高度近视黄斑裂孔性视网膜脱离行玻璃体切割术后C_(3)F_(8)与硅油填充的疗效比较

Efficacy of C_(3)F_(8)versus silicone oil tamponade in highly myopic macular hole retinal detachment

目的:比较高度近视黄斑裂孔性视网膜脱离(MHRD)行玻璃体切割联合内界膜剥离后玻璃体腔内分别行硅油或C_(3)F_(8)填充治疗的疗效观察。方法:回顾性临床研究。2019-01/2022-08就诊于我院的45例45眼高度近视MHRD患者,根据手术方式分为硅油组(23例)及C_(3)F_(8)组(22例),两组患者均常规三切口玻璃体切割手术,内界膜剥离后行内界膜填塞、自体血覆盖,硅油填充组行硅油填充,C_(3)F_(8)组行15%C_(3)F_(8)气体填充。两组患者分别观察最佳矫正视力(BCVA)、多焦视网膜电图(mfERG)、裂孔的闭合及视网膜复位情况,统计两组患者术后并发症情况。结果:C_(3)F_(8)组、硅油组患者裂孔闭合率为77%、83%(P>0.05),视网膜复位率分别为95%、96%(P>0.05)。C_(3)F_(8)组、硅油组术后视力分别为0.99±0.34、1.22±0.37,C_(3)F_(8)组视力优于硅油组(t=-2.156,P=0.037),两组均较术前显著提高。术后12 mo,两组患者mfERG一阶函数1环(C_(3)F_(8)组114.27±26.37 nV/deg2,硅油组98.08±24.36 nV/deg2)及2环(C_(3)F_(8)组80.45±14.94 nV/deg2,硅油组67.73±15.33 nV/deg2)P1波反应密度较术前(1环P1波反应密度:C_(3)F_(8)组58.13±13.96 nV/deg2、硅油组55.30±10.48 nV/deg2;2环P1波反应密度:C_(3)F_(8)组51.18±8.19 nV/deg2、硅油组47.43±11.97 nV/deg2)明显增加(均P<0.05),C_(3)F_(8)组较硅油组增加明显(P<0.05)。硅油组与C_(3)F_(8)组患者术后并发症发生情况无差异(P>0.05)。结论:玻璃体切割联合内界膜剥离后玻璃体腔内分别行硅油或C_(3)F_(8)填充均可促进高度近视MHRD患者视网膜复位及黄斑裂孔闭合,而且在视功能恢复C_(3)F_(8)填充优于硅油填充。

AIM:To compare the outcome of C_(3)F_(8)versus silicone oil tamponade after pars plana vitrectomy(PPV)and inverted internal limiting membrane(ILM)for the treatment of highly myopic macular hole retinal detachment(MHRD).METHODS:Retrospective clinical study.Totally 45 patients(45 eyes)with highly myopic MHRD who visited our hospital between January 2019 and August 2022 were selected as the research subjects.The patients were divided into two groups according to different intraocular tamponade agents:C_(3)F_(8)(22 eyes)and silicone oil(23 eyes)groups.All patients underwent conventional three-incision PPV,ILM was tamped,a venous blood clot was placed on the tamped ILM,and 15%C_(3)F_(8)and silicone oil were used as tamponade,respectively.The best corrected visual acuity(BCVA),multifocal electroretinogram(mfERG),the closure of the macular hole,retinal reattachment and the complications were observed.RESULTS:The macular hole closure rate was 77%in the C_(3)F_(8)group and 83%in the silicone oil group,respectively(P>0.05),and retinal reattachment rates were 95%and 96%,respectively(P>0.05).The visual acuity of the two groups significantly improved,which was 0.99±0.34 and 1.22±0.37,respectively,and the C_(3)F_(8)group was better than that of the silicone oil group(t=-2.156,P=0.037).After operation,the response density of the first ring of P1 wave in the first order kernel in mfERG was 114.27±26.37 nV/deg 2 for the C_(3)F_(8)group and 98.08±24.36 nV/deg 2 for the silicone oil group,and the response density of the second ring of P1 wave was 80.45±14.94 nV/deg 2 for the C_(3)F_(8)group and 67.73±15.33 nV/deg 2 for the silicone oil group,all of which were significantly higher compared to pre-operation[the response density of the first ring of P1 wave:58.13±13.96 nV/deg 2 for the C_(3)F_(8)group and 55.30±10.48 nV/deg 2 for the silicone oil group,the response density of the second ring of P1 wave:51.18±8.19 nV/deg 2 for the C_(3)F_(8)group and 47.43±11.97 nV/deg 2 for the silicone oil group](all P<0.05).It was found that the response density of the first ring of P1 wave was lower in the silicone oil group than in the C_(3)F_(8)group(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).CONCLUSION:Silicone oil tamponade or C_(3)F_(8)tamponade after PPV combined with ILM can both promote retinal reattachment and macular hole closure in patients with MHRD,and the C_(3)F_(8)tamponade was superior to silicone oil in visual function recovery.