无眼内填充的玻璃体切割手术联合内界膜剥除治疗高度近视黄斑劈裂疗效观察

Evaluation of effectiveness of vitrectomy associated with internal limiting membrane peeling without tamponade for myopic foveoschisis

目的观察无眼内填充的玻璃体切割手术联合内界膜（ILM）剥除治疗高度近视黄斑劈裂的疗效。方法回顾性病例分析。临床检查确诊的高度近视黄斑劈裂患者23例23只眼纳入研究。行最佳矫正视力（BCVA）、眼压、裂隙灯显微镜、间接检眼镜、眼底彩色照相、A型和（或）B型超声、光相干断层扫描检查。患眼BCVA0．02～0．4。平均屈光度（-14．1±3．8）D；平均眼轴长度（28．8±1．5）mm；平均黄斑中心凹视网膜厚度（CFT）（573．2±142．8）btm。采用经睫状体平坦部三切口25G玻璃体切割手术联合ILM剥除，手术结束时未填充气体或硅油，仅保留玻璃体灌注液。手术后随访6～28个月，观察患眼BCVA、CFT变化、黄斑区视网膜复位情况以及手术并发症发生情况。结果末次随访时，23只眼中，劈裂腔消失，视网膜完全复位者16只眼，占69．6％；劈裂腔高度不同程度下降，视网膜部分复位者4只眼，占17．4％；视网膜未复位者3只眼，占13．0％。视力提高者12只眼，占52．2％；视力稳定者9只眼，占39．1％；视力下降者2只眼，占8．7％。随访期间未见黄斑裂孔、眼底出血、低眼压以及眼内炎等并发症发生。结论无眼内填充的璃体切割手术联合ILM剥除治疗高度近视黄斑劈裂可获得较好疗效；未见手术相关并发症发生。

Objective To evaluate the efficacy of vitrectomy with internal limiting membrane peeling without intraocular tamponade in the treatment of myopic foveoschisis. Methods Twenty three eyes of 23 patients with myopic foveoschisis underwent vitreoretinal surgery were analyzed retrospectively. All the patients had undergone the examinations of best corrected visual acuity （BCVA）, intraocular pressure, slit lamp microscope,direct ophthalmoscope,A or B ultrasonic scan and optical coherence tomography（OCT）. The mean BCVA was 0.02 0.4, mean diopter was （ 14. 1±3.8） D, mean axial length was （28.8± l. 5） ram, mean central fovea thickness （CFT） was （573.2±142.8） μm. A standard 3-port pars plana vltrectomy （25-gauge system） was performed in all patients. There was no tamponade at the end of the operation. The follow up varied from 6 to 28 months. The visual acuity, CFT, retinal reattachment and the complications were observed. Results At the latest follow up, there were 16 eyes （69.6%） were anatomically reattached, 4 eyes （17.4%） were partly anatomically reattached, 3 eyes （13.0%） were not reattached. Postoperative BCVA improved in 22 eyes （52.2%）, unchanged in 9 eyes （39. 1%）, and decreased in 2 eyes （8.7%）. No ocular complications such as macular hole, fundus hemorrhage, low or high intraocular pressure, endophthalmitis were found. Conclusion Vitrectomy with internal limiting membrane peeling without gas tamponade can effectively treat myopic foveoschisis without ocular complications.