Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia

AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment(MHRD) with PS.METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS(62 eyes) were enrolled in the study. Patients were divided into 23 G PPV combined with PS marginal retina intraoperative photocoagulation group(combined group) and conventional surgery group(conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane(ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21 mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity(BCVA) and average number of operations were observed and compared between the two groups.RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7%(29/31) and 67.7%(21/31), respectively(χ~2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2%(23/31) and 67.7%(21/31), respectively(χ~2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group(t=-41.962, P≤0.001). Postoperative log MAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the log MAR BCVA before surgery, each group was improved(t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the log MAR BCVA between the eyes of the two groups(t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average(t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens

AIM:To investigate the clinical characteristics,treatment methods and outcomes of rhegmatogenous retinal detachment(RRD)in highly myopic eyes with implantable collamer lens(ICL).METHODS:High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed.Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient.RESULTS:A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included.The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo(range,1-60mo).At the initial visit for RRD,giant retinal tear(GRT),horseshoe tear,simple round hole,and horseshoe tear combined with round hole were detected in 3,3,2,and 1 eye(s),respectively,with maculaoff in eyes.Eight patients received surgical treatment,and one patient was treated by retinal laser photocoagulation alone.The ICL was preserved in 7 eyes.At the last followup,the mean best corrected visual acuity(BCVA)improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR(P=0.035),and no case of recurrent retinal detachment was found.CONCLUSION:The morphological presentation of retinal breaks is diverse in this study.The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data,companied with acceptable visual and anatomical outcomes.

Surgical Management of Retinal Detachment Resulting from Macular Hole in a Setting of High Myopia

Purpose:To evaluate the anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM).peeling and use of retinal tamponade for retinal detachments resulting from macular hole (MHRD) in highly myopic eyes. Methods:.Twenty-nine highly myopic patients.(29 eyes) underwent PPV with ILM peeling and retinal tamponade for MHRD were enrolled. Demographics and best-corrected visual acuity.(BCVA).were measured preoperatively and at final follow-up. Anatomical success and macular hole closure were analyzed. Results:.Patients' mean age of patients was 58.7±10.6 years, mean follow-up was 11.7±7.4 months. Twenty three eyes (23/26,88.5%)undergoing primary PPV combined with ILM peeling had successful initial retinal reattachment, including 19 eyes (19/19, 100%) with silicone oil tamponade and in 4 eyes (4/7,57.1%).with sulfur hexafluoride.(C3F8).tamponade. Overall anatomical success was achieved in 27 eyes (27/29, 93.1%)..The macular hole closure was observed in 17 eyes (17/26, 65.4%) with final anatomical success. Compared to preoperative BCVA,.the mean postoperative BCVA in the eyes with anatomical success was significantly improved (P = 0.007, Wilcoxon signed rank test). Conclusion:.As a primary or secondary procedure,.PPV combined with ILM peeling and usage of retinal tamponade serves as an effective method for MHRD in highly myopic eyes.

Amniotic membrane for covering high myopic macular hole associated with retinal detachment following failed primary surgery

AIM:To evaluate the therapeutic effect of amniotic membrane(AM)for covering high myopic macular hole associated with retinal detachment following failed primary surgery.METHODS:Seventeen eyes of 17 patients whose axial length was more than 29 mm suffered from macular hole(MH)or MH associated with retinal detachment(RD),and had previously surgery of pars plana vitrectomy(PPV)with internal limiting membrane(ILM)peeling and silicone oil(SO)tamponade.Half a year after the surgery,optical coherence tomography(OCT)showed that MH did not heal in all 17 eyes and RD was still maintained in 13 eyes of these 17 eyes.We performed SO removal combined with AM covering on macular area and C3 F8 tamponade,and phacoemulsification combined with intraocular lens implantation simultaneously cataract eyes.We followed up these patients for one year.RESULTS:In all 17 eyes,SO was removed successfully,MHs were healed and RDs were reattached.One eye(5.89%,1/17)had AM shifted half a month after surgery and underwent a second surgery to adjust the position of the AM and supplement C3 F8.After surgery,the visual acuity(VA)improved in 15 eyes(88.24%,15/17),no change in two eyes(11.76%,2/17).No serious complications occurred in all eyes.CONCLUSION:AM covering is helpful to rescue the previous failure surgery of high myopic MH.

