黄斑兜带手术治疗高度近视牵拉性黄斑病变4年疗效观察  

Four-year outcomes of macular buckling for traction maculopathy in highly myopic eyes

作　　者：宋慧莹 刘炳乾[1] 马伟[1] 赵秀娟[1] 吕林[1] Song Huiying;Liu Bingqian;Ma Wei;Zhao Xiujuan;Lyu Lin(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangdong Provincial Clinical Research Center for Ocular Diseases,Guangzhou 510060,China)

机构地区：[1]中山大学中山眼科中心,眼科学国家重点实验室,广东省眼科视觉科学重点实验室,广东省眼部疾病临床医学研究中心,广州510060

出　　处：《中华眼底病杂志》2022年第6期503-509,共7页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察黄斑兜带手术(MB)治疗高度近视牵拉性黄斑病变的长期疗效及安全性。方法回顾性临床研究。2014年1月至2017年12月于中山大学中山眼科中心行MB治疗的高度近视牵拉性黄斑病变患者57例57只眼纳入研究。其中,男性15例15只眼,年龄(51.80±10.72)岁;女性42例42只眼,年龄(59.14±11.51)岁。高度近视黄斑裂孔合并黄斑脱离(MHMD)21例21只眼,高度近视黄斑劈裂合并黄斑脱离(FSMD)36例36只眼,并据此分组。患者均行最佳矫正视力(BCVA)、光相干断层扫描检查以及眼轴长度(AL)测量。采用标准对数视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力。患眼均行MB治疗,对于存在明显的玻璃体黄斑牵拉的患眼,联合后入路玻璃体切割手术。手术后1、3、6个月及1、2、3、4年采用手术前相同设备和方法行相关检查,观察两组患眼的长期疗效和安全性。结果手术前,MHMD组、FSMD组患眼logMAR BCVA分别为1.35±0.47.1.17±0.59;手术后4年,分别为1.02±0.49.0.73±0.55.两组患眼手术前、手术后4年logMAR BCVA比较,差异均有统计学意义(P=0.039、0.001),MHMD组患眼手术后3年起BCVA较手术前显著提高(P=0.042);FSMD组患眼手术后3个月起BCVA较手术前显著提高(P=0.013)。手术后4年,MHMD组患眼黄斑脱离均复位(100.0%,21/21);裂孔闭合14只眼(66.7%,14/21).FSMD组患眼黄斑脱离复位、劈裂恢复均为35只眼(97.2%,35/36).手术后,黄斑区出现脉络膜新生血管2只眼;黄斑区视网膜内囊泡3只眼。结论MB治疗高度近视牵拉性黄斑病变长期疗效、安全性均较好。Objective To observe the long-term efficacy and safety of macular buckling(MB)in the treatment of high myopia traction maculopathy.Methods A retrospective clinical study.From January 2014 to December 2017,57 eyes of 57 patients with high myopia traction maculopathy who underwent MB treatment at Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study.Among them,there were 15 males with 15 eyes,average age was 51.80±10.72 years;there were 42 females with 42 eyes,average age was 59.14±11.51 years.There were 21 eyes of 21 cases with highly myopic macular hole with macular detachment(MHMD),and 36 eyes in 36 cases with highly myopic foveoschisis with macular detachment(FSMD),and they were grouped accordingly.All patients underwent best corrected visual acuity(BCVA),optical coherence tomography(OCT),and axial length(AL)measurements.The standard logarithmic visual acuity chart was used for BCVA examination,which was converted into logarithm of the minimum angle of resolution(logMAR)visual acuity during statistics.All patients underwent MB,either on its own or combined with vitrectomy.Patients with significant vitreous macular traction on OCT were treated with combined surgery.One,3,6 months and 1,2,3,and 4 years after the operation,the same equipment and methods before the operation were used to conduct related examinations,and the long-term efficacy and safety of the two groups of eyes were observed.Results Before surgery,the logMAR BCVA of eyes in MHMD group and FSMD group were 1.35±0.47 and 1.17±0.59,respectively;4 years after surgery,they were 1.02±0.49 and 0.73±0.55,respectively.The BCVA improved significantly at postoperative 4 years than preoperative in both groups(P=0.039,0.001).In the eyes with MHMD,the BCVA was found to be significant improved 3 years after surgery(P=0.042).Whereas,in the eyes with FSMD,the BCVA was found to be significantly improved 3 months after surgery(P=0.013).Macular reattachment was achieved in 100%of cases,while macular hole closure rate was achieved in 66

关 键 词：近视 退行性 黄斑劈裂 黄斑裂孔 黄斑兜带手术 

分 类 号：R779.6[医药卫生—眼科]