中华眼底病杂志

中华眼底病杂志

玻璃体切割联合内界膜剥除手术治疗高度近视黄斑裂孔伴黄斑劈裂的疗效观察及黄斑裂孔闭合率的影响因素分析

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目的观察玻璃体切割(PPV)联合内界膜剥除(ILMP)手术治疗高度近视黄斑裂孔(MH)伴黄斑劈裂的临床效果,分析MH闭合率的影响因素。方法回顾性研究。临床确诊为高度近视MH伴黄斑劈裂的21例患者22只眼纳入研究。所有患眼均行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜、间接检眼镜、A型和(或)B型超声、光相干断层扫描及视觉电生理等眼部检查。患眼BCVA为数指~0.2。眼轴长度(AL)为26.00~31.00 mm,平均AL为27.47 mm。其中,AL为26.00~27.00 mm者9只眼,27.10~28.00 mm者5只眼,28.10~29.00 mm者3只眼,29.10~30.00 mm者3只眼,>30.00 mm者2只眼。MH最小直径为227~597 μm,平均最小直径为432 μm。其中,最小直径为200~400 μm者4只眼,401~450 μm者13只眼,451~500 μm者3只眼,501~600 μm者2只眼。所有患眼均行PPV联合ILMP手术治疗,采用向心性ILMP,即用力方向尽可能朝向黄斑中心。手术后平均随访时间为17个月。以末次随访为疗效判定时间点,观察患眼MH闭合、黄斑劈裂状态及视力变化情况。MH闭合分为完全闭合、桥样闭合、裸露型闭合及未闭合4种情况。黄斑劈裂状态分为消失、好转、无变化3种情况。视力分为提高、稳定、下降3种情况。同时,对比分析不同MH最小直径及不同AL患眼之间的MH闭合率。结果末次随访时,22只眼中,MH完全闭合17只眼,占77.3%;桥样闭合4只眼,占18.2%;未闭合1只眼,占4.5%。黄斑劈裂完全消失19只眼,占86.4%;好转2只眼,占9.1%;无变化1只眼,占4.5%。MH最小直径越小,MH完全闭合率越高。不同MH最小直径患眼之间的MH闭合率比较,差异有统计学意义(χ2=12.036,P=0.032)。AL越长,MH完全闭合率越低。不同AL患眼之间的MH闭合率比较,差异有统计学意义(χ2=16.095,P=0.003)。患眼BCVA为数指~0.25。22只眼中,视力提高9只眼,占40.9%;视力稳定8只眼,占36.4%;视力下降5只眼,占22.7%。结论PPV联合ILMP手术治疗MH最小直径不超过600 μm的高度近视MH伴黄斑劈裂能促进大部分患眼MH闭合、黄斑劈裂消失或好转,改善或稳定视力。MH最小直径、AL是影响MH闭合的因素。

ObjectiveTo observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes, and to analyze factors affecting the MH closure rate.MethodsThis is a retrospective case study. 21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study. All eyes were examined for best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, indirect ophthalmoscope, A and/or B-scan ultrasound, optical coherence tomography and visual electrophysiological examination. The BCVA was ranged from finger counting to 0.2. The axial length (AL) was ranged from 26.00 to 31.00 mm, with an average of 27.47 mm. Among 22 eyes, AL was between 26.00 mm to 27.00 mm in 9 eyes, 27.10 mm to 28.00 mm in 5 eyes, 28.10 mm to 29.00 mm in 3 eyes, 29.10 mm to 30.00 mm in 3 eyes, and longer than 30.00 mm in 2 eyes. The diameter of MH was ranged from 227 µm to 597 µm and with an average of 432 µm. Among them, the minimum diameter was between 200 µm to 400 µm in 4 eyes, 401 µm to 450 µm in 13 eyes, 451 µm to 500 µm in 3 eyes, 501 µm to 600 µm in 2 eyes. All the eyes were treated with PPV combined with ILMP surgery. The average follow-up time was 17 months after surgery. The efficacy was determined at the final follow up, including the MH closure, the state of macular retinoschisis and the BCVA. MH closure rate with different MH diameters and different AL were compared and analyzed.ResultsDuring the final follow-up, MH were fully closed in 17 eyes (77.3%), bridge-closed in 4 eyes (18.2%) and not closed in 1 eye (4.5%). Retinoschisis was resolved in 19 eyes (86.4%), partially resolved in 2 eyes (9.1%) and not changed in 1 eye (4.4%). MH with smaller diameter had higher MH closure rate (χ2=12.036, P=0.032). MH with longer AL had lower MH closure rate (χ2=16.095, P=0.003).The final BCVA was ranged from finger counting to 0.25. Among 22 eyes, BCVA or metamorphopsia were improved in 9 eyes (40.9%), stable in 8 eyes (36.4%). BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7%).ConclusionsPPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes. After surgery, MH was closed and retinoschisis was resolved in most patients. The major factors affect the MH closure were the minimum diameter of MH and AL.

关键词: 视网膜穿孔/外科学; 视网膜劈裂症/外科学; 近视,退行性/并发症; 玻璃体切除术

Key words: Retinal perforations/surgery; Retinoschisis/surgery; Myopia, degenerative/complications; Vitrectomy

引用本文: 田超伟, 王雨生, 朱锦婷, 李璐希, 武静. 玻璃体切割联合内界膜剥除手术治疗高度近视黄斑裂孔伴黄斑劈裂的疗效观察及黄斑裂孔闭合率的影响因素分析. 中华眼底病杂志, 2017, 33(4): 359-363. doi: 10.3760/cma.j.issn.1005-1015.2017.04.008 复制

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