玻璃体内惰性气体填充联合激光光凝治疗高度近视性黄斑劈裂患者疗效观察

Clinical effects of intravitreal perfluoropropane tamponade and laser photocoagulation for the treatment of highly myopic foveoschisis

目的观察并分析玻璃体内C_3F_8气体填充联合黄斑区视网膜激光光凝治疗高度近视性黄斑劈裂患者的疗效。方法回顾性分析了高度近视性黄斑劈裂患者14例(18眼)。所有患者均接受0.5~0.7 m L C_3F_8气体眼内填充,在1周后行黄斑区视网膜激光光凝治疗,观察患者治疗前后的最佳矫正视力(best-corrected visual acuity,BCVA),OCT检测黄斑区中心凹视网膜厚度(central foveal thickness,CFT)和黄斑区视网膜最大厚度(maximal macular thickness,MMT)。结果 OCT检查显示治疗前CFT为(494.00±454.80)μm,治疗后末次随访下降到(193.61±97.42)μm,差异有统计学意义(P=0.01);治疗前MMT为(687.33±385.15)μm,治疗后下降至(331.06±109.31)μm,差异亦有统计学意义(P=0.001)。在末次随访时中心凹处劈裂完全或部分愈合的14眼,治疗前CFT为(567.36±493.01)μm,治疗后下降至(171.43±90.84)μm,差异有统计学意义(P=0.006);MMT治疗前为(744.14±417.38)μm,治疗后下降至(303.86±83.62)μm,差异有统计学意义(P=0.002)。所有患者治疗前BCVA为(0.94±0.39)log MAR,其中13眼的BCVA<0.6 log MAR;在末次随访时,BCVA提高到(0.92±0.36)log MAR,与治疗前相比差异无统计学意义(P=0.78)。中心凹处劈裂完全或部分愈合的14眼,治疗前BCVA为(1.04±0.37)log MAR;治疗后提高到(0.90±0.34)log MAR,与治疗前相比差异亦无统计学意义(P=0.16)。在末次随访时,4眼视力提高2行及以上,10眼的视力不变。所有患者在治疗后均无中心暗点等视觉症状,未出现眼压升高。结论玻璃体内C_3F_8气体填充联合黄斑区视网膜激光光凝治疗高度近视性黄斑劈裂患者有较好疗效。

ObjectiveTo observe and analyze the clinical outcomes of perfluoropropane(C3F8)injection and laser photocoagulation on myopic foveoschisis.MethodsA total of14patients(18eyes)diagnosed as myopic foveoschisis were enrolled in this retrospective study.All patients received intraocular tamponade of0.5-0.7mL C3F8,and after1week,underwent macular photocoagulation.These patients were given the best corrected visual acuity(BCVA)and optical coherence tomography(OCT)examination for central foveal thickness(CFT)and maximal macular thickness(MMT)before and after treatment.ResultsOCT examination showed that the mean CFT decreased significantly from(494.00±454.80)μm before treatment to(193.61±97.42)μm at the last follow up,with statistical significance(P=0.01),and the mean MMT decreased from(687.33±385.15)μm to(331.06±109.31)μm at the same duration,approaching significant difference(P=0.001).The foveoschisis healed completely and partially in14eyes at the last follow up,the mean CFT decreased significantly from(567.36±493.01)μm before treatment to(171.43±90.84)μm after treatment,with statistical significance(P=0.006),and the mean MMT decreased from(744.14±41738)μm to(303.86±8.62)μm at the same duration,approaching significant difference(P=0.002).Patients’BCVA before treatment was(0.94±0.39)logMAR,of which13eyes had BCVA<0.6logMAR,and increased to(0.92±0.36)logMAR at the last follow up,with no significant difference(P=0.78).The foveoschisis healed completely and partially in14eyes,and the BCVA was(1.04±0.37)logMAR before treatment,up to(0.90±0.34)logMAR after treatment,and the difference was not statistically significant(P=0.16).At the last follow up,the vision of4eyes was increased by2lines and above,and unchanged in10eyes.All patients had no visual symptoms such as dark spots and no increase in intraocular pressure after treatment.ConclusionIntraocular C3F8tamponade and macular photocoagulation can be an satisfying alternative treatment for patients with myopic foveoschisis.