ILMP及玻璃体腔注药联合硅油填充治疗高度近视MHRD合并脉络膜脱离

Efficacy of internal limiting membrane peeling and vitrectomy with triamcinoione acetonide and silicone oil tamponade for the treatment of retinal detachment with choroidal detachment attributable to macular hole in high myopia

目的:观察内界膜剥除(internal limiting membrane peeling,ILMP)和玻璃体腔注射曲安奈德联合硅油填充治疗高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离的临床疗效。方法:高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离患者28例28眼,均行玻璃体切割(pars plana vitrectomy,PPV)吲哚菁绿辅助的ILMP以及硅油填充手术,术中将曲安奈德注射于玻璃体腔,术后随访6~24mo,观察术后视网膜复位率、视力恢复情况和术后并发症。结果:术后随访6~24mo,患者手术后平均LogM AR矫正视力为1.01±0.31,与手术前平均LogM AR矫正视力比较,差异有统计学意义(t=-39.28,P<0.01)。黄斑裂孔闭合19眼(68%),黄斑裂孔未闭合9眼(32%),26眼视网膜复位(93%),6眼出现高眼压。结论:玻璃体切割联合ILMP及硅油填充和玻璃体腔注射曲安奈德治疗高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离,可阻止增生性玻璃体视网膜病变的再生,提高视网膜复位率。

AIM： To evaluate the effects of internal limiting membrane peeling and vitrectomy with triamcinolone acetonide and silicone oil tamponade for the treatment of retinal detachment with choroidal detachment attributable to macular hole in patients with high myopia. METHODS： Totally 28 eyes of 28 patients with retinal detachment associated with choroidal detachment attributable to macular hole in patients with high myopia, were treated with pars plana vitrectomy （PPV） and indocyanine green （ICG） assisted internal limiting membrane peeling （ILMP） and silicone oil tamponade. All patients had been followed up for 6-24mo. The reset rate of retinal detachment and the vision recovery, complications were analyzed. RESULTS： All patients had been followed up 6-24mo. The mean LogMAR CVA was 1.01 ± 0.31 after surgery, which significantly improved compared to that before surgery （ t=-39.28, P〈0.01 ）. Of these 28 eyes, macular hole closed in 19 eyes（68% ）, macular hole did not close in9 eyes（32%）, retinal reattached in 26 eyes （93%）, high intraocular pressure appeared in 6 eyes. CONCLUSION. For the treatment of retinal detachment associated with choroidal detachment attributable to macular hole in patients with high myopia, PPV combined with ILMP and silicone oil tamponade and triamcinolone acetonide show a high retinal reattachment rate, which can arrest the regeneration of proliferative vitreoretinopathy.