玻璃体切割联合内界膜剥除及空气填充治疗病理性近视黄斑劈裂手术后黄斑区微视野观察

Macular functional changes after vitrectomy with internal limiting membrane peeling and air filling for myopic foveoschisis by microperimetry

目的观察病理性近视黄斑劈裂(MF)玻璃体切割手术(PPV)联合内界膜剥除及空气填充治疗后黄斑区视功能变化。方法单中心、回顾性病例研究。2018年10月至2019年10月于天津市眼科医院检查确诊的MF患者29例32只眼纳入研究。其中,男性3例4只眼,女性26例28只眼;年龄(63.00±3.45)岁。患眼等效球镜度数(-14.16±2.54)D;眼轴长度(29.14±1.04)mm。合并黄斑板层裂孔3例3只眼。患眼均行标准经睫状体平坦部三通道25G PPV联合内界膜剥除、空气填充治疗。手术前及手术后1、3、6个月采用黄斑完整性评估仪行黄斑区微视野检查,记录患眼黄斑10°范围内视网膜平均光敏感度(MS)、黄斑中心凹2°和4°固视率(P1、P2)、63%和95%双向正态分布椭圆面积(BCEA)。手术前与手术后不同时间MS、P1、P2、63%BCEA、95%BCEA比较行配对t检验;固视稳定率比较行χ2检验。结果与手术前比较,手术后1、3、6个月,患眼MS提高差异均有统计学意义(t=-2.208、-3.435、-4.919,P=0.038、0.002、0.000)。手术后不同时间两两比较,仅手术后6个月与手术后1个月差异有统计学意义(P=0.036)。与手术前P1、P2、63%BCEA、95%BCEA比较,患眼手术后P1、P2逐渐提高,63%BCEA、95%BCEA逐渐降低,但差异均无统计学意义(P1:t=-1.595、-1.698、-1.966,P=0.125、0.104、0.062;P2:t=-1.622、-1.654、-1.707,P=0.119、0.112、0.102;63%BCEA:t=1.410、1.409、1.553,P=0.172、0.173、0.135;95%BCEA:t=1.412、1.408、1.564,P=0.172、0.173、0.132)。手术后6个月,所有患眼黄斑区解剖复位,未发现全层黄斑裂孔、黄斑裂孔视网膜脱离等严重并发症。结论PPV联合内界膜剥除及空气填充治疗MF安全、有效;手术后6个月内黄斑区MS内可显著提高。

Objective To observe the changes of macular visual function after myopic foveoschisis(MF)and pars plana vitrectomy(PPV)combined with internal limiting membrane peeling and air filling.Methods A single-center,retrospective study.From October 2018 to October 2019,29 MF inpatients(32 eyes)in Tianjin Eye Hospital were included in this study.There were 3 males(4 eyes)and 26 females(28 eyes).The age was 63.00±3.45 years old.Equivalent spherical lens degree was-14.16±2.54 D,and axial length was 29.14±1.04 mm.Among them,3 patients(3 eyes)had lamellar macular holes.All eyes underwent standard pars plana three-channel 25G PPV combined with internal limiting membrane peeling and air filling.Before surgery and at 1,3,and 6 months after surgery,macular microperimetry was performed with a macular integrity assessment instrument,and the mean retinal sensitivitie(MS)within 10°of the macula,fovea 2°and 4°fixation rates(P1,P2),63%and 95%bivariate contour ellipse area(BCEA)were recorded.The comparison of MS,P1,P2,63%BCEA and 95%BCEA at different times before and after surgery was performed by paired t test;the comparison of fixation stability rate was performed byχ2 test.Results Compared with before surgery,there were significant differences in the improvement of MS in affected eyes at 1,3 and 6 months after surgery(t=-2.208,-3.435,-4.919;P=0.038,0.002,0.000).In the pairwise comparison at different times after surgery,only 6 months after surgery and 1 month after surgery were significantly different(P=0.036).Compared with the preoperative P1,P2,63%BCEA and 95%BCEA,the P1 and P2 of the eyes gradually increased after surgery,while the 63%BCEA and 95%BCEA gradually decreased,however,the difference was not statistically significant(P1:t=-1.595,-1.698,-1.966;P=0.125,0.104,0.062.P2:t=-1.622,-1.654,-1.707;P=0.119,0.112,0.102.63%BCEA:t=1.410,1.409,1.553;P=0.172,0.173,0.135.95%BCEA:t=1.412,1.408,1.564;P=0.172,0.173,0.132).Six months after surgery,all the eyes underwent anatomical repositioning of the macular area,and no serious complications such as full-thickness macular hole and macular hole retinal detachment were found.Conclusions PPV with internal limiting membrane peeling and air filling is an effective and safe method for MF,and the macular function improved significantly within 6 months postoperatively.