高度近视黄斑裂孔视网膜脱离玻璃体切割手术二期内界膜剥除治疗患眼的临床特征及疗效观察

Observation of macular hole retinal detachment in high myopic eyes after secondary internal limiting membrane peeling vitrectomy

目的：观察高度近视黄斑裂孔视网膜脱离（MHRD）行玻璃体切割手术二期内界膜剥除治疗患眼的临床特征和疗效。方法回顾性分析行二期 PPV 联合内界膜剥除手术的高度近视 MHRD 患者15例15只眼的临床资料。其中,男性3例3只眼,女性12例12只眼；平均年龄（60.80±5.85）岁。均行最佳矫正视力（BCVA）、裂隙灯显微镜联合＋90D 前置镜、间接检眼镜、A 型超声、光相干断层扫描（OCT）检查。第一次手术后,硅油填充状态下眼底检查黄斑区视网膜复位,OCT 检查见黄斑裂孔周围视网膜浅脱离,尤以葡萄肿较深的部位明显。第二次硅油取出手术时,联合内界膜剥除玻璃体腔填充 C3 F8。分析患眼病程、屈光度、眼轴、后巩膜葡萄肿类型与第一、二次手术后 BCVA、黄斑区视网膜复位及黄裂孔愈合情况。结果患眼平均屈光度（-12.6±1.86）D；平均眼轴长度（29.82±0.993）mm；平均病程（5.20±1.24）个月。第一次手术前视网膜4个象限全脱离,同时合并脉络膜脱离和黄斑区视网膜脉络膜萎缩。后巩膜葡萄肿类型均为Ⅱ型（黄斑区）。第二次手术后,所有患眼眼底检查见视网膜复位；OCT 检查,黄斑裂孔闭合7只眼,黄斑裂孔贴附且视网膜复位8只眼。第一、二次手术后患眼 BCVA 均较手术前提高,差异有统计学意义（P =0.000）；第二次手术后 BCVA 较手术前及第一次手术后提高,差异有统计学意义（P =0.038）。结论患眼主要临床特征为病程长、伴脉络膜脱离、Ⅱ型后巩膜葡萄肿；二期内界膜剥除、C3 F8填充可提高患眼视力及视网膜解剖复位率。

9 Objective The aim of this study is to observe the clinical characteristics and surgical effects of macular hole retinal detachment in high myopia patients with pars plana vitrectomy （PPV）and secondary internal limiting membrane （ILM）peeling.Methods This was a retrospective study.The clinical data of 1 5 patients （1 5 eyes）with macular hole retinal detachment and high myopia,who underwent primary PPV and secondary ILM peeling,were analyzed,including disease history,refraction diopter,ocular axis length,posterior scleral staphyloma,BCVA,macular reattachment and macular hole heeling.There were 3 males （3 eyes）and 12 female （12 eyes）,the average age was （60.80 ± 5.85 ）years.All patients were examined by best corrected visual acuity （BCVA ）, slit lamp microscopy with 90D pre-lens, indirect ophthalmoscopy,A scan and optical coherence tomography （OCT）.After the first PPV and silicone oil tamponade,a shallow retinal detachment around the macular hole,especially around the scleral staphyloma was detected by OCT.During the 2nd surgery to remove the silicone oil,ILM peeling and C3 F8 tamponade were performed.Results The average refraction diopter was （- 12.6 ±1.86）D,the average ocular axial length （29.82±0.993）mm and the average disease duration was （5.20±1.24）months.All eyes had total retinal detachment of all four quadrants,choroid detachment and macular choroidal atrophy,and type ⅡCurtin posterior scleral staphyloma. After the second surgery, all had retina attached by fundus examination.OCT examination indicated that macular hole closure in 7 eye,macular hole attached and retinal attached in 8 eyes.Their BCVA improved after both the first and second surgery （P =0.000）,the BCVA after second surgery was better than that after first surgery （P =0.038）.Conclusions The clinical characteristic of our series of patients were as follows：long history,with choroidal detachment and type ⅡCurtin posterior scleral staphyloma.All 1 5 eyes showed retinal attached after secondary ILM peeling.The secondary ILM peeling and C3 F8 tamponade may improve the visual outcome and retinal reattachment rate.