内界膜翻转覆盖与内界膜多层填塞治疗高度近视黄斑裂孔性视网膜脱离的疗效对比观察  

Comparison of inverted internal limiting membrane flap and internal limiting membrane multilayer tamponade techniques in the treatment of highly myopic macular hole-associated retinal detachment

作　　者：潘奕吉 杨家翼 易贝茜 李璐[1] 苏钰[1] 贺涛[1] Pan Yiji;Yang Jiayi;Yi Beiqian;Li Lu;Su Yu;He Tao(Eye Center,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院眼科中心,武汉430000

出　　处：《中华眼底病杂志》2023年第12期964-968,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的对比观察内界膜(ILM)翻转覆盖与ILM多层填塞治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。方法回顾性临床研究。2019年11月至2022年6月于武汉大学人民医院眼科中心检查确诊的连续MHRD患者53例53只眼纳入研究。其中,男性21例21只眼,女性32例32只眼;年龄(55.28±11.40)岁。根据手术方式将患者分为ILM覆盖组(2019年11月至2020年9月)、ILM多层填塞组(2020年10月至2022年6月),分别为11例11只眼、42例42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检查采用国际标准视力表进行,统计时换算为最小分辨角对数(logMAR)视力。患眼均接受标准经睫状平坦部三通道23G玻璃体切割手术。ILM覆盖组联合行上方ILM翻转覆盖;ILM多层填塞组联合行保留黄斑区ILM的环形ILM剥离,并将裂孔周围的ILM翻转行多层ILM填塞。手术后随访时间≥6个月。随访时采用与手术前相同的设备和方法行相关检查。观察患眼BCVA以及裂孔闭合、视网膜复位、黄斑区增生情况。结果ILM覆盖组11只眼中,手术后1周时,裂孔闭合7只眼;1个月时,所有患眼裂孔均闭合;6个月时,裂孔闭合9只眼,裂孔再次开放2只眼。ILM多层填塞组42只眼中,手术后1周及1、6个月时,裂孔闭合41只眼;裂孔未闭合1只眼。手术后6个月时,ILM覆盖组、ILM多层填塞组患眼BCVA分别为0.91±0.29、1.05±0.39;两组BCVA比较,差异无统计学意义(t=1.140,P=0.260);与手术前比较,两组患眼BCVA均明显改善,差异有统计学意义(t=8.490、13.840,P<0.0001)。手术后6个月时,ILM覆盖组11只眼中,视网膜复位10只眼;所有患眼均未见明显黄斑区增生。ILM多层填塞组42只眼视网膜均复位,其中明显黄斑区增生19只眼。结论ILM翻转覆盖或ILM多层填塞均有助于高度近视MHRD患眼裂孔闭合,改善视力。与ILM翻转覆盖比较,ILM多层填塞手术后裂孔闭合时间更早且闭合率更高,裂孔再次开放Objective To compare the efficacy of internal limiting membrane(ILM)flip coverage with ILM multilayer tamponade in the treatment of highly myopic macular hole-associated retinal detachment(MHRD).Methods A retrospective clinical study.From November 2019 to June 2022,53 cases and 53 eyes of MHRD patients who were examined and diagnosed at the Eye Centre of Renmin Hospital of Wuhan University were included in the study.Among them,21 cases and 21 eyes were male and 32 cases and 32 eyes were female.The age was(55.28±11.40)years.The patients were categorized into two groups:the ILM coverage group(from November 2019 to September 2020)and the ILM multilayer tamponade group(from October 2020 to June 2022)based on their surgical procedures.The ILM coverage group comprised of 11 cases involving 11 eyes,while the ILM multilayer tamponade group comprised of 42 cases involving 42 eyes.Best-corrected visual acuity(BCVA)and optical coherence tomography were conducted.BCVA was measured using standardized international visual acuity charts and transformed to logarithmic minimum angle of resolution(logMAR)visual acuity for statistical analysis.The affected eyes were all treated with standard transciliary flattening three-channel 23-gauge vitrectomy.The inverted ILM flap technique was combined with flap coverage in the inverted group,while the ILM multilayer tamponade group used circular ILM stripping to preserve the ILM in the macular area and ILM flap around the macular hole with multilayer ILM tamponade.Postoperative follow-up was carried out for a minimum of 6 months.Relevant examinations were conducted during the follow-up using the same equipment and methods as those used before surgery.The BCVA,as well as the closure of macular hole,resurfacing of the retina,and development of macular hyperplasia,were observed.Results In the ILM-covered group,the macular hole was closed in 7 out of 11 eyes after 1 week of surgery.At 1 month after surgery,the macular hole was closed in all treated eyes.At 6 months after surgery,the macular ho

关 键 词：高度近视 黄斑裂孔性视网膜脱离 内界膜翻转覆盖 内界膜多层填塞 

分 类 号：R779.6[医药卫生—眼科]