近视牵引性黄斑病变的玻璃体手术治疗

Vitreous surgery for the myopia traction maculopathy

目的观察近视牵引性黄斑病变(myopia traction maculopathy,MTM)的玻璃体手术治疗。方法回顾分析2002年1月到2004年12月间收治的12例MTM患者12眼的临床资料。所有患者均接受玻璃体手术治疗,术中剥除玻璃体后皮质和黄斑前膜,未做视网膜内界膜剥除,以C3F8内填充。结果术前光学相干断层扫描(optical coherence tomography,OCT)检查及术中均证实此类患眼存在异常的玻璃体视网膜界面关系。术后随访4～21个月,视力提高8眼,视物变形改善9眼。OCT检查显示8眼黄斑部视网膜解剖复位。2眼术后出现黄斑裂孔,其中1眼发展为视网膜脱离。结论MTM是一种发生在高度近视眼中,由视网膜前、视网膜和视网膜下因素所导致的玻璃体视网膜复合性病变。OCT是诊断MTM最重要的方法。玻璃体手术可以阻止或改善该病的自然病程。

Objective To evaluate vitrectomy for myopic traction maculopathy （MTM）. Methods Medical records for 12 eyes of 12 consecutive patients who had been surgically treated with pars plana vitrectomy were retrospectively reviewed in order to clarify the future of MTM. During the surgery, the posterior vitreous cortex attached to the macula and macular epi-retinal membrane were removed after injection with C3F8. This was done without peeling the internal limiting membrane. Results Both the preoperative optical coherence tomography （OCT） results and the findings during surgery confirmed the existence of abnormalities on the vitreoretinal interface, which exerted traction on the macula. The postoperative follow-up period was 4-21 months. Postoperative visual acuity improved in 8 eyes and metamorphopsia was relieved in 9 eyes. OCT confirmed retinal reattachment in 8 eyes. The main complications were macular holes in 2 eyes, with one of them developing retinal detachment, Conclusion MTM is a type of vitroretinal compound disease with pathologic features generated by traction in the high myopia environment. OCT should be considered mandatory in the diagnosis of the disease. Vitrectomy is indicated as a means for regaining normal macular structure and slowing the progression of the disease.