内界膜反转填塞治疗高度近视黄斑孔严重视网膜脱离

Inverted internal limiting membrane filling for severe retinal detachment secondary to macular hole in high myopia

目的观察玻璃体切除联合视盘上方造孔排液、内界膜瓣反转填塞及硅油填充治疗高度近视黄斑孔性严重视网膜脱离的临床效果。方法回顾性病例系列研究。纳入华中科技大学同济医学院附属协和医院眼科2019年5月至2021年11月高度近视黄斑孔严重视网膜脱离32例(32只眼), 均接受玻璃体切除术。所有患眼均为广泛性视网膜脱离, 眼轴长度为(30.20±1.70) mm, 其中13只眼合并脉络膜脱离。手术中行视盘上方1~2 PD造孔, 排出视网膜下液, 制作黄斑孔周围内界膜瓣, 并行内界膜瓣反转填塞黄斑孔, 再联合硅油填充。观察患者视网膜复位情况、黄斑孔闭合及视力变化。硅油取出后随访4~24个月。结果术后黄斑孔U型闭合者71.88%(23/32), 均成功实施了内界膜瓣反转填塞;W型闭合者25.00%(8/32), 其中6只眼未成功剥离内界膜, 2只眼未成功填塞内界膜。所有患眼一次硅油取出后视网膜在位, 视网膜复位率为100.00%。视力(BCVA, logMAR)从术前2.14±0.27提高到1.48±0.34(t=11.37, P<0.001)。结论玻璃体切除联合视盘上方造孔排液、内界膜瓣反转填塞及硅油填充治疗严重的高度近视黄斑孔性视网膜脱离临床疗效较好。

Objective To observe the clinical efficacy of vitrectomy with hole-making and subretinal fluid drainage above the optic disc,inverted internal limiting membrane flap filling and silicone oil tamponade in the treatment of severe retinal detachment caused by macular hole(MHRD)in high myopia.Methods This was a retrospective case series study.Thirty-two eyes of 32 patients with severe MHRD in high myopia from May 2019 to Nov.2021 in the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were included.All cases were with extensive retinal detachment.Thirteen cases were complicated with choroidal detachment.The axial length was(30.20±1.70)mm.All cases received vitrectomy.During the operation,the hole was made about 1-2 PD above the optic disc first,then the subretinal fluid was drained and internal limiting membrane flap around the macular hole was made,finally the internal limiting membrane flap was reversed to fill the macular hole combined with silicone oil tamponade.Retinal reattachment,macular hole closure and changes of visual acuity were observed in the follow-up.The follow-up time was 4-24 months after primary silicone oil removal.Results After operation,U-type macular hole closure occurred up to 71.88%(23/32),and the inverted internal limiting membrane flap filling was successfully implemented in eyes with U-type macular hole closure.W-type macular hole closure occurred at 25.00%(8/32).Among the W-type macular hole closure,the internal limiting membrane was not successfully removed in 6 eyes and not successfully filled in 2 eyes.The retina was reattached in all eyes after primary silicone oil removal at 100.00%.The visual acuity(BCVA,logMAR)improved from 2.14±0.27 before operation to 1.48±0.34(t=11.37,P<0.001).Conclusion Vitrectomy combined with hole-making and subretinal fluid drainage above the optic disc,inverted internal limiting membrane flap filling and silicone oil tamponade is effective in the treatment of severe MHRD in high myopia.