后巩膜加固术治疗近视牵引性黄斑病变

Modified posterior scleral reinforcement for the treatment of traction maculopathy in myopia

目的探讨改良后巩膜加固术治疗近视牵引性黄斑病变（MTM）的安全性和疗效。方法回顾性系列病例研究。观察分析30例（52眼）行改良后巩膜加固术的MTM患者的临床资料，其中高度近视黄斑劈裂（MF）14例（26眼），黄斑脱离不合并黄斑裂孔（MD）11例（19眼），黄斑脱离合并黄斑裂孔（MHMD）5例（7眼）。所有患者均行改良后巩膜加固联合前房穿刺放液术。手术前后各组视力和眼轴长度比较采用配对t检验。结果术前和术后3个月平均最佳矫正视力：MF组为0．82±0．15和0．58±0．24（t=7．552，P〈0．001），MD组为1．06±0．17和0．71±0．27（t=7．120，P〈0．001），MHMD组为1．78±0．22和0．91±0．21（t=17．571，P〈0．001），术后视力较术前改善，差异均有统计学意义。术前和术后3个月平均眼轴长度为（29．59±1．57）mm和（27．60±1．35）mm，眼轴缩短（1．99±0．63）mm，差异有统计学意义（t=22．880，P〈0．001）。MHMD患眼视网膜均复位，4眼（4／7）裂孔闭合。所有MD患眼及21只MF患眼视网膜复位，余5只MF患眼病情明显改善。术后并发症包括疼痛、结膜损伤、视物变形或变形加重等。结论改良后巩膜加固术治疗MTM安全有效，在临床上可考虑首选。

Objective To evaluate the clinical effect and safety of modified posterior scleral reinforcement for the treatment of traction maculopathy in myopia. Methods This retrospective study included 30 patients （52 eyes） who were diagnosed with traction maculopathy in myopia. Fourteen cases （26 eyes） of macular foveoschisis （MF）, 11 cases （19 eyes） of macular detachment （MD）, and 5 cases （7 eyes） of macular hole with macular detachment （MHMD） were included in the study. All patients underwent modified scleral reinforcement combined with anterior chamber paracentesis. Best corrected visual acuity （BCVA） and axial length before and after the operation were compared by paired t-tests. Results The preoperative and 3 months postoperative BCVAs in the MF group （0.82±0.15 vs. 0.58±0.24, t=7.552, P〈0.001）, the MD group （1.06±0.17 vs. 0.71±0.27, t=7.120, P〈 0.001）, and the MHMD group （1.78±0.22 vs. 0.91±0.21, t=17.571, P〈0.001） each improved significantly. The axial lengths shortened from 29.59±1.57 mm to 27.60±1.35 mm of all the patients （t=22.880, P〈0.001）. Macular holes closed in 4 eyes in the MHMD group. The retina reattached in all eyes in the MD group and in 21 eyes in the MF group. The remaining 5 eyes in the MF group had an improved retinal appearance. Postoperative complications included pain, conjunctival injury, visual distortion, and a worsening visual distortion. Conclusion Modified posterior scleral reinforcement is an effective and safe way to treat traction maculopathy in myopia. It can be considered as the first choice in the clinic.