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气体填充手术治疗高度近视黄斑劈裂的疗效观察

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目的 观察玻璃体切割手术(PPV)联合内界膜(ILM)剥除和气体填充治疗高度近视黄斑劈裂(MF)的疗效。 方法 回顾性病例系列研究。接受PPV联合ILM剥除和气体填充治疗的连续高度近视MF患者35例36只眼纳入研究。其中,男性5例5只眼,女性30例31只眼;平均年龄(60.13±10.00)岁。所有患眼均行最佳矫正视力(BCVA)、屈光度、频域光相干断层扫描检查以及眼轴长度(AL)测量。根据患眼MF频域OCT影像特征将其分为单纯MF组(A组)、MF伴中心凹脱离组(B组)、MF伴板层黄斑裂孔(MH)组(C组),分别为10、12、14只眼。3组患者之间年龄、性别构成比、等效球镜度数、AL比较,差异均无统计学意义(F=0.020、0.624、0.009、0.195,P>0.05);最小分辨角对数(logMAR)BCVA、黄斑中心凹视网膜厚度(CFT)比较,差异均有统计学意义(F=11.100、41.790,P<0.05)。采用经睫状体平坦部三切口23G PPV联合ILM剥除,气液交换后,填充12% C3F8或空气。手术后随访时间>1年。观察末次随访时患眼BCVA和黄斑中心凹结构情况;对比分析不同类型MF之间疗效差异。 结果 末次随访时,36只眼平均logMAR BCVA、CFT分别为0.40±0.44和(213.35±97.58)μm。与手术前比较,差异均有统计学意义(t=5.984、5.113,P<0.001)。MF愈合33只眼。A、B、C组患眼平均logMAR BCVA分别为0.13±0.10、0.73±0.33、0.38±0.52;平均CFT分别为(222.40±57.16)、(212.50±150.45)、(206.67±55.97)μm;MF愈合分别为10、11、12只眼;黄斑区椭圆体带完整分别为8、2、12只眼。B组患眼logMAR BCVA低于A、C组,差异有统计学意义(F=6.750,P=0.003);平均CFT比较,组间差异无统计学意义(F=0.068,P=0.935);MF愈合率比较,组间差异无统计学意义(χ2=1.558,P=0.459);B组患眼椭圆体带完整率最低,组间差异有统计学意义(χ2=18.590,P<0.001)。C组14只眼中并发全层MH 1只眼。 结论 PPV联合ILM剥除和气体填充可有效治疗高度近视MF;合并中心凹脱离患眼手术后BCVA和黄斑区外层结构最差。

Objective To observe the efficacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF). Methods This is a retrospective case study. A total of 35 MF patients (36 eyes) were enrolled in this study. There were 5 males (5 eyes) and 30 females (31 eyes), with an average age of (60.13±10.00) years. All patients were examined for best corrected visual acuity (BCVA), diopter, optical coherence tomography (OCT) and axial length. The patients were divided into a MF group (group A, 10 eyes), MF with foveal detachment group (group B, 12 eyes) and MF with lamellar macular hole group (group C, 14 eyes) according to the OCT characteristics. There was no difference of age, gender, spherical equivalent refraction and axial length among 3 groups (F=0.020, 0.624, 0.009, 0.195; P>0.05). There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100, 41.790; P<0.05). All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade. The follow-up was more than one year. The BCVA and macular structure at the final follow-up were analyzed. The efficacy between 3 forms of MF was compared. Results At the final follow-up, the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm, which were significantly improved compared with preoperative measurements (t=5.984, 5.113; P<0.001). MF was resolved in 33 eyes. In group A, B and C, the logMAR BCVA were 0.13±0.10, 0.73±0.33 and 0.38±0.52, respectively; CFT was (222.40±57.16), (212.50±150.45), (206.67±55.97) μm, respectively; MF was resolved in 10, 11 and 12 eyes, respectively; complete ellipsoid was observe in 8, 2 and 12 eyes. The logMAR BCVA (F=6.750, P=0.003) and the rate of complete ellipsoid (χ2=18.590, P<0.001) in group B was lower than group A and C, the differences were significant. There was no difference of CFT (F=0.068, P=0.935) and the rate of MF resolving (χ2=1.558, P=0.459) among the three groups. One eye (1/14) in group C suffered from full layer macular hole. Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis. The macular structures and BCVA are worst in eyes with foveal detachment.

关键词: 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: Retinoschisis/surgery; Myopia, degenerative/complications; Vitrectomy

引用本文: 陶继伟, 俞雪婷, 沈丽君, 陈亦棋, 张赟, 林丽, 吴韩飞. 玻璃体切割联合内界膜剥除和气体填充手术治疗高度近视黄斑劈裂的疗效观察. 中华眼底病杂志, 2018, 34(2): 111-115. doi: 10.3760/cma.j.issn.1005-1015.2018.02.002 复制

