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和巩膜缩短手术治疗高度近视黄斑劈裂疗效观察

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目的观察玻璃体切割(PPV)联合内界膜(ILM)剥除和巩膜缩短手术治疗高度近视黄斑劈裂(MF)的疗效。方法前瞻性非随机同期对照临床研究。临床检查确诊的高度近视MF患者35例35只眼纳入研究。根据不同的手术方式将患眼分为PPV联合ILM剥除和巩膜缩短手术(内外路联合手术)组、PPV联合ILM剥除手术(内路手术)组,分别为18例18只眼、17例17只眼。采用Snellen视力表行最佳矫正视力(BCVA)检查,转换为最小分辨角对数(logMAR)视力进行统计。采用IOL-Master或A型超声测量眼轴长度(AL)。采用频域光相干断层扫描测量黄斑区视网膜劈裂最高值(MxFT)。采用德国罗兰公司视诱发反应成像系统行多焦视网膜电图检查b波振幅。两组患者年龄(t=0.460)、AL(t=1.520)、屈光度(t=0.020)、logMAR BCVA(t=−2.280)、MxFT(Z=−4.179)、b波振幅(Z=−0.198)比较,差异均无统计学意义(P>0.05)。内外路联合手术组行23G PPV联合ILM剥除和巩膜缩短手术;内路手术组行23G PPV联合ILM剥除手术。手术后随访3~12个月,观察患眼BCVA、AL、MxFT、b波振幅变化。结果末次随访时,内外路联合手术组18只眼劈裂腔高度均不同程度下降,其中劈裂腔消失,视网膜完全复位4只眼。内外路联合手术组、内路手术组患眼logMAR BCVA(t=7.272、5.951)、MxFT(Z=−3.724、−3.622)、b波振幅(Z=−3.223、−3.243)与手术前比较,差异均有统计学意义(P=0.000、0.000、0.000、0.000、0.001、0.001)。两组患眼之间logMAR BCVA(t=−2.280)、MxFT(Z=−4.179)比较,差异有统计学意义(P=0.029、0.000);b波振幅比较,差异无统计学意义(Z=−0.198,P=0.843)。内外路联合手术组患眼AL较手术前缩短,差异有统计学意义(t=10.017,P=0.000)。随访期间无眼底出血、眼内炎等并发症发生。结论PPV联合ILM剥除和巩膜缩短手术治疗高度近视MF可明显缩短AL,促使视网膜结构恢复,改善视力。

ObjectiveTo observe the efficacy of vitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).MethodsProspective and non-randomized concurrent control study. A total of 35 MF patients (35 eyes) were enrolled in this study. The patients were divided into 2 groups according to surgery, including group A (18 eyes) and group B (17 eyes), all received vitrectomy combined with ILM peeling, but group A also received scleral shortening. The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR). Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical, France). The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg, Germany). Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult, Gemany).There was no statistically significant difference between the two groups (P>0.05) in age (t=0.460), AL (t=1.520), diopter (t=0.020), logMAR BCVA (t=−2.280), MxFT (Z=−4.179) and b-wave ERG amplitude (Z=−0.198). The changes of BCVA, AL, MxFT and b wave amplitude were followed-up for 3-12 months.ResultsAt the last follow-up, the height of MF was decreased in 18 eyes of group A, and MF was completely disappeared in 4 eyes. The logMAR BCVA (t=7.272, 5.951), MxFT (Z=−3.724, −3.622) and b- wave ERG amplitude (Z=−3.223, −3.243) in both groups A and B were statistically improved (P=0.000, 0.000, 0.000, 0.000, 0.001, 0.001) compared to pre-operational results. There was significant difference of logMAR BCVA (t=−2.280) and MxFT (Z=−4.179) between the two groups (P=0.029, 0.000). But there was no significant difference in the amplitude of b-wave(Z=−0.198, P=0.843). The AL in group A was shortened after surgery, the difference was statistically significant (t=10.017, P=0.000). During the follow-up, there was no ocular hemorrhage, endophthalmitis and other complications.ConclusionPPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients, and gain relative normal anatomical structure of the fovea, thus improve the vision.

关键词: 近视,退行性/并发症; 近视,退行性/外科学; 视网膜穿孔/外科学; 玻璃体视网膜手术; 巩膜成形术

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

引用本文: 肖亚伟, 郝玉华, 尚庆丽, 殷志博, 杨雅青, 叶存喜. 玻璃体切割联合内界膜剥除和巩膜缩短手术治疗高度近视黄斑劈裂疗效观察. 中华眼底病杂志, 2017, 33(4): 373-377. doi: 10.3760/cma.j.issn.1005-1015.2017.04.011 复制

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