中华眼底病杂志

中华眼底病杂志

玻璃体切割联合内界膜填塞手术治疗高度近视黄斑裂孔性视网膜脱离疗效观察

查看全文

目的观察玻璃体切割(PPV)联合内界膜(ILM)填塞手术治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效和安全性。方法回顾性非随机临床研究。经眼底、眼底彩色照相、光相干断层扫描、B型超声检查确诊的高度近视MHRD患者23例23只眼纳入研究。其中,男性5例5只眼,女性18例18只眼。平均年龄(62.35±8.28)岁。平均病程1.1个月。平均最小分辨角对数(logMAR)最佳矫正视力(BCVA)2.31±0.72。平均眼轴长度(28.66±1.99)mm。均接受标准经睫状体平坦部三通道23G PPV。手术中切除玻璃体后皮质膜后,吲哚青绿辅助染色黄斑区ILM,将裂孔周围部分ILM反折填塞至裂孔中,手术完毕时C3F8或硅油眼内填充。其中,C3F8填充5只眼;硅油填充18只眼。硅油填充者手术后3个月取出硅油。手术后随访6个月,观察手术后BCVA变化、裂孔闭合、视网膜复位情况。以手术中和手术后眼部及全身不良反应作为安全性评价指标,观察相应并发症发生情况。结果手术后6个月,患眼logMAR BCVA为1.13±0.38;与手术前logMAR BCVA比较,差异有统计学意义(t=15.33,P=0.00)。所有患眼裂孔均闭合,视网膜解剖复位;裂孔闭合、视网膜脱离复位率均为100.0%。所有患者手术中及手术后均未见明显眼部或全身不良反应。结论PPV联合ILM填塞手术治疗MHRD可提高患眼裂孔闭合率,改善视力;治疗高度近视MHRD安全有效。

ObjectiveTo evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes.Methods23 patients (23 eyes) were retrospectively reviewed, who were diagnosed as MHRD through examination of the ocular fundus, optic coherence tomography (OCT) and B-mode ultrasonography. There were 5 males (5 eyes) and 18 females (18 eyes). The mean age was (62.35±8.28) years. The mean course of disease was 1.1 months. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31±0.72. The mean axial length was (28.66±1.99) mm. All patients underwent 23G micro-incision vitrectomy. After vitreous gel and cortex were gently resected, the ILM around the edges of the macular hole was stained with indocyanine green, and was folded and pushed to fill the macular hole gently. Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes, respectively. The silicone oil was removed after 3 months. The follow-up was 6 months. The BCVA, macular hole closure, retinal anatomical reattachment were retrospectively observed, and were used to evaluate the safety and effectiveness of the surgery.ResultsAt the 6 months after surgery, the logMAR BCVA was improved to 1.13±0.38, the difference was significant (t=15.33, P=0.00). The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100%. There were no ocular or systemic adverse events observed in all patients.ConclusionVitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD.

关键词: 视网膜穿孔/外科学; 视网膜脱离/外科学; 近视, 退行性/并发症; 玻璃体视网膜手术

Key words: Retinal perforations/surgery; Retinal detachment/surgery; Myopia, degenerative/complications; Vitreoretinal surgery

