玻璃体切除联合重水辅助内界膜填塞术治疗黄斑裂孔性视网膜脱离

Pars plana vitrectomy combined with heavy water⁃assisted internal limiting membrane peeling for macular hole⁃related retinal detachment

目的观察玻璃体切除联合重水辅助内界膜填塞术治疗黄斑裂孔性视网膜脱离(MHRD)的疗效。方法回顾性病例对照研究。纳入2020年1月至2022年10月在我院诊断MHRD并行玻璃体切除(PPV)联合内界膜(ILM)填塞术的患者;其中,2020年1月至2021年4月20例(20只眼)MHRD患者归于对照组(内界膜直接填塞组),2021年5月至2022年10月20例(20只眼)MHRD患者归于实验组(重水辅助内界膜填塞组)。随访至术后6个月,观察记录患者的最佳矫正视力(BCVA)、黄斑裂孔愈合及网膜复位情况,有无术后并发症如高眼压等。以术后6个月的检查结果作为最终的疗效结果。结果末次随访结束,所有患者脱离的网膜均复位,MH均闭合,随访过程中未出现高眼压、眼内炎等并发症。末次随访结束,对照组黄斑裂孔I型闭合9只眼(其中U形愈合只眼,V形愈合4只眼),II型闭合11只眼;实验组黄斑裂孔I型闭合16只眼其中U形愈合13只眼,V形愈合3只眼,II型闭合4只眼;两组间MH不同类型愈合占比比较差异有统计学意义(P=0.022)。两组术前BCVA(log⁃MAR)差异无统计学意义(P=0.744);两组术后6个月BCVA(logMAR)较术前均有改善(P<0.001),两组间术后6个月BCVA(logMAR)比较,试验组(重水辅助内界膜填塞组)视力改善优于对照组(内界膜直接填塞组)(P<0.001)。结论PPV联合重水辅助内界膜填塞是一种有效安全的手术方式,可以提高裂孔的I型愈合率,一定程度上改善术后视力。

Objective To observe the therapeutic effect of pars plana vitrectomy(PPV)combined with heavy wa⁃ter⁃assisted internal limiting membrane(ILM)tamponade for macular hole⁃related retinal detachment(MHRD).Methods This study was a retrospective case⁃control study.Patients who were diagnosed with MHRD and treated with PPV com⁃bined with ILM peeling at our hospital from January 2020 to October 2022 were included.20 cases(20 eyes)of MHRD patients from January 2020 to April 2021 were assigned to the control group(direct ILM peeling group),and 20 cases(20 eyes)of MHRD patients from May 2021 to October 2022 were assigned to the experimental group(heavy water⁃assisted ILM peeling group).The followed⁃up duration was 6 months.The best corrected visual acuity(BCVA),macular hole clo⁃sure and retinal reattachment were observed,and postoperative complications such as high intraocular pressure were recor⁃ded.The examination results at 6 months after surgery were used as the final therapeutic effect.Results At the final fol⁃low⁃up,the detached retina in all patients was reattached,the MH was closed,and no complications such as high intraocu⁃lar pressure or endophthalmitis occurred during the follow⁃up.At the final follow⁃up,macular hole type I closure was a⁃chieved in 9 eyes(U⁃shaped closure in 5 eyes and V⁃shaped closure in 4 eyes)and type II closure in 11 eyes in the control group.Macular hole type I closure was achieved in 16 eyes(U⁃shaped closure in 13 eyes and V⁃shaped closure in 3 eyes)and type II closure in 4 eyes in the experimental group.There was a statistically significant difference in MH closure rate between the two groups(P<0.05).There was no statistically significant difference in preoperative BCVA(logMAR)be⁃tween the two groups(P>0.05).The BCVA(logMAR)at 6 months after the surgery was significantly improved in both groups compared with preoperative(P<0.001).The BCVA(logMAR)improvement at 6 months after the surgery in the experimental group(heavy water⁃assisted ILM peeling group)was better than that in the control group(direct ILM peeling group)(P<0.001).Conclusions PPV combined with heavy water⁃assisted ILM peeling is an effective and safe surgical approach,which can increase the type I closure rate of macular holes and improve postoperative vision to some extent.