后巩膜葡萄肿边缘视网膜激光光凝在高度近视黄斑裂孔性视网膜脱离玻璃体切割手术中的应用  

Clinical observation of posterior staphyloma marginal retinal photocoagulation in vitrectomy for macular hole retinal detachment in high myopia

作　　者：何广辉 田歌 陈松 武斌 董蒙 张笑天 王梦 吴冠男 He Guanghui;Tian Ge;Chen Song;Wu Bin;Dong Meng;Zhang Xiaotian;Wang Meng;Wu Guannan(Tianjin Eye Hospital,Tianjin Key Lab of Ophthalmology and Visual Science,Tianjin Eye Institute,The Ophthalmic Clinical College of Tianjin Medical University,Tianjin 300020,China)

机构地区：[1]天津市眼科医院,天津医科大学眼科临床学院,天津市眼科学与视觉科学重点实验室,天津市眼科研究所,300020

出　　处：《中华眼底病杂志》2021年第4期271-276,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：天津市眼科医院科技基金(YKZD1901)。

摘　　要：目的观察伴有后巩膜葡萄肿(PS)的高度近视黄斑裂孔性视网膜脱离(MHRD)患眼玻璃体切割手术(PPV)中PS边缘视网膜激光光凝的临床疗效。方法2017年1月至2019年6月于天津市眼科医院住院接受PPV治疗的伴有PS的MHRD患者49例49只眼纳入研究。其中,男性13例13只眼,女性36例36只眼。所有患眼均行最佳矫正视力(BCVA)、光相干断层扫描检查。BCVA检查采用标准对数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。采用随机数余数分组法将患眼随机分为PS边缘视网膜激光组(激光组)、常规手术组(常规组),分别为25、24只眼。常规组、激光组患眼logMAR BCVA分别为1.87±0.28、1.80±0.37,差异无统计学意义(t=0.604,P=0.551)。常规组患眼行23G PPV,手术中曲安奈德染色,剥除视网膜前膜,吲哚青绿辅助染色,剥除后极部黄斑区内界膜(ILM),手术中详查周边部视网膜,如存在视网膜变性区则行激光光凝加固,经黄斑裂孔排出视网膜下液后硅油填充。激光组患眼除按照常规组手术步骤进行外,于PS边缘行视网膜激光光凝2~3排。手术后平均随访时间(8.34±3.21)个月。观察视网膜复位率、黄斑裂孔闭合率、BCVA以及两组患眼的手术次数。计数资料比较采用χ^(2)检验或Fisher确切概率;计量资料比较采用独立样本t检验。结果首次手术后,常规组、激光组患眼视网膜复位分别为17(70.8%,17/24)、24(96.0%,24/25)只眼;激光组患眼视网膜复位率高于常规组,差异有统计学意义(χ^(2)=3.984,P=0.046)。末次随访时,两组患眼视网膜均复位。常规组、激光组患眼黄斑裂孔闭合分别为15(62.5%,15/24)、19(76.0%,19/25)只眼;两组患眼黄斑裂孔闭合率比较,差异无统计学意义(χ^(2)=1.051,P=0.305)。常规组、激光组患眼logMAR BCVA分别为1.20±0.47、1.08±0.39;与手术前logMAR BCVA比较,差异均有统计学意义(t=2.899、5.327,P=0.001、0.000);两组患眼间logMAR BCVA比较,差�Objective To observe the outcome of posterior staphyloma(PS)marginal retinal photocoagulation in pars plana vitrectomy(PPV)for high myopia macular hole retinal detachment eyes accompanied with PS.Methods From January 2017 to June 2019,49 patients(49 eyes)with high myopia macular hole retinal detachment accompanied with PS who were undergone PPV operation from Tianjin Eye Hospital were included in this study.There were 13 males(13 eyes)and 36 females(36 eyes).All patients underwent best corrected visual acuities(BCVA)and optical coherence tomography examinations.The standard logarithmic visual acuity chart was used for BCVA examination,and the visual acuity was converted to minimum resolution angle in logarithmic(logMAR)when recorded.The patients were randomly divided into two groups according to surgical options:conventional PPV with internal limiting membrane(ILM)peeling(group A,24 eyes),PS marginal retinal photocoagulation in PPV with ILM peeling(group A,25 eyes).The mean preoperative logMAR BCVA of group A and B were 1.87±0.28 and 1.80±0.37,the difference was not statistically significant(t=0.604,P=0.551).The patients in the group A received 23G PPV,triamcinolone acetonide staining during the operation,the epiretinal membrane was peeled off,indocyanine green assisted staining,the posterior macular ILM was peeled off,and the peripheral retina was examined in detail during the operation.Areas with retinal degeneration were reinforced by laser photocoagulation,and the subretinal fluid was drained through the macular hole and filled with silicone oil.The eyes of the group B were subjected to retinal photocoagulation for 2 to 3 rows at the edge of the PS in addition to the usual surgical procedures.The average follow-up time was 8.34±3.21 months.Surgical outcome were estimated by the average number of operation,retinal reattachment rate,macular hole closure rate and BCVA.Theχ^(2) test or Fisher exact probability was used to compare the count data.Independent sample t test was used to compare the measurement dat

关 键 词：近视 退行性 视网膜穿孔 视网膜脱离 激光凝固术 玻璃体切除术 

分 类 号：R779.6[医药卫生—眼科]