玻璃体切割联合不同术式治疗高度近视黄斑裂孔性视网膜脱离的疗效及对视觉相关生存质量的影响比较  

Effect of vitrectomy combined with different surgical procedures on macular hole retinal detachment in high myopia and its effect on visual related quality of life

作　　者：马成 茅彦 孟泽兰 马英鹏 曹金芳 马雅玲[2] MA Cheng;MAO Yan;MEHG Ze-lan(Department of Ophthalmology,942 Hospital of PLA,Yinchuan Ningxia 750004,China)

机构地区：[1]宁夏银川市解放军第942医院眼科,宁夏银川750004 [2]宁夏医科大学总医院眼科,宁夏银川750004

出　　处：《临床和实验医学杂志》2022年第10期1099-1102,共4页Journal of Clinical and Experimental Medicine

基　　金：宁夏自治区健康系统课题(编号:2019-NW-002)。

摘　　要：目的探讨玻璃体切割联合联合内界膜剥除术或内界膜覆盖术治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效及对视觉相关生存质量的影响。方法回顾性收集2015年1月至2020年6月在宁夏银川市解放军第942医院诊治的76例MHRD患者,按手术方式不同分组,其中40例(40只眼)行玻璃体切割联合内界膜剥除术(剥除组),36例(36只眼)行玻璃体切割联合内界膜覆盖术(覆盖组)。比较两组末次随访时黄斑裂孔闭合情况、最佳矫正视力(BCVA)和视觉相关生存质量表(CVRQOL-25)评分。结果末次随访时,覆盖组黄斑裂孔完全闭合率为88.89%,显著高于剥除组(15.00%),差异有统计学意义(P<0.05)。覆盖组视网膜再脱离发病率为5.56%,低于剥除组(15.00%),但差异无统计学意义(P>0.05)。末次随访时,两组患眼BCVA均和CVRQOL-25评分均显著提高,且覆盖组BCVA和CVRQOL-25评分为1.05±0.3、(75.68±8.97)分,均显著优于剥除组[21.24±0.39、(1.25±9.36)分],差异均有统计学意义(P<0.05)。两组均无严重并发症。结论与内界膜剥除术相比,玻璃体切割联合内界膜覆盖术可提高黄斑裂孔完全闭合率,一定程度上减少视网膜再脱离发生,并可提高术后视力,改善视功能相关生存质量。Objective To investigate the effect of vitrectomy combined with internal limiting membrane peeling or inverted internal limiting membrane in the treatment of macular hole retinal detachment(MHRD)in high myopia and its effect on visual related quality of life.Methods A total of 76 patients with MHRD who were diagnosed and treated in 942 Hospital of PLA from January 2015 to June 2020 were retrospectively collected and divided into groups according to different surgical methods.Among them,40 cases(40 eyes)were treated with vitrectomy combined with internal limiting membrane peeling(peeling group),and 36 cases(36 eyes)were treated with vitrectomy combined with internal limiting membrane capping(capping group).The macular hole closure,best corrected visual acuity(BCVA)and visual-related quality of life(CVRQOL-25)scores were compared between the two groups at the last follow-up.Results At the last follow-up,the complete closure rate of macular hole in the capping group was 88.89%,which was significantly higher than that in the peeling group(15.00%),and the difference was statistically significant(P<0.05).The incidence of retinal detachment in the capping group was 5.56%,which was lower than that in the peeling group(15.00%),but the difference was not statistically significant(P>0.05).At the last follow-up,the BCVA and CVRQOL-25 scores of the two groups were significantly improved(P<0.05).The BCVA and CVRQOL-25 scores in the capping group were 1.05±0.3,(75.68±8.97)points,which were significantly better than those in the peeling group[21.24±0.39,(1.25±9.36)points],and the differences were statistically significant(P<0.05).There were no serious complications in both groups.Conclusion Compared with internal limiting membrane peeling,vitrectomy combined with internal limiting membrane capping can improve the complete closure rate of macular hole,reduce the occurrence of retinal detachment to some extent,and improve postoperative visual acuity and visual function related quality of life.

关 键 词：近视 黄斑裂孔 视网膜脱离 玻璃体切割 内界膜剥除术 内界膜覆盖术 

分 类 号：R779.6[医药卫生—眼科]