视网膜内界膜剥离手术治疗高度近视黄斑裂孔视网膜脱离的疗效观察

Therapeutic effects of internal limiting membrane peeling on retinal detachment with macular hole in eyes with high myopia

目的观察视网膜内界膜剥离治疗高度近视黄斑裂孔视网膜脱离的疗效。方法回顾分析25例25只眼高度近视黄斑裂孔伴视网膜脱离患者的临床资料。根据治疗方法分为2组，A组为单纯玻璃体切割手术，13例13只眼；B组为玻璃体切割手术加吲哚青绿染色内界膜剥离，12例12只眼。所有患者行惰性气体填充，手术后保持面朝下体位7～15d。观察最佳矫正分辨角对数（LogMAR）视力，检查眼底，光相干断层扫描（OCT）、B型超声检查视网膜复位及黄斑裂孔闭合情况，比较两组间疗效差异。手术后随访6～18个月，平均随访时间10个月。结果A组13只眼中，7只眼手术后视网膜复位，占53．8％；B组12只眼中，11只眼手术后视网膜复位，占91．7％。B组视网膜复位率明显优于A组（X^2=4．427，P=0．046）；25只眼中，手术后黄斑裂孔闭合者17只眼，占68．0%。其中，A组13只眼中，6只眼黄斑裂孔闭合，占A组患者的46．2％；B组12只眼中，11只眼黄斑裂孔闭合，占B组患者的91．7％。两组患者手术后黄斑裂孔闭合率比较，差异有统计学意义（X^2=5．940，P=0．020）。A组手术后最佳矫正LogMAR视力提高平均0．32，与手术前比较，差异有统计学意义（Z=-2．045，P=0．041），B组手术后最佳矫正LogMAR视力提高平均0．53，与手术前比较，差异有统计学意义（Z=-2．481，P=0．012）。两组间手术后视力差异无统计学意义（U=51．5，P=0．16）。结论玻璃体切割联合视网膜内界膜剥离手术可能通过完全解除玻璃体黄斑牵引、增加视网膜顺应性而提高高度近视黄斑裂孔视网膜脱离的治疗效果，显著增加视网膜复位率及黄斑裂孔闭合率。

Objective To evaluate the therapeutic effects of vitrectomy with internal limiting membrane （ILM） peeling on retinal detachment in eyes with high myopia. Methods The clinical data of 25 high myopia patients （25 eyes） with retinal detachment and macular hole were retrospectively analyzed. The patients were divided into two groups according to the treatment： 13 patients in group A had undergone conventional vitrectomy; 12 patients in group B had undergone vitrectomy and ILM peeling. All patients had been tamponaded by inert gas and kept in a face-down position for 7-15 days after the operation. The followup period was 6-18 months （average 10 months）. LogMAR visual acuity, ocular fundus, B-scan ultrasonography and optical coherence tomography had been followed up. Results Retinal reattachment was found in 7 eyes （53.8%） in group A and 11 eyes in group B （91.7%）, the difference was significant （X^2 = 4. 427, P=0. 046）. The macular hole closed in 6 eyes （46.2%） in group A, and 11 eyes （91.7%） in group B the difference was significant between those two groups （X^2 = 5. 940, P = 0. 020）. The postoperative visual acuity increased significantly in both groups （Z=-2. 045, 2. 481 P=0. 041, 0. 012）, the difference of vision improvement was not significant between those two groups （Mann-Whitnay U = 51.5, P = 0. 16）. Conclusions By completely releasing the macular traction and increasing retinal flexibility, vitrectomy with ILM peeling can significantly increase the rate of retinal reattachment and closure of macular hole in eyes with high myopia.