23G和20G玻璃体切除术治疗高度近视黄斑裂孔性视网膜脱离疗效比较

Comparative study on the clinical effect internal limiting membrane peeling and detachment in highly myopic eyes of 23G versus 20G vitrectomy combined with silicone oil tamponade for macular hole retinal

目的比较23G和20G玻璃体切割术联合内界膜剥离和眼内硅油填充治疗高度近视黄斑裂孔视网膜脱离的临床疗效。方法临床病例对照研究。对2007年1月至2012年8月在温州医科大学附属眼视光医院就诊的39例（39只眼）高度近视黄斑裂孔视网膜脱离患者行玻璃体切除联合内界膜剥离和硅油充填术，其中23G微创玻璃体切割术20例（20只眼）为23G组；20G玻璃体切割术19例（19只眼）为20G组。所有患者术前行A与B超、眼压、最佳矫正视力、光相干断层扫描（optical coherence tomographic，OCT）等检查。术后观察眼压、最佳矫正视力、黄斑裂孔的闭合情况及视网膜复位情况。将最佳矫正视力转化为最小视角对数（10gMAR）视力进行统计分析。结果23G组患者术前平均logMAR视力为（2．19±0．14），术后平均logMAR视力为（1．33±0．55），差异有统计学意义（Z=-3．728，P=0．000〈0．05）；20G组患者术前平均视力为logMAR（2．05±0．35），术后平均视力为log—MAR（1．74±0．44），差异有统计学意义（Z=-2．887，P=0．004〈0．05）。两组间手术后logMAR视力差异有统计学意义（U=108．5，P=0．021〈0．05）。23G组术后1d眼压下降7只眼（35％），平均为（9．62±4．03）mmHg，与术前1d相比，差异有统计学意义（t=2．747，P=0．013〈0．05）；20G组术后1d眼压下降2只眼（10．52％），平均为（11．79±6．9）mmHg，与术前1d相比，差异没有统计学意义（t=-0．432，P=0．671〉0．05）。两组术后1d眼压相比差异有统计学意义（t=-2．118，P=0．041〈0．05）。末次随访OCT，23G组显示7只眼（35％）黄斑裂孔闭合，20G组显示5只眼（26．3％）黄斑裂孔闭合。末次术后OCT示23G组视网膜复位率100％和20G组94．7％（18／19）。结论23G微创玻璃体切除术联合硅油填充和内界膜剥除治疗高度近视黄斑裂孔性视网膜脱离，视网膜复位率高，术后视力提高明显，并发症少，两组黄斑裂孔闭合率都低。

Objective To compare the effect of 23G vitrectomy and 20G vitrectomy combined with intemal limiting membrane （IML） peeling and silicone oil tamponade for macular hole retinal detachment （MHRD） in highly myopia eyes. Methods A retrospective case series study. Thirty-nine patients （39 eyes） with macular hole retinal detachment （MHRD）in highly myopic eyes underwent either 23G （20 eyes, 23G group） or 20G vitectomy （19 eyes, 20G group） combined with internal IML and silicone tamponade. Preoperatively, all the patients had A/B-ultrasonography, intraocular pressure, best-corrected visual acuity （BCVA） and optical coherence tomography （OCT） examinations. Postoperatively, intraocular pressure, BCVA, the rate of the macular hole closure and retinal reattachment were observed. The BCVA was converted to logarithm of the minimal angle of resolution （logMAR） and analyzed. Results The mean preoperative and postoperative BCVA in 23G group were logMAR 2.19±0.14 and logMAR1.33±0.55. The difference between preoperative and postoperative IogMAR BCVA was significant （Z =-3.728, P =0.000〈0.05）. The mean preoperative and postoperative BCVA in 20G group were logMAR 2.05-4-0.35 and logMAR1.74±0.44. The difference between preoperative and postoperative IogMAR BCVA was significant （Z =-2.887, P =0.004〈0.05）. The difference between postoperative logMAR BCVA in two groups was significant （U =108.5, P =0.021〈0.05）. Seven （35%） cases of low intraocular pressure （IOP） after surgery were found in 23G group. The mean IOP at day 1 after surgery was 9.62±4.03mmHg. Comparing with preoperative lOP, the difference was significant （t =2.747, P =0.013〈0.05）. Two （10.52%） cases of low intraocular pressure （lOP） after surgery were found in 20G group. The mean IOP at day 1 after surgery was 11.79±6.9mmHg. Comparing with preoperative IOP, the difference was not significant （t =-0.432, P =0.671〉0.05）. The difference of the mean IOP at day 1 after surgery between two groups was significant （t =2.118, P = 0.041〈0.05）. The final OCT showed seven eyes （35%） in 23 G group were found macular hole closure and four eyes （26.3%） in 20G group. The reattachment rate in final visit of 23G and 20G were 100% and 94.7%. Conclusions There is a high retinal reattachment rate and a significant improvement without many complications in VA in MHRD patients for 23-gauge vitrectomy with IML peeling and silicone oil tamponade. The macular hole closure rate of two groups is low.