病理性近视并发黄斑裂孔玻璃体切除联合内界膜剥除术后疗效分析

Efficacy of vitrectomy combined with internal limiting membrane peeling to treat pathological myopic macular hole

目的:探讨玻璃体切除联合内界膜剥除术治疗病理性近视黄斑裂孔的临床效果。方法:回顾性研究。选取2017-01/2019-01于我院确诊的高度近视黄斑裂孔患者18例19眼,将其分为病理性近视组(9例10眼)和非病理性近视组(9例9眼),均接受玻璃体切除联合内界膜剥除术。术后随访3~23mo,观察两组患者末次随访时最佳矫正视力(BCVA)、视物变形症状及黄斑裂孔闭合情况。结果:末次随访时,病理性近视组术后BCVA提高6眼,不变2眼,下降2眼,黄斑裂孔完全闭合7眼(70%),裸露型闭合2眼(20%),未闭合1眼(10%);非病理性近视组术后BCVA提高6眼,不变2眼,下降1眼,黄斑裂孔完全闭合8眼(88%),裸露型闭合1眼(11%)。术前两组患者眼轴长度有明显差异,眼轴长度与末次随访时黄斑裂孔闭合率呈负相关(rs=-0.477,P=0.039)。结论:玻璃体切除联合内界膜剥除术治疗高度近视黄斑裂孔可有效改善最佳矫正视力,但病理性近视患者裂孔闭合率低于非病理性近视患者。

AIM:To discuss the clinical effects of pars plana vitrectomy(PPV)combined with interal limiting membrane peeling(ILMP)for macular hole(MH)in pathological myopic eyes.METHODS:This is a retrospective case study.Eighteen patients(19 eyes)with high myopic MH diagnosed in our hospital from January 2017 to January 2019 were enrolled in this study.All eyes were grouped for pathological myopia(9 patients 10 eyes)and non-pathological myopia groups(9 patients 9 eyes).All eyes were treated with PPV combined with ILMP surgery.Postoperative follow up was 3-23mo,the efficacy was determined at the final follow up,including BCVA,visual deformation symptoms and macular hole closure.RESULTS:During the final follow up,BCVA was improved in 6 eyes,stable in 2 eyes,more severe in 2 eyes in pathological myopia group,and MH was fully closed in 7 eyes(70%),bareness-closed in 2 eyes(20%)and not closed in 1 eye(10%).In non-pathological myopia group,BCVA was improved in 6 eyes,stable in 2 eyes,more severe in 1 eyes,and MH was fully closed in 8 eyes(88%),not closed in 1 eye(11%).There were significant differences in the axial length between the two groups before surgery,axial length was negatively correlated with the macular hole closure rate at the last follow up(rs=-0.477,P=0.039).CONCLUSION:PPV combined with ILMP for the treatment of MH in high myopia can effectively improve BCVA.However,the hiatal closure rate of pathological myopia patients was lower than that of non-pathological myopia patients.