内界膜剥除治疗变性近视黄斑孔视网膜脱离的效果

Efficacy of internal limiting membrane peeling for macular hole retinal detachment in degenerative myopia

目的观察玻璃体切除联合内界膜剥除及硅油填充术治疗变性近视黄斑孔视网膜脱离（DM－MHRD）的效果，分析影响术后疗效的相关因素。方法回顾性分析2007年4月至2014年4月温州医科大学附属眼视光医院手术治疗的DM－MHRD69例（74眼）。所有患眼均行玻璃体切除联合内界膜剥除及硅油填充术，并二次手术取出硅油。随访至少6个月。比较手术前后最佳矫正视力（BCVA）的变化，观察术后视网膜复位、黄斑孔闭合及并发症情况。采用逻辑回归分析术后孔闭合和视力提高的影响因素。结果术后BCVA（logMAR）为（1．10±0．43），较术前的（1．44±0．48）有显著提高（P=0．001）。视网膜复位68眼，复位率91．9％，视网膜复位且黄斑孔完全闭合，即一类愈合43眼，视网膜复位但孔不能完全闭合，即二类愈合25眼。术后视力提高46眼，提高率62．2％。逻辑回归分析，术前视力情况是术后视力提高的影响因素（OR=10．680，P=0．003）。术后2眼复发网脱，再次手术达到视网膜解剖复位。结论内界膜剥除联合硅油填充术是治疗DM－MHRD的有效术式，术前视力情况是影响视力预后的主要因素。

Objective To observe the efficacy of vitrectomy combined with internal limiting membrane（ILM） peeling and silicone oil tamponade for the treatment of macular hole retinal detachment （MHRD） in degenerative myopia （DM）, and analyze the related factors affecting the operative efficacy. Methods A retrospective analysis. Seventy-four eyes of 69 patients with DM-MHRD between April 2007 and April 2014 in the Affiliated Hospital of Wenzhou Medical University were enrolled. All patients underwent vitrectomy combined with ILM peeling and silicone oil tamponade after gas exchange, and a secend surgery to remove the oil. The follow up was at least 6 months. The changes of BCVA were compared before and after surgery. The visual acuity improved rate , the retinal reattachment, macular hole closure and postoperative complications were recorded, and the factors on macular hole closure and improvement of visual acuity were analyzed. Results The BCVA（logMAR） was （1.10 ± 0.43 ） ,which was significantly improved compared to that before surgery （ 1. 44 ±0. 48 ） （ P = 0. 001 ）. Sixty-eight eyes （ 91. 9% ） demonstrated retinal reattachment,43 eyes （58.1%） achieved the Ⅰ-type of macular hole closure, and another 25 eyes （33.8%） got the Ⅱ-type of macular hole closure. The visual acuity improved rate was 62.2% ,which meant there were 46 eyes got better BCVA after operation. Logistic regression analysis showed that postoperative visual acuity improvement was correlation with preoperative BCVA （OR = 10. 680, P = 0. 003 ）. After operation, MHRD recurred in 2 eyes, and the retina reattched by reoperation. Conclusion Vitrectomy combined with ILM peeling and silicone oil tamponade is an effective procedure for the treatment of DM-MHRD. Prognosis of postoperative vision depends on preoperative visual acuity.