不同类型近视牵引性黄斑病变玻璃体切割手术后疗效分析

The efficacy of vitrectomy for myopic traction maculopathy

目的观察不同类型近视牵引性黄斑病变（MTM）患者玻璃体切割手术后黄斑区结构和视功能的变化。方法回顾性病例研究。2010年1月至2014年5月连续收治的不伴孔源性视网膜脱离的MTM患者47例47只眼纳入研究。患者中，男性9例9只眼，女性38例38只眼。平均年龄（65．13±6．98）岁，平均眼轴长度（29．23±1．77）mm。根据光相干断层扫描（OCT）检查显示的黄斑病变形态将患眼分为单纯黄斑劈裂（MRS）组、无裂孔性视网膜脱离（FD）组、全层黄斑裂孔（MH）组，分别为18、13、16只眼。均行最佳矫正视力（BCVA）、眼压、眼轴、A／B型超声、眼底彩色照相、OCT、微视野检查。BCVA记录时转换为最小分辨角对数（logMAR）视力。患眼平均logMARBCVA1．43±0．52。MRS组、FD组患眼平均黄斑中心视网膜厚度（CRT）为（528．45±167．61）μm。所有患眼均接受标准经睫状体平坦部三通道23G微创玻璃体切割联合内界膜剥除手术。手术后平均随访时间23．4个月。观察手术后患眼视力、微视野及黄斑区解剖结构变化。结果末次随访时，47只眼平均logMARBCVA为0．86±0．42；与手术前平均logMARBCVA比较，差异有统计学意义（t=7．36，P〈0．001）。MRS组、FD组患眼平均CRT为（250．90±91．81）μm；与手术前平均CRT比较，差异有统计学意义（t=8．17，P〈0．001）。MRS组18只眼视网膜结构均复位或改善。FD组13只眼中，黄斑区视网膜结构复位11只眼；MH形成2只眼。MH组16只眼中，MH性视网膜脱离复发1只眼。MRS组、FD组、MH组患眼之间IogMARBCVA（x2=6．38）、黄斑区视敏度（x2=11．08）比较，差异有统计学意义（P=0．030、0．004）。结论近视性MRS手术后黄斑区结构与视功能恢复优于近视性MH、无裂孔性视网膜脱离。

Objective To observe the anatomical and functional changes in patients with different degrees of myopic traction maculopathy （MTM） after vitrectomy. Methods It was a retrospective case series study. Forty-seven consecutive patients （47 eyes） diagnosed with MTM were studied between January 2010 and May 2014. There were 38 females （38 eyes） and 9 male （9 eyes）,mean age was （65.13±6.98） years, mean axial length was （29.23 ± 1.77） mm. The eyes was divided into 3 groups according to the macular morphologies on optical coherence tomography （OCT）, including macular retinoschisis only group （MRS group, 18 eyes）, foveal retinal detachment group （FD group, 13 eyes） and full-thickness macular hole group （MH group, 16 eyes）. All the eyes underwent minimum resolution angle in logarithmic （ logMAR ） best corrected visual acuity （ BCVA ）, intraocular pressure, axial length, A or B-ultrasonography, fundus photography, OCT and microperimetry examinations. The average IogMAR BCVA of 47 eyes was 1.43±0.52. The center retinal thickness （CRT） of eyes in MRS and FD group was （528.45 ± 167.61） μm. All the patients underwent pars plana vitrectomy combined with internal limiting membrane peeling. The mean follow-up period was 23.4 months. The changes of logMAR BCVA, microperimetry and macular microstructural were observed. Results At the final follow-up, the logMAR BCVA of 47 eyes was 0. 86±0.42, which improved compared with the preoperative vision （t=7.36,P〈 0.001）. The mean CRT of eyes in MRS and FD group was （250.90 ± 91.81） μm, which improved compared with the preoperative CRT （t=8. 17, P〈0. 001）. In MRS group, the retina was attached in 18 eyes. In FDgroup, the retina was attached in 11 eyes, MH was observed in 2 eyes. In MH group, recurrent retinal detachment was observed in 1 eye. The differences of logMAR BCVA and retinal sensitivity among MRS, FD and M H groups were significant （x2=6.38, 11.08; P =0. 030, 0. 004）. Conclusion The macular structural and visual function in MTM eyes with macular retinoschisis only after vitrectomy are better than those in MTM eyes with MH and foveal retinal detachment.