高度近视眼黄斑裂孔视网膜脱离临床特征及其手术方法

Retinal detachment with macular hole in high myopic eyes and surgical treatment

目的 观察高度近视眼黄斑裂孔视网膜脱离的临床特征与手术方法的关系。方法 检查 30例 (31只眼 )高度近视眼黄斑裂孔视网膜脱离 ,并根据手术方法分两组。第一组 (14只眼 ) ,行环扎术、玻璃体腔内注气或C3 F8。第二组 (17只眼 ) ,行环扎术、玻璃体切除术和 C3 F8眼内填充术。结果 31只眼中玻璃体后脱离 6 1.2 9%,周边部破孔 5 1.6 1%,后巩膜葡萄肿“白孔”眼 5 8.0 6 %。术后复发 8只眼 (第一组 5只眼 ,第二组 3只眼 ) ,复发率2 5 .8%。再手术 7只眼痊愈 ,1只眼拒绝手术 ,属未愈。痊愈 30只眼 ,痊愈率 96 .77%。结论 第一组没有玻璃体手术 ,复发率虽较高 ,但两组复发病例统计学处理无显著差异 (P >0 .0 5 )。两组中 3只眼第一次手术未做环扎术 ,术后复发 ,占复发眼 (8只眼 ) 37.5 %。玻璃体切除术和眼内气体填充术虽为视网膜脱离广泛应用之手术 ,但也应重视环扎术对高度近视眼黄斑裂孔视网膜脱离治疗的作用。

Objective To investigate factors associated with retinal detachment of macular hole in high myopic eyes and relevent surgical methods.Methods 31 eyes(30 patients) of retinal detachment with macular hole and high myopia were examined.According to the operation methods,they were divided into two groups.The 1 st group (14 eyes)-encircling and intravitreous air or C 3F 8 injection.The 2 nd group (17 eyes)-encircling,pars plana vitrectomy (PPV) and intraocular C 3F 8 tamponade.Results Of these eyes,61.2% of posterior vitreous detachment (PVD),51.61% of peripheral breaks and 58.06% of posterior staphyloma with 'white hole'were found.After operation 8 eyes were relapsed (5 in group 1,3 in group 2).Relapsing rate 25.8%.Among them 7 eyes were cured after re-operation,1 eye refused re-operation as failure.There were 30 eyes cured,cure rate 96.77%.Conclusion The relapsing rate in the 1 st group(P>0.05).3 eyes without encircling in the primary operation were all relapsed (37.5% of the totally 8 relapsed eyes).PPV and gas tamponade is widely used in retinal detachment operation,it is emphatic in the treatment of macular hole in high myopic eyes encircling is properly indicated.