玻璃体切割联合内界膜填塞术治疗高度近视黄斑裂孔性视网膜脱离

Observation on the curative effects of vitrectomy combined with internal limiting membrane packing in the treatment of retinal detachment with macular hole due to high myopia

目的观察玻璃体切割联合内界膜填塞手术治疗高度近视黄斑裂孔性视网膜脱离的疗效。方法对2015年5月至2018年1月在我院接受玻璃体切割联合内界膜填塞手术治疗的高度近视黄斑裂孔性视网膜脱离患者18例18眼的临床资料进行回顾性分析,均采用23G玻璃体切割联合内界膜填塞的手术方式,术中根据患者晶状体混浊情况,必要时联合行白内障超声乳化摘出手术。术后随访6个月,观察术眼的最佳矫正视力、黄斑孔闭合、视网膜复位以及并发症发生情况。结果术后17眼(94.44%)一次手术后视网膜复位,1眼经再次手术后仍存在局限性视网膜脱离,患者未进行再次手术治疗。OCT随访显示,黄斑裂孔Ⅰ类U形愈合3眼(16.67%),Ⅰ类V形愈合9眼(50.00%),Ⅱ类W形愈合5眼(27.78%),未愈合1眼(5.56%)。所有患者手术后最佳矫正视力均较术前有不同程度改善,差异有统计学意义(P<0.05)。术后2眼发生一过性眼压升高,1眼术后出现前房房水闪辉,1眼因患者术后俯卧位置不当出现人工晶状体瞳孔区夹持,经治疗后均恢复正常;2眼术后出现晶状体后囊羽毛状混浊。结论玻璃体切割联合内界膜填塞手术是治疗高度近视黄斑裂孔性视网膜脱离的有效方法,能够有效促进黄斑裂孔的愈合以及视网膜的复位。

Objective To observe the curative effects of vitrectomy combined with internal limiting membrane(ILM) packing in the treatment of retinal detachment with macular hole due to high myopia.Methods A retrospective analysis on the clinical data of 18 patients(18 eyes) with high myopia and retinal detachment with macular hole was carried out,who had been treated by vitrectomy combined with internal limiting membrane(ILM) packing between May 2015 and January 2018 in the hospital.All the patients underwent 23 G vitrectomy combined with ILM packing.According to their phacoscotasmus,if necessary,the patients also accepted phacoemulsification.The postoperative observations mainly focused on the eye visions,intraocular pressure,closure of macular hole,retinal reattachment and complications.The follow-up lasted for 6 months.Results After the operation,a total of 17 eyes had retinal reattachment,while one eye remained with local retinal detachment after the second operation.The patient did not further undergo operation.OCT follow-up showed that the macular holes in 3 eyes(16.67%) saw class Ⅰ U-shaped healing,9 eyes(50.00%) class Ⅰ V-shaped healing,and 5 eyes(27.78%) class Ⅱ W-shaped healing,while 1 eye(5.56%) had no healing.After the operation,visions of all the patients improved at different degrees,the difference has statistically significant(P<0.05).Postoperatively,two eyes appeared transient increased intraocular pressure within a week,one eye appeared aqueous flare in anterior chamber,one eye appeared intraocular lens pupillary capture due to improper prone position,which recovered by treatment and two eyes had posterior capsule opacification.Conclusion Vitrectomy combined with ILM packing is an effective method for treatment of retinal detachment with macular hole due to high myopia,which could effectively help the healing of macular hole and retinal reattachment.