玻璃体切除联合内界膜剥除术治疗高度近视眼黄斑劈裂的疗效观察

Therapeutic effects of pars plana vitrectomy combined with internal limiting membrane peeling on high myopic foveoschisis

目的探讨玻璃体切除联合保留黄斑中心凹的环形内界膜剥除术治疗高度近视眼黄斑劈裂的临床疗效。方法病例对照研究。纳入2016年6月至2017年5月在浙江省丽水市中心医院拟行玻璃体切除联合内界膜剥除术治疗高度近视眼黄斑劈裂的患者72例(86只眼),其中男性18例(18只眼),女性54例(68只眼),年龄(50.5±8.9)岁。采用随机数字表和随机数余数分组法随机分为观察组(34例,43只眼)和对照组(38例,43只眼)。所有患者均行玻璃体切除手术,对照组术中剥除黄斑区内界膜,观察组术中保留中心凹的环形内界膜,白内障严重者联合白内障摘除手术。观察所有患者治疗前后的最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CFT)、屈光度数、眼压、眼轴长度及黄斑形态完全愈合情况。两组治疗前后计量数据的比较采用配对t检验,黄斑愈合分布的比较采用卡方检验。结果观察组治疗前CFT为(723.49±130.95)μm,末次随访下降至(286.33±210.73)μm,差异有统计学意义(t=17.059,P=0.000);黄斑中心凹处劈裂完全或部分愈合的39只眼中,治疗前BCVA为0.99±0.40,治疗后提高到0.68±0.24,差异有统计学意义(t=7.585,P=0.000)。对照组治疗前CFT为(726.98±140.62)μm;治疗后末次随访下降至(297.88±241.56)μm,差异有统计学意义(t=16.271,P=0.000);中心凹处劈裂完全或部分愈合的38只眼中,治疗前BCVA为1.04±0.47,治疗后提高到0.69±0.21,与治疗前相比差异有统计学意义(t=6.707,P=0.00)。以末次随访时间为疗效判定时间,观察组和对照组BCVA(t=0.22)和CFT(t=0.236)的差异均无统计学意义(P>0.05);观察组和对照组中出现黄斑裂孔差异率有统计学意义(P=0.026)。结论玻璃体切除联合保留黄斑中心凹的环形内界膜剥除治术在有效治疗高度近视眼黄斑劈裂的同时,可减少术后黄斑裂孔的形成。

Objective To observe the clinical efficacy of vitrectomy combined with foveal-sparing circular internal limiting membrane peeling with the central fovea reserved in patients with high myopic foveoschisis.Methods Case-control study.A total of 72 patients(86 eyes)with foveoschisis due to high myopia who underwent vitrectomy combined with internal limiting membrane peeling in Lishui Municipal Central Hospital of Zhejiang Province from June 2016 to May 2017 were enrolled,including 18 males(18 eyes)and 54 females(68 eyes),aged(50.5±8.9)years.The patients were randomly divided into the observation group(34 cases,43 eyes)and the control group(38 cases,43 eyes)using a random number table and random number residual grouping method.Vitrectomy was performed in all patients.In the control group,the limiting membrane in the macular area was removed during surgery.In the observation group,the foveal annular internal limiting membrane was preserved during surgery.In severe cases,cataract extraction was performed.Results In the observation group,the mean central foveal thickness(CFT)on optical coherence tomography was(723.49±130.95)μm preoperatively and decreased to(286.33±210.73)μm postoperatively,and the difference had statistical significance(t=17.059,P=0.000).In 39 eyes with complete or partial healing of the foveal split,the best corrected visual acuity(BCVA)was(0.99±0.40)logMAR before the treatment and increased to 0.68±0.24 after the treatment,and the difference had statistical significance(t=7.585,P=0.000).In the control group,the mean CFT was(726.98±140.62)μm and(297.88±241.56.)μm before and after the treatment,respectively,and the difference had statistical significance(t=16.271,P=0.000).In 38 eyes with complete or partial healing of the foveal split,the BCVA increased from preoperative 1.04±0.47 to postoperative 0.69±0.21,and the difference had statistical significance(t=6.707,P=0.00).With the follow-up time as the efficacy determination time,there was no significant difference in BCVA(t=0.22,P=0.983)and CFT(t=0.236,P=0.814)between the observation group and the control group(P>0.05);there was significant difference in the incidence rate of macular holes(P=0.026).There was no statistically significant difference in the rate of complete macular morphology healing between the two groups(P=0.816).Conclusion Vitrectomy combined with foveal-sparing circular internal limiting membrane peeling can effectively treat high myopic macular holes and reduce the formation of postoperative macular holes.