玻璃体切除联合羊膜覆盖术治疗复发性高度近视黄斑孔性视网膜脱离的效果

Efficacy of vitrectomy combined with amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia

目的分析玻璃体切除(PPV)联合羊膜覆盖术治疗复发性高度近视黄斑孔性视网膜脱离(MHRD)的效果。方法回顾性病例系列研究。纳入郑州市第二人民医院2021年12月至2023年11月的复发性高度近视MHRD患者11例(11眼)。眼轴长度(28.36±1.27)mm。所有患者既往均因高度近视MHRD行PPV、玻璃体腔内注气或后巩膜加固术等。本研究所有患者行PPV联合羊膜覆盖及硅油填充术,术后3~6个月取出眼内硅油,随访7~12个月。观察患者术后黄斑孔闭合情况、最佳矫正视力(BCVA,logMAR)、眼压及并发症情况。结果所有患者视网膜均复位,黄斑孔均良好闭合。术前BCVA为1.62±0.45,硅油取出术后BCVA为1.09±0.36,差异具有统计学意义(t=4.81,P<0.001);视力提高者10例,视力无改善者1例。术后并发症:高眼压2例,采用降眼压药物后眼压控制正常。视网膜下出血1例。随访期间未见羊膜排斥反应。结论PPV联合羊膜覆盖术可有效的治疗复发性高度近视MHRD。

Objective To analyze the efficacy of par plana vitrectomy(PPV)combined with amniotic membrane patching in the treatment for recurrent high myopia macular hole retinal detachment(MHRD).Methods This was a retrospective case series study.A total of 11 cases(11 eyes)of recurrent high myopia MHRD treated in Zhengzhou Municipal Second People′s Hospital from Dec.2021 to Nov.2023 were included in the study,with an axial length of(28.36±1.27)mm.All patients underwent surgical treatment for high MHRD(such as PPV,intravitreal injection of air or posterior scleral reinforcement),and all patients underwent vitrectomy combined with amniotic membrane patching and silicone oil tamponade.The intraocular silicone oil was removed according to the condition at 3-6 months after surgery,and the follow-up period was 7-12 months.The closure of macular hole,best corrected visual acuity(BCVA,logMAR),intraocular pressure,and complications of the patients after surgery were observed.Results All patients’retinas were reattached and the macular holes were closed.Preoperative BCVA was 1.62±0.45,and the postoperative BCVA after silicone oil removal was 1.09±0.36,with a statistically significant difference(t=4.81,P<0.001).There were 10 cases with improved vision.One case had no improvement in vision.Postoperative complications included subretinal hemorrhage in 1 case,and high intraocular pressure in 2 cases,which normalized after being applied with intraocular pressure lowering drugs.No amniotic membrane exclusion reaction were observed during follow-up.Conclusion PPV combined with amniotic membrane patching is an effective method for the treatment of recurrent high myopia MHRD.