高度近视眼黄斑裂孔性视网膜脱离的临床特征和手术疗效分析

Clinical features and vitreous surgery outcomes of retinal detachment associated with macular hole in high myopic eyes

目的分析高度近视眼黄斑裂孔性视网膜脱离的临床特征和手术疗效。方法采用系列病例研究，对近6年40例（40只眼）高度近视眼黄斑裂孔性视网膜脱离患者临床资料进行回顾性分析，所有患者均屈光不正均≥-6．00D，不伴有周边视网膜裂孔。结果40例（40只眼）中，男8例，女32例。年龄33～76岁，平均59.3岁。平均随诊时间12、3个月。视网膜最终复位36只眼（90．0％）。术后视力提高30只眼（75．0％），保持稳定5只眼（12．5％），下降5只眼。术后视力较术前视力提高（P=0．000）。预示术后视力差的因素：伴有后巩膜葡萄肿（P=0．023），伴有视网膜色素上皮萎缩（P=0．001）。术中剥除内界膜17只眼，保留内界膜23只眼，剥除内界膜组视网膜复位率（94．1％），保留内界膜组视网膜复位率（78．3％），两组术后视力提高差异无统计学意义（P=0．240）。结论现代玻璃体视网膜手术治疗高度近视眼黄斑裂孔性视网膜脱离可以使视网膜脱离绝大多数复位，手术后大多数眼能改善或保持视力。

Objective To investigate the clinical features and to evaluate the visual and anatomical outcomes in a series of vitreous surgeries for retinal detachment associated with macular hole in high myopic eyes. Methods The clinical data of 40 patients （40 eyes） , 8 males and 32 females, aged 33 -76, who received vitreous surgery for retinal detachment clue to rnacular hole in high myopic eyes with the previous refractive error ~〉 -6.00 D without peripheral retinal hole from January 2001 to January 2007 were retrospectively analyzed. The patients were followed up for 12.3 months. Results Overall anatomical success was achieved in 36 eyes （90.0%）. 30 eyes （75.0%） had visual improvement. Vision remained unchanged in 5 eyes （ 12.5% ） and decreased in 5 eyes. Postoperative visual acuity improved much more than preoperative visual acuity （ P = 0.000 ）. Predictors of poor visual outcome were： posterior staphylorna （ P =0.023 ） and atrophy of retinal pigment epithelium （ P = 0. 001 ）. Internal limiting membrane （ ILM ） peeling （ILM-peeled group） was performed on 17 eyes, and the ILM was not removed on 23 eyes （ILM- preserved group）. The anatomic reattachment rate after the initial surgery in the ILM-peeled group was 94. 1%. and in the ILM-preserved group was 78.3%. There was not significant difference in the improvement of postoperative visual acuity between these two groups （P = 0. 240）. Conclusion Vitreous surgery achieves retinal reattachment and improves or preserves the visual acuity in the eyes with retinal detachment clue to macular hole in high myopic eyes.