(t=-1.170),diopter(t=0.504),AL(t=0.474),logMAR BCVA(t=0.935),and hole diameter(t=-0.334)of the two groups were compared,and there was no statistically significant difference(P>0.05).Two independent sample t test was used to compare the exposed distance of BCVA and RPE before and after the operation of the two groups of eyes.Theχ2 test was used to compare the rates between the two groups.Results At the last follow-up,the logMAR BCVA of the eyes in the ILM inverted group and ILM peeling group were 0.87±0.27 and 1.45±0.39,respectively.Compared with pre-operation,the BCVA of the two groups of eyes were significantly improved,and the difference was statistically significant(t=8.790,4.640,P<0.001,<0.001).The logMAR BCVA of the two groups of eyes was compared with statistical significance(t=6.830,P<0.001).The exposed RPE distances of the eyes in the ILM inverted group and the inner limiting membrane peeling group were 31.81±23.52 and 681.80±466.61μm,respectively.the difference in the RPE exposure distance between the two g

关 键 词：高度近视 视网膜穿孔 视网膜脱离 内界膜剥除 内界膜覆盖 

分 类 号：R779.6[医药卫生—眼科]