白内障超乳联合玻璃体手术治疗病理性近视黄斑劈裂的疗效观察

Combined phaco and vitrectomy with and without ILM peeling in the treatment of myopic foveoschisis

目的探讨白内障超乳（Phaco）联合玻璃体手术，剥离与不剥离内界膜（ILM）治疗病理性近视黄斑劈裂（PMFs）的临床疗效。方法自2014年1月至2016年10月将我院收治的PMFS患者19例（20只眼）随机分成内界膜剥离LLM组和不内界膜剥离LLM组。所有患者均行Phaco并人工晶体植入，同时联合玻璃体手术，术中行ILM剥离或不剥离，术后比较两组情况。随访7-66个月，平均30个月。结果术后两组患者的最佳矫正视力均比术前提高，差异具有统计学意义（P〈0．01）；但两组的术后logMARBCVA差异无统计学意义（P=0．53）。两组术后黄斑厚度均较术前明显变薄，差异具有统计学意义（P〈0．01）；剥离ILM组术后黄斑厚度比不剥离ILM组更薄，差异具有统计学意义（P=0．03）。剥离ILM组9只眼术后黄斑劈裂完全恢复，1只眼黄斑劈裂减轻。不剥离ILM组术后黄斑劈裂完全恢复的3只眼，7只眼黄斑劈裂明显好转。结论Phaco联合玻璃体手术可以明显提高患者的视功能；虽然剥离ILM与否并不能进一步提高术后视力，但剥离ILM更容易使劈裂完全恢复，可能更有利于长远的视功能稳定。较大范围的内界膜剥离或有助于减少术后黄斑裂孔并发症的发生。

Objective To evaluate the clinical effects of combined phaco and vitrectomy with and without ILM peeling in the treatment of pathological myopic foveoschisis（PMFS）. Methods A total of 19 cases （20 eyes） of PMFS were treated with combined phaco and vitrectomy and random-ized into ILM peeling or non-ILM peeling group. Results The follow-up duration was 7 to 66 months. Postoperative 10gMAR BCVA was significantly improved compared to preoperative values in both groups （P 〈0.01） . But there was no significant difference in postoperative logMAR BCVA be-tween two groups. Postoperative foveal retinal thickness was decreased dramatically compared to pre-operative values in both groups（P 〈0.01）, whiie in ILM peeling group decreased more than that in non-ILM peeling group（P =0.03）. Nine of 10 eyes had schisis completely resolved in ILM-peeling group but only 3 of 10 eyes in non-ILM peeling group. Conclusions Phaeo-IOL combined with vit-rectiomy can improve the visual function no matter whether ILM is peeled or not, but foveo-schisis is more likely to be resolved completely with ILM peeling.