玻璃体切除术联合内界膜翻转填塞治疗高度近视黄斑孔性视网膜脱离的效果

Efficacy of vitrectomy combined with inverted internal limiting membrane tamponade on macular hole retinal detachment in high myopia

目的评价玻璃体切除术联合内界膜翻转填塞或内界膜剥除术(ILMP)治疗高度近视黄斑孔性视网膜脱离(MHRD)的效果。方法回顾性队列研究。收集信阳市中心医院2018年12月至2021年12月高度近视MHRD 67例(67只眼)的临床资料, 患者依据手术方式分为两组, A组36例, 采用玻璃体切除术联合内界膜翻转填塞术, B组31例, 采用玻璃体切除术联合ILMP。随访6个月, 比较两组的黄斑孔闭合率、视力(logMAR, BCVA)、椭圆体带缺损直径及外界膜缺损直径。结果 A组黄斑孔闭合率75.00%(27/36)高于B组的48.39%(15/31)(χ^(2)=5.04, P=0.025);术后两组BCVA均明显提高, 且A组视力0.41±0.09优于B组0.56±0.11(t=6.14, P<0.001);术后, 两组椭圆体带缺损直径、外界膜层缺损直径均较术前[A组(851.29±75.36)μm、(1 158.65±355.14)μm, B组(849.37±73.94)μm、(1 163.14±349.28)μm]降低, 且A组[(294.28±51.74)μm、(441.67±132.07)μm]低于B组[(511.07±61.35)μm、(559.64±135.58)μm](t=15.69、3.60, 均P<0.001)。结论与玻璃体切除术联合ILMP治疗方案相比, 玻璃体切除术联合内界膜翻转填塞治疗高度近视MHRD安全有效, 可显著提高黄斑孔闭合率。

Objective To evaluate the efficacy of vitrectomy combined with inverted internal limiting membrane tamponade and stripping of internal limiting membrane for the treatment of macular hole retinal detachment(MHRD)in high myopia.MethodsA retrospective cohort study was used to collect the clinical data of 67 eyes of 67 cases with high myopia MHRD in Xinyang Central Hospital from Dec.2018 to Dec.2021.The patients were divided into two groups based on the surgical methods.Group A with 36 cases received vitrectomy combined with inverted internal limiting membrane tamponade,and 31 cases in group B were treated with vitrectomy combined with stripping of internal limiting membrane.The follow-up time was 6 months.The closure rate of macular hole,the best corrected visual acuity(logMAR,BCVA),the diameters of ellipsoidal zone defects and the external membrane defects between the two groups were compared.Results The closure rate of macular hole in group A was 75.00%(27/36),which was higher than the 48.39%(15/31)in group B(X?=5.04,P=0.025).Postoperative BCVA significantly improved in both groups,and it was better in group A(0.41±0.09)than in group B(0.56±0.11)(t=6.14,P<0.001).After operation,the diameters of ellipsoidal zone defects and the external membrane defects in both groups were lower than those before operation[group A:(851.29±75.36)μm,(1158.65±355.14)μm,group B:(849.37±73.94)μm,(1163.14±349.28)μm],and they were lower in group A[(294.28±51.74)μm,(441.67±132.07)μm)than in group B[(511.07±61.35)μm,(559.64±135.58)μm](t=15.69,3.60;P<o.oo1).Conclusion Compared with vitrectomy combined with stripping of internal limiting membrane,vitrectomy combined with inverted internal limiting membrane tamponade is a safe and effective method to treat high myopia MHRD.The closure rate of the hole can be improved significantly.