高度近视黄斑孔视网膜脱离内界膜遮盖与填塞的效果比较

Comparison on the efficacy between inverted internal limiting membrane covering and internal limiting membrane insertion for the treatment of high myopia with macular hole and retinal detachment

目的比较玻璃体切除术联合内界膜翻转遮盖与联合内界膜填塞两种手术方式治疗高度近视黄斑孔视网膜脱离的效果。方法本研究为回顾性病例对照研究。纳入安阳市眼科医院2017年5月至2021年3月收治的高度近视黄斑孔视网膜脱离62例(62眼)。其中采用玻璃体切除术联合内界膜翻转遮盖自体血覆盖33眼为遮盖组, 玻璃体切除术联合内界膜填塞自体血覆盖29眼为填塞组。术后3个月进行两组效果比较。结果术后视力均较术前改善。术前术后视力两组间比较差异均无统计学意义(t=1.242, P=0.219;t=-0.518, P=0.608)。术后两组黄斑孔均闭合且视网膜脱离复发。术后填塞组黄斑中心区厚度大于遮盖组(t=-2.485, P=0.019), 椭圆体带缺失长度小于遮盖组(t=2.230, P=0.033)。结论玻璃体切除术联合内界膜填塞治疗高度近视黄斑孔视网膜脱离其黄斑孔愈合厚度与椭圆体带缺失长度优于内界膜遮盖, 但是两组闭孔率与术后视力提升效果无差异。

Objective To compare the efficacy between vitrectomy combined with inverted internal limiting membrane covering and vitrectomy combined with internal limiting membrane insertion for the treatment of high myopia with macular hole and retinal detachment.Methods This was a retrospective case controlled study.Total of 62 eyes of 62 cases of high myopia with macular hole and retinal detachment from May 2017 to Mar.2021 in Anyang Eye Hospital were included.Among them,33 eyes in the covering group received vitrectomy combined with inverted internal limiting membrane covering and autologous blood sealing,29 eyes in the insertion group received vitrectomy combined with internal limiting membrane insertion and autologous blood sealing.The efficacy between the two groups were compared after 3 months postoperatively.Results BCVA after operation in the two groups were improved.There was no significant difference in BC V A between the two groups before and after operation(t=1.242,P=0.219;t=-0.518,P=0.608).No macular hole unclosure or recurrent retinal detachment occurred in the two groups.In the insertion group,the central macular thickness was higher than that of the covering group and the difference was statistically significant(t=-2.485,P=0.019).In insertion group,the defect length of the elliptical band was smaller than that of the covering group and the difference was statistically significant(t=2.230,P=0.033).Conclusion Vitrectomy combined with internal limiting membrane insertion for the treatment of high myopia with macular hole retinal detachment is superior to the covering group in macular hole healing and ellipsoidal band defect length.However,there is no difference between the two groups in obturation rate and postoperative visual acuity.