近视性黄斑裂孔视网膜脱离手术选择

Surgical selection of retinal detachment with macular hole in highly myopic eyes

目的探讨近视性黄斑裂孔视网膜脱离手术方式选择原则。方法选择近视性黄斑裂孔视网膜脱离患者72例75眼，根据黄斑裂孔底部呈红色（红孔）或白色（白孔），后巩膜葡萄肿形态等选择手术方式。所有病例分三组：A组行16％C2F6充气性视网膜固定术（26例26眼），B组行玻璃体切除联合16％C2F6眼内填充术（23例26眼），C组行玻璃体切除联合硅油填充术（23例23眼），并进行6～16个月的随访观察。结果A组患者一次手术复位率69．2％（18／26），B组为73．1％（19／26），C组为87．O％（20／23），三组比较差异无统计学意义（P=0．3184）。结论近视性黄斑裂孔视网膜脱离患者根据视网膜脱离手术原则选择手术方式，均可获得良好的视网膜复位。

Objective To investigate the surgical selection of retinal detachment with myopic macular holes. Methods Management strategies were adopted according to the ocular symptoms of patients with high myopia involved in posterior chorioretinal atrophy, the colour showed by the bottom of macular holes and the shape of posterior staphyloma. Seventy-five eyes of 72 patients fulfilled the study criteria. The patients were followed up in an average of eight-month-observation and were divided into three groups ： single 16% C2F6 gas tamponade （26 eyes of 26 patients） as group A,vitrectomy combined with 16% C2F6 gas tamponade （26 eyes of 23 patients） as group B and vitrectomy with silicon oil tamponade （23 eyes of 23 patients） as group C. Results 69.2% （18/26） of the macular holes were closed in group A, 73 1% （19/26） in group B and 87.0% （20/23） in group C after the primary surgery. Comparison of postoperative outcomes, macular hole closure rate was not significantly different among three groups （P ~ 0.3184）. Conclusions It suggests that good anatomic retinal reattachment be achieved using any approach. However, the optimal surgical choice regarding of the personality case offered less surgical burden and more rapid visual rehabilitation to patients.