玻璃体手术治疗高度近视黄斑孔性视网膜脱离及合并黄斑孔的裂孔源性视网膜脱离的疗效比较

Comparison of clinical efficacy of vitrectomy for macular hole induced retinal detachment in high myopia and for rhegmatogenous retinal detachment with maeular hole

目的比较玻璃体切除联合内界膜剥除术治疗高度近视黄斑孔性视网膜脱离和合并黄斑孔的裂孔源性视网膜脱离的疗效。方法回顾性研究。将眼轴长度≥26mm的轴性高度近视黄斑孔性视网膜脱离30例30只眼纳入研究，以同时期合并黄斑孔的裂孔源性视网膜脱离21例21只眼作为对照组。所有患者均行玻璃体切除联合内界膜剥除手术，玻璃体腔内填充16％C，F。或硅油。对比两组黄斑孔闭合率及视力恢复情况。结果高度近视黄斑孔性视网膜脱离组黄斑孔闭合率为96．67％（29／30），合并黄斑孔的裂孔源性视网膜脱离组黄斑孔闭合率为90．48％（19／21），两组黄斑孔闭合率差异无统计学意义（X2=0．10，P=0．75）；高度近视黄斑孔性视网膜脱离组平均最佳矫正视力（LogMAR）术前为（1．87±0．55），术后为（1．13±0．50）；合并黄斑孔的裂孔源性视网膜脱离组平均最佳矫正视力（LogMAR）术前为（2．00±0．54），术后为（1．16±0．51），两组患者末次随访视力提高幅度差异无统计学意义（F=0．19，P=0．66）。结论玻璃体切除联合内界膜剥除是治疗高度近视黄斑孔性视网膜脱离及合并黄斑孔的裂孑L源性视网膜脱离的有效方式，黄斑孔闭合率及视网膜复位率高，视力恢复良好。

Objective To compare the outcomes of vitrectomy and internal limiting membrane peeling for the treatment of macular hole retinal detachment （ MHRD ） in high myopia and rhegmatogenous retinal detachment with macular hole （ RRD ＋ MH）. Methods In this retrospective ease-control study, 51 eyes of 51 consecutive patients of retinal detachment with macular hole received standard pars plana vitrectomy with internal limiting membrane peeling and 16% C3 Fs/silieon oil tamponade. They were divided into two groups. Thirty eyes of MHRD with axial high myopia （the axial length longer than 26.0 mm） were in research group （high myopia group） and 21 eyes of 21 patients with RRD ＋ MH were in control group （ RRD ＋ MH group）. Anatomical closure of macular holes using optical coherence tomography （OCT） and final best-corrected visual acuity （BCVA） were compared between the two groups. Results Anatomical closure of the macular hole confirmed by OCT was achieved in 29 of 30 eyes （96.67%） in the high myopia group, and in 19 of 21 eyes （90.48%） in the RRD ＋ MH group. There was no statistically significant difference between the two groups （X2 = 0. 10, P = 0.75 ） ： In the high myopia group, the mean LogMAR VA was （ 1.13 ±0.50） at the final follow-up after the surgery, and it was （ 1.87 ±0.55） before the surgery. In the RRD ＋ MH group, it was （2.00 ± 0.54） before surgery and （ 1.16 ± 0.51 ） after surgery. There was no significant statistically difference between the two groups in visual increase （p = 0.66 ）. Conclusion Vitrectomy and internal limiting membrane peeling with C3Fs/silicone oil tamponade is effective for the treatment of macular hole induced retinal detachment in high myopia and rhegmatogenous retinal detachment with macular hole, with high closure rate of the macular hole and significant visual improvement.