玻璃体切割联合晶状体置换治疗中青年高度近视性黄斑劈裂的疗效

Analysis of minimally invasive vitrectomy combined with lens replacement for myopic foveoschisis in young and middle-aged

目的探讨玻璃体切割联合晶状体置换治疗中青年高度近视黄斑劈裂的疗效。方法将我院眼科2013年9月至2015年10月中青年高度近视黄斑劈裂患者60眼按手术方式不同随机分为联合手术组(30眼)和分期手术组(30眼),联合手术组行玻璃体切割联合晶状体置换手术,分期手术组单纯行玻璃体切割手术,术后根据晶状体混浊程度择期行白内障手术。术后随访6~12个月,观察分期手术组二次手术率,两组术前术后最佳矫正视力(best corrected visual acuity,BCVA)、远近视力,术后6个月黄斑区视网膜复位情况并行视觉质量调查问卷。结果分期手术组术后晶状体混浊加重27只眼(90%),因此行Ⅱ期白内障手术21只眼(70%)。联合手术组BCVA恢复、术后远视力及术前术后远视力差值明显高于分期手术组(P<0.05)。两组术前、术后黄斑区视网膜情况及视网膜复位率无明显差异(P>0.05)。术后6个月视觉质量综合评分联合手术组优于分期手术组(t=-3.95,P=0.00),联合手术组在远视力、立体视觉、视疲劳项目上评分占优势,分期手术组在干眼、夜间眩光项目上评分高于联合手术组(均P<0.05)。结论玻璃体切割联合晶状体置换治疗中青年高度近视黄斑劈裂有效避免二次手术,改善视功能,是临床上可行的手术方式。

Objective To investigate the clinical effects of minimally invasive vitrectomy combined with cataract surgery for myopic foveoschisis in young and middle-aged. Methods Sixty myopic eyes with myopic fo- veoschisis diagnosed from September 2013 to October 2015 in our hospital were included in the study. According to different surgical methods, patients were divided into two groups： combined operation group （vitrectomy combined with lens replacement surgery, 30 eyes） and staged operation group （simple vitreetomy group, 30 eyes）. Cataract surgery were performed according to the opacity of lens. All the patients were followed up for 6 - 12 months. Reop- eration rate of staged operation group, the best corrected visual acuity （BCVA）, the distant and near visual acuity and retinal reattaehment rate of each group were observed. Every patient was interviewed with a questionnaire about visual quality at 6th month after surgery. Results 27 eyes developed lens opacity after operation （90%） in staged operation group, among them, 21 eyes underwent secondary cataract surgery （70%）. The BCVA recovery, postop- erative distant vision, and preoperative and postoperative distant vision difference in the combined operation group were significantly higher than those in the staged group （P 〈 0.05 ）. There were no significant differences in macu- lar retinal condition and retinal reattachment rate between the two groups （P 〉 0.05）. Six months after operation, the visual quality of the combined operation group was significantly better than that of the staged group （t = -3.95, P = 0.00）. In the combined surgery group, the scores of distant vision, stereopsis and visual fatigue were higher than those of staged operation group. The score of dry eye and night glare in staged operation group was higher than that in combined operation group （ all P 〈 0.05 ）. Conclusions Vitrectomy combined with intraocular lens replace- ment for myopic foveoschisis in young and middle-aged people can avoid second operations and improves the visualfunction, proving to be a feasible operation in clinic.