引用本文: 黄志坚, 陈晓, 洪玲, 晏颖, 曾苗. 玻璃体切割联合内界膜填塞手术治疗高度近视黄斑裂孔性视网膜脱离疗效观察. 中华眼底病杂志, 2017, 33(4): 350-353. doi: 10.3760/cma.j.issn.1005-1015.2017.04.006 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 沈烨宇, 唐于荣, 万丽, 等. 玻璃体切割与内界膜剥离术联合治疗黄斑裂孔性视网膜脱落的有效性及安全性[J]. 安徽医学, 2014, 35(10): 1352-1355. DOI: 10.3969/j.issn.1000-0399. 2014.010.006.Shen YY, Tang YR, Wan L, et al. Effectiveness of pars plana vitrectomy combined with internal limiting membrane peeling for patients with macular hole retinal detachment[J]. Anhui Medical Journal, 2014, 35(10): 1352-1355. DOI: 10.3969/j.issn.10.3969/j.issn.1000-0399.2014.010.006.
2. 林静娜, 辜智强, 周悦, 等.玻璃体切割术联合内界膜剥离术治疗黄斑裂孔性视网膜脱落[J]. 国际眼科杂志, 2017, 17(3): 508-510. DOI: 10.3980/j.issn.1672-5123.2017.3.30.Lin JN, Gu ZQ, Zhou Y, et al. Pars plana vitrectomy combined with internal limiting membrane peeling for macular hole retinal detachment[J]. Int Eye Sci, 2017, 17(3): 508-510. DOI: 10.3980/j.issn.1672-5123.2017.3.30.
3. Hayashi H, Kuriyama S.Foveal microstructure in macular holes surgically closed by inverted internal limiting membrane flap technique[J]. Retina, 2014, 34 (12): 2444-2450. doi: 10.1097/IAE.0000000000000252.
4. Lai CC, Chen YP, Wang NK, et al. Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes[J]. Ophthalmology, 2015, 122(9): 1889-1898. DOI: 10.1016/j.ophtha.2015.05.040.
5. Qu J, Zhao M, Jiang Y, et al. Vitrectomy outcomes in eyes with high myopic macular hole without retinal detachment[J]. Retina, 2012, 32(2): 275-280. DOI: 10.1097/IAE.0b013e31821a8901.
6. Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1): 125-131. DOI: 10.1016/j.ajo.2013.02.014.
7. Oh J, Yang SM, Yong MC, et al. Glial proliferation after vitrectomy for a macular hole: a spectral domain optical coherence tomography study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2013, 251(2): 477-484. DOI: 10.1007/s00417-012-2058-9.
8. Bu SC, Kuijer R, Rj VDW, et al. Glial cells and collagens in epiretinal membranes associated with idiopathic macular holes[J]. Retina, 2014, 34(5): 897-906. DOI: 10.1097/IAE.0000000000000013.
9. Kasuga Y, Arai J, Akimoto M, et al. Optical coherence tomograghy to confirm early closure of macular holes[J]. Am J Ophthalmol, 2000, 130(5): 675-676.
10. 吴鹏, 黄旭东, 孙先勇, 等.内界膜剥除及其联合内界膜移植治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2014, 30(3): 253-256. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.007.Wu P, Huang XD, Sun XY, et al. Efficacy of internal limiting membrane peeling and transplantation for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, , 2014, 30(3): 253-256. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.007.
11. 刘鹏飞, 廖奇志, 刘淑伟, 等.23G玻璃体切割联合双重多次染色黄斑前膜、内界膜治疗黄斑裂孔性视网膜脱离[J]. 眼科新进展, 2015, 35(9): 878-881. DOI: 10.13389/j.cnki.rao.2015.0240.Liu PF, Liao QZ, Liu SW, et al. 23 gauge vitrectomy combined with double and multiple staining macular eptiretinal membrane and internal limiting membrane for macular hole retinal detachment[J]. Rec Adv Ophthalmol, 2015, 35(9): 878-881. DOI: 10.13389/j.cnki.rao.2015.0240.
12. Chen X, Zhang Y, Yan Y, et al. Complete subretinal fluid drainage is not necessary during vitrectomy surgery for macula-off rhegmatogenous retinal detachment with peripheral breaks: a prospective, nonrandomized comparative interventional study[J]. Retina, 2017, 37(3): 487-493. DOI: 10.1097/IAE.0000000000001180.
13. 万文萃, 刘宇莹, 杨果果, 等.玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离[J]. 眼科新进展, 2015, 35(8): 748-750. DOI: 10.13389/j.cnki.rao.2015.0205.Wan WC, Liu YY, Yang GG, et al. Vitrectomy combined with macular buckling for high myopia and macular hole retinal detachment[J]. Rec Adv Ophthalmol, 2015, 35 (8): 748-750. DOI: 10.13389/j.cnki.rao.2015.
14. Nadal J, Verdaguer P, Canut MI.Treatment of retinal detachment secondary to macular hole in high myopia: vitrectomy with dissection of the inner limiting membrane to the edge of the staphyloma and long-term tamponade[J]. Retina, 2012, 32(8): 1525-1530. DOI: 10.1097/IAE.0b013e3182411cb8.