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1. 李楚, 郑文斌, 黄浩, 等. 高度近视黄斑劈裂治疗研究进展[J]. 中华眼底病杂志, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.Li C, Zhen WB, Huang H, et al. Progress in the treatment of myopic macular retinoschisis [J]. Chin J Ocul Fundus Dis, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.
2. Gaucher D, Haouchine B, Tadayoni R, et al. Long-term follow up of high myopic foveoschisis: natural course and surgical outcome[J]. Am J Ophthalmol, 2006, 143(3): 455-462. DOI: 10.1016/j.ajo.2006.10.053.
3. Zheng B, Chen Y, Chen Y, et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis[J]. Retina, 2011, 31(4): 692-701. DOI: 10.1097/IAE.0b013e3181f84fc1.
4. Figueroa MS, Ruiz-Moreno JM, Govetto A, et al. Long-term outcomes of 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for myopic traction maculopathy[J]. Retina, 2015, 35(9): 1836-1843. DOI: 10.1097/IAE.0000000000000554.
5. Ikuno Y, Sayanagi K, Soga K, et al. Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis[J]. Jpn J Ophthalmol, 2008, 52(4): 269-276. DOI: 10.1007/s10384-008-0544-8.
6. Taniuchi S, Hirakata A, Itoh Y, et al. Vitrectomy with or without internal limiting membrane peeling for each stage of myopic traction maculopathy[J]. Retina, 2013, 33(10): 2018-2025. DOI: 10.1097/IAE.0b013e3182a4892b.
7. 徐格致, 孙中萃. 关注高度近视黄斑劈裂玻璃体视网膜手术治疗效果的影响因素, 努力提升手术治疗效果[J]. 中华眼底病杂志, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.002.Xu GZ, Sun ZC.Pay attention to the influencing factor of vitrectomy outcome for the treatment of myopic foveoschisis[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.002.
8. Sun CB, Liu Z, Xue AQ, et al. Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes[J]. Eye, 2010, 24 (12): 1787-1791. DOI: 10.1038/eye.2010.123.
9. Uchida A, Shinoda H, Koto T, et al. Vitrectomy for myopic foveoschisis with internal limiting membrane peeling and no gas tamponade[J]. Retina, 2014, 34 (3): 455-460. DOI: 10.1097/IAE.0b013e3182a0e477.
10. Kim KS, Lee SB, Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis[J]. Am J Ophthalmol, 2012, 153(2): 320-326. DOI: 10.1016/j.ajo.2011.07.007.
11. Kumagai K, Furukawa M, Ogino N, et al. Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis[J]. Retina, 2010, 30(6): 874-880. DOI: 10.1097/IAE.0b013e3181c703fc.
12. Wu TY, Yang CH, Yang CM. Gas tamponade for myopic foveoschisis with foveal detachment[J]. Graefe’s Arch Clin Exp Ophthalmol, 2012, 251(5): 1319-1324. DOI: 10.1007/s00417-012-2192-4.
13. Rodrigues IA, Stangos AN, Mchugh DA, et al. Intravitreal injection of expansile perfluoropropane (C3F8) for the treatment of vitreomacular traction[J]. Am J Ophthalmol, 2013, 155 (2): 270-276. DOI: 10.1016/j.ajo.2012.08.018.
14. Mii M, Matsuoka M, Matsuyama K, et al.Favorable anatomic and visual outcomes with 25-gauge vitrectomy for myopic foveoschisis[J]. Clin Ophthalmol, 2014, 8: 1837-1844. DOI: 10.2147/OPTH.S67619.
15. Hirakata A, Hida T. Vitrectomy for myopic posterior retinoschisis or foveal detachment[J]. Jpn J Ophthalmol, 2006, 50(1): 53-61.DOI: 10.1007/s10384-005-0270-4.
16. Gao X, Ikuno Y, Fujimoto S, et al. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol, 2013, 155(6): 1021-1027. DOI: 10.1016/j.ajo.2013.01.023.
17. Wolf S, Schnurbusch U, Wiedemann P, et al. Peeling of the basal membrane in the human retina: ultrastructural effects[J]. Ophthalmology, 2004, 111(2): 238-243. DOI: 10.1016/j.ophtha.2003.05.022.
18. Sayanagi K, Ikuno Y, Soga K, et al. Photoreceptor inner and outer segment defects in myopic foveoschisis[J]. Am J Ophthalmol, 2008, 145(5): 902-908. DOI: 10.1016/j.ajo.2008.01.011.
19. Ho TC, Chen MS, Huang JS, et al. Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery[J]. Retina, 2012, 32(3): 631-634. DOI: 10.1097/IAE.0B013E31824D0A4B.
20. Shimada N, Sugamoto Y, Ogawa M, et al. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy[J]. Am J Ophthalmol, 2012, 154(4): 693-701. DOI: 10.1016/j.ajo.2012.04.013.
21. Ho TC, Yang CM, Huang JS, et al. Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy[J]. Retina, 2014, 34(9): 1833-1840. DOI: 10.1097/IAE.0000000000000149.
22. Lee CL, Wu WC, Chen KJ, et al. Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery[J]. Acta Ophthalmol, 2017, 95(2): 128-131. DOI: 10.1111/aos.13115.
23. Jin H, Zhang Q, Zhao P, et al. Fovea sparing internal limiting membrane peeling using multiple parafoveal curvilinear peels for myopic foveoschisis: technique and outcome[J]. BMC Ophthalmol, 2016, 16(1): 180. DOI: 10.1186/s12886-016-0356-4.