玻璃体切割联合内界膜剥离术对高度近视MHRD患者黄斑区结构功能的影响及术后黄斑裂孔闭合影响因素分析

Effect of vitrectomy combined with internal limiting membrane peeling on macular structure and function in high myopia patients with MHRD and analysis of the influencing factors of macular hole closure after operation

目的探讨玻璃体切割联合内界膜剥离术(ILMP)对高度近视黄斑裂孔性视网膜脱离(MHRD)患者黄斑区结构功能的影响及术后黄斑裂孔闭合的影响因素。方法回顾性分析2016年2月—2018年8月于河北省邯郸市眼科医院行玻璃体切割联合ILMP治疗的69例高度近视MHRD患者的临床资料,根据术后3个月黄斑裂孔闭合随访结果,分为闭合组(57例)及未闭合组(12例)。所有患者均于手术前后行光学相干断层扫描、裂隙灯显微镜、最佳矫正视力检查,测量术后黄斑中心凹视网膜厚度(FRT)、黄斑中心凹下脉络膜厚度(SFCT)变化情况及术前黄斑裂孔参数、指数,并结合患者的临床资料用单因素及多因素logistic回归模型分析术后黄斑裂孔闭合影响因素。结果两组术前FRT、SFCT比较,差异无统计学意义(P>0.05)。术后,两组FRT、SFCT均薄于术前,且闭合组薄于未闭合组,差异有统计学意义(P<0.05)。两组裂孔最小径(MD)、黄斑裂孔指数(MHI)和裂孔牵拉指数(THI)比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,MD(OR=1.003,95%CI:1.000~1.005,P=0.048)、MHI(OR=108.369,95%CI:5.047~2326.771,P=0.003)、THI(OR=215.263,95%CI:2.248~20609.444,P=0.021)均为患者术后黄斑裂孔闭合的独立危险因素。结论玻璃体切割联合ILMP可明显改善高度近视MHRD患者的黄斑区结构功能,MD、MHI、THI均为影响患者术后黄斑裂孔闭合的危险因素。

Objective To investigate the effect of vitrectomy combined with internal limiting membrane peeling(ILMP)on macular structure and function in high myopia patients with macular hole retinal detachment(MHRD)and analysis of the influencing factors of macular hole closure after operation.Methods Clinical data of 69 patients with MHRD with high myopia treated with vitrectomy and ILMP in Hebei Handan Eye Hospital from February 2016 to August 2018 were retrospectively analyzed.According to the follow-up results of macular hole closure at three months after operation,they were divided into closed group(57 cases)and unclosed group(12 cases).All patients underwent optical coherence tomography,slit lamp microscopy and best corrected visual acuity before and after surgery.The changes of foveal retinal thickness(FRT),sub foveal choroidal thickness(SFCT),and the parameters and index of macular hole before and after operation were measured.Combined with clinical data of the patients,univariate and multivariate logistic regression models were used to analyze the influencing factors of macular hole closure.Results There were no significant differences in FRT and SFCT between two groups before operation(P>0.05).After operation,FRT and SFCT of two groups were thinner than those before operation,and closed group was thinner than that unclosed group,the differences were statistically significant(P<0.05).There were significant differences in MD,MHI and THI between two groups(P<0.05).Multivariate logistic regression analysis showed that MD(OR=1.003,95%CI:1.000-1.005,P=0.048),MHI(OR=108.369,95%CI:5.047-2326.771,P=0.003)and THI(OR=215.263,95%CI:2.248-20609.444,P=0.021)were independent risk factors for macular hole closure.Conclusion Vitrectomy combined with ILMP can significantly improve the macular structure and function in MHRD patients with high myopia.MD,MHI and THI are risk factors for macular hole closure.