高度近视黄斑劈裂玻璃体切除联合内界膜剥离

Vitrectomy with internal limiting membrane peeling for myopic foveoschisis

目的探讨23G玻璃体切除术联合内界膜剥离和全氟丙烷（c，F。）填充治疗高度近视黄斑劈裂的效果。方法25例（28只眼）高度近视黄斑劈裂23G玻璃体切除和C，F。填充术，分为A组13例（15只眼）剥离内界膜组，B组12例（13只眼）未剥离内界膜组。术后随访6～11个月。观察术前及术后1、3、6个月最佳矫正视力（BCVA）以及黄斑中心凹厚度。结果术后1、3、6个月两组13CVA均较术前提高（A组t=-6．167，-10．724，-9．510，B组t=-7．426，-7．754，-9．381，P〈0．05），差异有统计学意义，术后1、3、6个月两组间BCVA比较（t=0．239，P=0．813；t=-0．408，P=0．686；t=-759，P=0．455），差异无统计学意义。OCT显示术后1、3、6个月两组黄斑中心凹厚度均较术前下降（P〈0．05），差异有统计学意义；术后3、6个月两组间黄斑中心凹厚度比较，A组下降较B组明显，（t=-2．998，P=0．006，t=-3．800，P=0．001），差异有统计学意义。随访中，A组1眼术后1个月发现黄斑孔视网膜脱离。结论23G玻璃体切除术联合或不联合剥离内界膜全氟丙烷填充治疗高度近视黄斑劈裂都是安全、有效的，剥离内界膜有助于劈裂的复位，同时也增加了黄斑孔风险。

Objective To evaluate the efficacy of 23G vitrectomy with internal limiting membrane （ILM） peeling and perfluoropropane （C3Fs ） tamponade to treat myopic foveoschisis. Methods Twenty- eight eyes of 25 patients with myopic foveosehisis were analyzed retrospectively. 23G vitrectomy was per- formed with 15% C3 F8 tamponade. The patients were divided into two groups according to the treatment： 15 eyes of 13 patients were in group A with a combination of ILM peeling; 13 eyes of 12 patients were in group B without ILM peeling. The follow up period was 6 - 11 months. The best corrected visual acuity（BCVA） and optical coherence tomogrphic（OCT） finding of the foveal thickness before and 1 m, 3 m, 6 m after operation were obtained and compared. Results The postoperative BCVA increased significantly in both groups （Group A t = - 6. 167, - 10. 724, - 9. 510,Group B t = - 7. 426, - 7. 754, - 9. 381,P 〈 0.05 ）. And the difference of vision improvement between the two groups was no significant at each time point after operation （ t = 0. 239,P = 0. 813 ; t = - O. 408, P = 0. 686 ; t = - 759, P = 0. 455 ）. The OCT image showed the mean foveal thickness was decreased postoperatively （ P 〈 0.05 ）. And the difference of thickness decrease was significant between the two groups, at the 3rd （t = - 2. 998,P = O. 006） and 6th （t = - 3. 800,P = 0. 001 ） month postoperatively. The foveal thickness of Group A was thinner than that of Group B. During the follow- up, one eye in the group A developed macular hole and retinal detachment 1 month after surgery. Conclu- sion 23G vitrectomy with or without ILM peeling and C3F8 tamponade is safe and effective for myopic fove- oschisis,and ILM peeling can improve the reattaehment of the myopic foveosehisis, but increase the risk of the macular hole.