玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂的疗效及与视觉相关生存质量的评估

Evaluation of effectiveness and vision-related quality of life following vitrectomy associated with internal limiting membrane peeling for high myopic foveoschisis

目的评估玻璃体切割联合内界膜剥除术对高度近视黄斑劈裂的疗效,并比较术前、术后与视觉相关生存质量的变化。方法研究设计为非对照病例观察研究。采用闭合式经睫状体平坦部三切口玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂患者19例20眼。术前及术后6个月对黄斑区视网膜进行光学相干断层扫描(OCT)检查,记录黄斑中心凹最小厚度和黄斑区90°方位视网膜劈裂处的最大厚度。术后6个月检查双眼最佳矫正视力(BCVA)并与术前进行比较;应用视力相关生存质量量表-25(VFQ-25)对与视觉相关生存质量进行评价,并与术前进行比较。结果术后随访超过6个月,手术眼黄斑中心凹厚度和黄斑区视网膜平均最大厚度分别从术前的(360.7±183.7)μm、(483.0±138.3)μm减小到术后的(180.2±75.2)μm、(328.1±82.2)μm,差异均有统计学意义(u=-3.211,P=0.001;u=-3.472,P=0.001)。术后BCVA提高2行以上者14眼(70%)。术后LogMAR视力平均值为0.59±0.46,明显好于术前的0.87±0.61,差异有统计学意义(u=-2.223,P=0.026)。患者VFQ-25评估统计表明,术后患者的总体视力、近距离活动、远距离活动、社会功能、精神健康、依赖程度、周边视力(视野)这7项维评分以及VFQ-25总分与术前相比明显改善,差异均有统计学意义(P<0.05);而术后整体健康、眼痛、社会角色限制、驾车、色觉这5项维评分与术前相比差异均无统计学意义(P>0.05)。术后8例(42.1%)患者视力较好眼为手术眼。结论玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂安全、有效,手术治疗可明显改善患者的与视觉相关生存质量。

Background Foveoschisis is one of the main causes that causes visual disorder for high myopic eye（HMF）.Vitrectomy can anatomically reattach the retina and improve the visual acuity in foveoschisis patient.25-Item National Eye Institute Visual Function Questionnaire （VFQ-25）has been widely adopted to evaluate numerous ocular diseases,yet not to high myopic foveoschisis.Objective This study was to evaluate the outcomes of vitrectomy combined with internal limiting membrane peeling for HMF.Methods A non-control case observational study was designed.Twenty eyes of 19 consecutive patients undergone vitrectomy and internal limiting membrane peeling for HMF were included in this study.Pars plana vitrectomy with internal limiting membrane peeling was performed in all of the patients.Best corrected visual acuity （BCVA） was assessed in the LogMar vision.The macular retinal thickness was measured by optical coherence tomography （OCT）.The vision-related quality of life （VR QoL） in 19 patients with HMF was evaluated with VFQ-25 before and 6 month after surgery.Results Central foveal minimal thickness and the parafovea maximal retinal thickness were reduced after surgery in all eyes with HMF from （360.7±183.7）μm and （483.0±138.3）μm to （180.2±75.2）μm and （328.1±90.9）μm respectively,showing statistically significant differences between them （u=-3.211,P=0.001;u=-3.472,P=0.001）.At the final visit,the BCVA improved by two lines or more in 14 eyes （70%）,and mean LogMAR improved from preoperative 0.87±0.61 to postoperative 0.59±0.46（u=-2.223;P=0.026）.The VFQ-25 composite score and the score of the VFQ-25 subscales associated with general vision,near activities,distance activities,social functioning,mental health,dependency and peripheral vision were significantly elevated after surgery in comparison with before surgery （P0.05）.No significant difference was found in the score of VFQ-25 subscales associated with general health,ocular pain,role difficulties,driving and color vision between before surgery and after surgery （P0.05）.Postoperatively,the better-seeing eye was the operated eye in eight patients （42.1%）.Conclusion Vitrectomy with limiting membrane peeling is safe and effective for HMF.Vision-related quality of life in postoperation is better than that of preoperation.