高度近视黄斑裂孔性视网膜脱离应用玻璃体切除联合硅油填充的手术效果分析

Macular hole with retinal detachment in high myopia: therapeutic effect of vitrectomy combined with silicone oil filling

目的：探讨玻璃体切除联合硅油填充治疗高度近视黄斑裂孔性视网膜病变脱离（ MHRD）的适应证及治疗效果。方法选择29例（29只眼）高度近视黄斑裂孔性视网膜脱离患者，同时伴有视网膜周边裂孔，行玻璃体切除联合硅油填充及内界膜撕除。术后保持头低位3周，随访6～12个月，其中硅油填充时间3～6个月。观察患眼手术后矫正视力、视网膜复位、黄斑裂孔闭合情况以及并发症。结果手术后29只眼视网膜完全复位，复位率为100％。视网膜脱离复发1只眼，占3．47％。黄斑裂孔复位闭合11只眼（37．9％）；术后视力提高者26例26只眼（89．7％），不变者3只眼（10．3％）；术后2周，出现高眼压4只眼，占13．8％，给予降低眼压药物治疗后眼压控制。硅油取出手术前出现高眼压2只眼（6．89％），硅油取出手术后眼压均得到控制。结论玻璃体切割联合内界膜撕除及硅油填充可在伴有视网膜周边裂孔高度近视黄斑裂孔性视网膜病变脱离患者中获得较高的手术复位率。

Objective To investigate the indications and therapeutic effect of vitrectomy combined with silicone oil filling in the treatment of macular hole with retinal detachment in high myopia （ MHRD ） .Methods 29 patients （ 29 eyes ） with MHRD were enrolled in the study.The patients also had peripheral retinal hiatus and received vitrectomy combined with silicone oil filling and inner boundary film removal.They were kept head low for 3 weeks and followed up for 6~12 months postoperatively.Silicone oil filling time was 3-6 months.Corrected visual acuity, retinal reposition, macular hole closure and complications were observed for the diseased eye after surgery.Results All 29 patients had complete retinal reposition after surgery with a success rate of 100%.Recurrence of retinal detachment occurred in 1 eye （3.47%）.Macular hole was closed in 11 eyes （37.9%）, postoperative visual acuity improved in 26 cases （89.7%） and unchanged in 3 cases （10.3%） .Two weeks after surgery, 4 eyes （13.8%） had high intraocular pressure and were controlled by medications. Two eyes （6.89%） had high intraocular pressure before silicone oil was taken out by surgery and recovered to normal pres-sure after surgery.Conclusion Vitrectomy combined with silicone oil filling and inner boundary film removal can achieve a high surgery success rate in patients with MHRD.