高度近视黄斑劈裂手术须防范手术相关黄斑裂孔形成的风险

The necessity to protect against the risk of surgery-related macular hole formation in high myopia foveoschis surgery

高度近视黄斑劈裂的经典手术方式为玻璃体切除、人工玻璃体后脱离、去除黄斑前玻璃体皮质、内界膜剥除以及眼内气体填塞,在此基础上有一些细微的操作变化,包括不剥除内界膜或保留中心凹的内界膜剥除,采用或不采用气体填充、硅油长期填充等。各种手术方式均取得了一定疗效,手术后可实现黄斑劈裂全部或部分缓解,视力得以不同程度提高。但值得重视的是,此类手术最常见且严重的并发症是手术后发生全层黄斑裂孔甚至黄斑裂孔性视网膜脱离。针对此类并发症风险,通过采用保留中心凹的内界膜剥除可使多数患者取得安全有效的结局,对于手术者有顾虑在手术中或手术后发生黄斑裂孔的高危病例,可采用硅油长期填充不剥除内界膜的术式,以防范手术相关黄斑裂孔形成的风险。未来应继续寻找更为安全有效的黄斑劈裂术式,以获得更好的治疗效果与更少的并发症。

The classical surgical operations for foveoschisis in high myopia are vitrectomy,artificial posterior vitreous detachment,removal of the pre-macular vitreous cortex,removal of the inner limiting membrane(ILM)and intraocular gas tamponade,with some minor variations on those basis,including no removal of the ILM or ILM peeling with preservation of the fovea area;with or without gas filling,long-term silicone oil tamponade,etc.All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees.It is worthwhile to emphasize,the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment.To address the risk of such complications,a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area.For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole,a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.