前后段联合手术及硅油填充治疗高度近视黄斑孔视网膜脱离的疗效观察

The therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia

目的观察前后段联合手术及硅油充填治疗高度近视黄斑孔视网膜脱离临床疗效。方法回顾分析前后段联合手术及硅油充填治疗高度近视黄斑孔视网膜脱离患者48例48只眼的临床资料。患者均有高度近视史，视网膜脱离以后极部为主，裂隙灯前置镜和（或）光相干断层扫描（OCT）检查均发现黄斑裂孔。均行白内障超声乳化或抽吸联合玻璃体切割硅油充填，41例行内界膜（ILM）剥离，23例植入人工晶状体（IOL）。硅油取出的时间距第一次手术时间为3．5～48．0个月。取硅油前均行OCT检查。取硅油后随访观察均1年以上。结果除5例外，其他患者手术后1周，前置镜检查均不能看到黄斑孔边缘；视力均有不同程度的提高。48例患者全部已取硅油。取硅油前OCT检查，黄斑孔愈合呈U型8例，V型为6例，W型为23例；未闭合11例。未闭合的11例经取硅油与膨胀气体充填后全部复位，其中，U型2例，W型9例。32例W型愈合者中2例患者在取油后13、38个月后出现视网膜脱离复发。最终黄斑裂孔U型和V型愈合者16例，占33．3％，W型愈合者32例，占66．7％。视网膜复位率为100．0％。结论前后段联合手术及硅油充填是治疗高度近视黄斑孔视网膜脱离的有效方法；OCT检查是确定黄斑孔是否封闭的客观标准。

Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia. Methods The clinical data of 48 high myopia patients （48 eyes） with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by non-contact Hruby lens and optical coherence tomography （OCT）. Phacoemulsifieation combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been remow, d 3.5 48.0 months after the first surgery and OCT had been performed before the removal. The follow-up period after the removal of the silicon oil was more than 1 year. Results The edge of the macular hole could not be seen under the non-contact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape （8 eyes）, V shape （6 eyes） or W shape （23 eyes）. About 13-38 months after the oil removal, retinal detachment recurred in 2 patients with the W-shaped holes. At the end of the follow-up period, 16 patients （33.3%） had U or V-shaped macular holes, and 32 patients （66.7%） had W shaped maeular holes. The rate of retinal reattachment was 100%. Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.