视网膜内界膜移植联合自体全血治疗高度近视继发黄斑裂孔

Treatment of macular hole in high myopia by vitrectomy with internal limiting membrane transplantation and autologous bleed

目的 探讨视网膜内界膜移植联合自体全血治疗高度近视继发黄斑裂孔的疗效.方法 选取2016年10月至2017年2月收治的高度近视继发黄斑裂孔[裂孔基底直径＞1 000 μm、裂孔形成因子（Hole Form Factor,HFF） ＜0.6]的患者50例行手术治疗,其中A组患者行玻璃体切割联合内界膜剥除术28只眼,B组患者行玻璃体切割联合内界膜移植术,术中使用自体全血封闭裂孔22只眼.术后随访3个月以上,记录术前、术后3个月的光学相干断层扫描裂孔封闭情况、最佳矫正视力（BCVA）,并对结果进行统计学分析.结果 术后3个月两组最佳矫正视力与术前相比明显提高（tA=4.024,tB=4.510,P＜0.05）,两组间视力改善比较差异无统计学意义（x2=0.136,P＞0.05）,但视力显著改善者差异有统计学意义（x2=5.021,P＜0.05）.术后3个月A组裂孔闭合率为64.2％,B组裂孔闭合率为95.5％,差异具有统计学意义（x2=6.592,P＜0.05）.术后3个月两组光感受器内外节连接（IS/OS）缺损直径较术前均明显减小,差异有统计学意义（tA=11.193,tB=15.918,P＜0.05）,两组间对比差异有统计学意义（f =3.054,P＜0.05）.结论 内界膜移植术联合自体全血可提高HFF值＜0.6的高度近视继发黄斑裂孔的术后闭合率,是一种安全有效的手术方式.

Objective To prospectively investigate the effect of internal limiting membrane transplantation and autologous plasmaon treating macular hole in high myopia.Methods fifty eyes with high myopia macular hole of the maximum diameter of the substrate 〉1000 μm and hole formation factor（Hole Form Factor,HFF）〈0.6 underwent surgical treatment..The patients were randomly divided into two groups.Group A 28 eyes in surgical removal of the internal limiting membrane group,group B 22 eyes in internal limiting membrane transplantation group who underwent the tamponade of internal limiting membrane into the hole.The patients were followed up for 3 months,and the optical coherence tomography（OCT）and the best corrected visual acuity（BCVA）were recorded before and after operation,and the results were statistically analyzed.Results In the ILM transplantation and autologous plasma group,macular hole in high myopia were closed in 21 cases（21/22,95.5%）,In the non ILM transplantation and autologous plasma group,macular hole in high myopia were closed only in 18 eyes（18/28,64.2%）.There was a sighnificant difference between the groups（x2=6.592,P 〈0.05）.The best corrected visual acuity was significantly improved compared with preoperative in two groups（tA=4.024,tB=4.510,P 〈0.05）,There was no significant difference in visual acuity between the two groups （x2=0.136,P 〉0.05）.But there was significant difference in visual acuity improvement（x2=5.021,P 〈0.05）.Conclusion Internal limiting membrane transplantation and autologous plasmais a valid treatment for macular hole in high myopia.