合并脉络膜脱离对高度近视黄斑裂孔性视网膜脱离手术预后的影响  

The impact of coexisting choroidal detachment on surgical prognosis in macular hole retinal detachment associated with high myopia

作　　者：才艺 赵明威[1] 梁建宏[1] 尹虹[1] 于文贞[1] 石璇[1] 曲进锋[1] 程湧[1] 侯婧[1] 苗恒[1] 金恩忠[1] Cai Yi;Zhao Mingwei;Liang Jianhong;Yin Hong;Yu Wenzhen;Shi Xuan;Qu Jinfeng;Cheng Yong;Hou Jing;Miao Heng;Jin Enzhong(Department of Ophthalmology,Peking University People's Hospital,Beijing Key Laboratory of Ocular Disease and Optometry Science,Beijing 100044,China)

机构地区：[1]北京大学人民医院眼科眼病与视光医学北京市重点实验室,北京100044

出　　处：《中华眼底病杂志》2025年第2期89-97,共9页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金青年项目(81800850);北京大学人民医院研究与发展基金(RDJP2022-41)。

摘　　要：目的观察合并脉络膜脱离的高度近视黄斑裂孔性视网膜脱离(MHRD)患者的临床特征,初步分析影响手术后裂孔闭合的相关因素。方法回顾性临床病例系列研究。2019年1月至2024年4月于北京大学人民医院眼科检查确诊的高度近视MHRD患者68例68只眼纳入本研究。其中,男性14例14只眼,女性54例54只眼;平均年龄(61.10±9.66)岁。患眼均接受玻璃体切割手术联合硅油或气体填充治疗。手术前后患眼均行最佳矫正视力(BCVA)、眼压、B型超声检查。BCVA检查采用Snellen视力表进行,统计时转换为最小分辨角对数(logMAR)视力。根据B型超声或手术中观察到的脉络膜脱离累及象限数定义脉络膜脱离范围,分为1~4个象限。在视网膜复位状态下测量眼轴长度(AL)。68例68只眼中,合并、未合并脉络膜脱离分别为17例17只眼、51例51只眼。合并脉络膜脱离17只眼中,脱离范围累及1、2、3、4个象限分别为1、2、2、12只眼。手术中填充13%C3F82只眼,均为未合并脉络膜脱离者;手术中填充硅油66只眼。根据是否合并脉络膜脱离,将患者分为未合并脉络膜脱离组、合并脉络膜脱离组。组间比较采用独立样本t检验、Welch双样本t检验或Mann-Whitney U检验。采用广义线性回归及logistic回归分析手术后裂孔未闭合者裂孔直径及手术后裂孔是否闭合与临床因素之间的关联。结果手术后3个月,患眼logMAR BCVA 1.29±0.43,手术前后差值为−1.60~0.70(−0.51±0.51)logMAR单位;AL为26.6~34.3(29.60±2.12)mm。68只眼中,裂孔未闭合、闭合分别为37(54.4%,37/68)、31(45.6%,31/68)只眼;裂孔未闭合眼的裂孔直径为(753±424)μm。未合并脉络膜脱离组、合并脉络膜脱离组患者年龄、病程、AL比较,差异无统计学意义(W=412.0、477.5、427.0,P>0.05)。手术前,与未合并脉络膜脱离组比较,合并脉络膜脱离组患眼BCVA更差(W=257.5)、眼压更低(t=4.051),差异均有统计学意义(P<0.05)。�Objective To investigate the clinical characteristics of patients with high-myopia macular hole retinal detachment(MHRD)combined with choroidal detachment and to preliminarily analyze factors associated with postoperative hole closure.Methods A retrospective clinical case series study.A total of 68 patients with high myopia(68 eyes)with MHRD diagnosed by Department of Ophthalmology,Peking University People’s Hospital from January 2019 to April 2024 were included in this study.Among them,there were 14 males(14 eyes)and 54 females(54 eyes).The mean age was(61.10±9.66)years.All eyes were treated with pars plana vitrectomy(PPV)combined with silicone oil or gas filling.Best corrected visual acuity(BCVA),intraocular pressure,and B-mode ultrasonography were performed.The BCVA test was performed using the Snellen visual acuity chart,which was statistically converted to logarithm of the minimum angle of resolution(logMAR)visual acuity.The range of choroidal detachment was defined according to the number of involved quadrants observed in B-mode ultrasound or surgery,which was divided into 1 to 4 quadrants.Axial length(AL)was measured under retinal reattachment.In 68 eyes,there were 17 eyes with choroidal detachment and 51 eyes without choroidal detachment,respectively.There were 17 eyes with choroidal detachment,and the detachment range involved 1,2,2 and 12 eyes in 1,2,3 and 4 quadrants,respectively.During operation,13%C3F8 was filled in 2 eyes,all of which were not complicated with choroidal detachment.66 eyes were filled with silicone oil.According to whether the patients were complicated with choroidal detachment,the patients were divided into the group without choroidal detachment and the group with choroidal detachment.Independent sample t test,Welch two-sample t test or Mann-Whitney U test were used for comparison between groups.Generalized linear regression and logistic regression were used to analyze the relationship between the aperture size of postoperative unclosed holes and the closed hole after surgery and

关 键 词：黄斑裂孔性视网膜脱离 脉络膜脱离 高度近视 玻璃体切除术 预后 

分 类 号：R779.6[医药卫生—眼科]