玻璃体切割手术治疗伴与不伴黄斑劈裂的高度近视黄斑裂孔的疗效分析

Efficacy of vitrectomy for highly myopic macular hole with or without foveoschisis

目的观察玻璃体切割手术(PPV)联合内界膜(ILM)剥除、C_(3)F_(8),填充治疗伴与不伴黄斑劈裂的高度近视黄斑裂孔(HM-MH)的临床疗效。方法回顾性病例对照研究。2017年1月至2022年2月于山东省眼科医院检查诊断为伴与不伴黄斑劈裂的HM-MH患者23例23只眼纳入研究。其中,男性5例5只眼,女性18例18只眼;年龄(54.43±12.96)岁。伴与不伴黄斑劈裂者分别为12例12只眼、11例11只眼,并据此分为劈裂组、非劈裂组。患眼均行最佳矫正视力(BCVA)、B型超声、光相干断层扫描检查以及眼轴长度(AL)测量。BCVA检查采用Snellen视力表进行,统计时转换为最小分辨角对数(logMAR)视力。两组患者年龄、性别构成比、黄斑裂孔(MH)直径、logMARBCVA、AL、后巩膜葡萄肿眼数比较,差异均无统计学意义(P>0.05)。所有患眼均行PPV联合ILM剥除、C_(3)F_(8).填充手术。随访时间为末次手术后至少3个月。对比观察两组患眼手术后BCVA变化及MH闭合情况。组内手术前后BCVA比较采用Wilcoxon检验;组间手术前及手术后BCVA比较采用Mann-whiteny U检验。结果初次手术后,23只眼中,MH闭合17只眼(74%,17/23)。劈裂组12只眼中,MH闭合8只眼(66.7%,8/12),未闭合4只眼(33.3%,4/12);非劈裂组11只眼中,MH闭合9只眼(81.8%,9/11),未闭合2只眼(18.2,2/11)。两组患眼初次手术后MH闭合率比较,差异无统计学意义(P>0.05)。手术后1、3个月,劈裂组、非劈裂组患眼1ogMARBCVA分别为1.00±0.46、1.03±0.83和0.53±0.63、0.55±0.41。与手术前比较,手术后1个月时,差异无统计学意义(P=0.783、0.358);手术后3个月时,差异有统计学意义(P=0.012、0.007)。劈裂组与非劈裂组患眼间1ogMARBCVA比较,手术后1、3个月差异均无统计学意义(P=0.687、0.950)。结论PPV联合ILM剥除、C_(3)F_(8)填充手术治疗伴与不伴黄斑劈裂的HM-MH能促进多数患眼MH闭合,改善患眼视力.

Objectivee To observe the clinical effects of pars plana vitrectomy(PPV)combined with internal limiting membrane(ILM)peeling and C_(3)F_(8)tamponade for patients with highly myopic macular hole(HM-MH)with and without foveoschisis.Methods A retrospective case controlled study.From January 2017 to February 2022,23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study.Among them,5 males had 5 eyes,and 18 females had 18 eyes,the age was(54.43±12.96)years old.The patients with or without foveoschisis were 12 eyes in 12 cases and 11l eyes in 11 cases.Studies were divided into two groups,depending on the presence of a concomitant myopic foveoschisis or not.The groups are high myopia macular hole with foveoschisis(group A)and high myopia macular hole without foveoschisis(group B).Best-corrected visual acuity(BCVA),B-scan ultrasonography,optical coherence tomography and axial length(AL)measurement were performed in all eyes.Snellen chart was used for BCVA examination,and the visual acuity was converted into logarithm of minimum angle of resolution(logMAR)during statistics.The age of the two groups,sex,macular hole(MH)diameter,logMAR BCVA,AL,posterior scleral staphyloma,there was no significant difference(P>0.05).PPV combined with ILM peeling and C_(3)F_(8)filling were performed in all eyes.Follow-up was at least 3 months after the last operation.BCVA changes and MH closure were compared between the two groups after surgery.Wilcoxon test was used to compare BCVA before and after operation.Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups.Results After initial surgery,MH was closed in 17 of 23 eyes(74%,17/23).MH was closed in 8 eyes in group A(66.7%,8/12).Four eyes were not closed(33.3%,4/12);MH closed in 9 eyes in group B(81.8%,9/11).There was no significant difference between the two groups after initial operation(P>0.05).At 1 and 3 months after surgery,the logMAR BCVA of patients in group A and group B were 1.00±0.46,1.03±0.83 and 0.53±0.63,0.55±0.41,respectively.Compared with before operation,there was no significant difference at 1 month(P=0.783,0.358),but the difference was statistically significant at 3 months(P=0.012,0.007).There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation(P=0.687,0.950).Conclusion PPV combined with ILM peeling and C_(3)F_(8)tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and withoutfoveoschisis.