Vitrectomy with internal limiting membrane peeling versus its flap insertion for macular hole in high myopia: a Meta-analysis

AIM: To compare the anatomic and functional outcomes between vitrectomy with internal limiting membrane(ILM) peeling and internal ILM flap insertion technique for high myopia macular hole(MH).METHODS: Pub Med, Cochrane Library, EMBASE, and CNKI were systematically searched, and all studies involved MH were included. The closure rate of MH and the postoperative best-corrected visual acuity(BCVA) at 6 mo after the initial surgery were the primary measures. All statistical tests were performed in Review Manager 5.3.RESULTS: Five studies that included 151 eyes of 151 patients were finally included, all of which were retrospectively comparative studies. Between the pars plana vitrectomy(PPV) with ILM peeling surgery and the ILM insertion technique, the latter had significantly better efficacy with respect to the closure rate of MH(OR=21.32, 95%CI=7.25-62.67, P<0.001);However, regarding BCVA at 6 mo after the initial surgery in MH, there was no statistical significance between the groups(OR=-0.04, 95%CI=-0.22-0.14, P=0.66). In addition, regarding the rate of retinal reattachment after the initial surgery, the two different methods were not significantly different(OR=2.22, 95%CI=0.34-14.32, P=0.4).CONCLUSION: Both ILM peeling and ILM insertion technique could significantly improve anatomic outcomes of MH in high myopia with or without retinal detachment(RD), and anatomic outcomes are more effective. However, there is no statistical significance in BCVA at 6 mo after the initial surgery in MH, or in the rate of retinal reattachment after the first surgery, between the two methods.

Episcleral macular buckling for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole

AIM: To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole.METHODS: Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post- EMB. The duration of follow -up time after removal of silicone oil was more than 3 months.RESULTS: Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08.CONCLUSION: Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome.

Surgical Treatment for the Proliferative Retinal Detachment Associated with Macular Hole in the Morning Glory Syndrome

Purpose: To evaluate the efficacy of vitrectomy with peripapillary photocoagulation and silicone oil tamponade for the proliferative retinal detachment associated with macular hole in children with morning glory syndrome. Methods: Eight children with morning glory syndrome (mean age 8.0±2.8 years; range 5～13 years) were included; all patients had unilateral eye disease and were initially misdiagnosed as having bilateral squint or amblyopia, with best corrected visual acuity <6/60. Five patients could not cooperate with the fundus examination and one patient had lens opacities.B-ultrasound confirmed that all eight patients had retinal detachment and optic disc dysplasia.All patients underwent standard 3-port pars plana vitrectomy surgery . (20G for three cases and 23G for five cases).At surgery,all patients were confirmed to have morning glory syndrome,macular hole, and proliferative retinal detachment;.two cases had a funnel shaped bulge. All the retinal detachments involved the macular area, and macular hole was detected in the abnormal expansion excavation of the optic disk. The epiretinal membrane and subretinal membrane were completely removed during surgery. Combined photocoagulation in the abnormal expansion excavation of the optic disk, and silicone oil tamponade were also performed. Results:All eyes achieved anatomical resolution of retinal detachment.After follow-ups ranging from eight months to four years,the visual function for all patients was improved by postoperative refractive correction associated with vision training. Best corrected visual acuity was 6/600 to 6/30 at the final follow-up, no retinal detachment recurred, and no silicone oil fluid entered the subretinal space. The silicone oil was successfully removed postoperatively after a mean of 1.5 years. Conclusion:Vitrectomy with peripapillary photocoagulation and silicone oil tamponade is effective in treating the proliferative retinal detachment associated with macular hole in children with morning glory syndrome. (Eye Science 2013;28:7-10)

CHARACTERISTICS OF MULTIFOCAL ELECTRORETINOGRAM IN THE FELLOW EYES OF PATIENTS WITH HIGH MYOPIA WITH RETINAL DETACHMENT

Objective To observe the changes on multifocal electroretinography (MfERG) in the fellow eyes of patients with high myopia without fundus lesions and rhegmatogenous retinal detachment (RRD).Methods MfERG was performed in 66 patients (66 eyes) which were grouped into: emmetropes (n=22) as the control eye; high myopes without fundus lesions (corrected visual acuity ≥1.0, n=15); and fellow eyes of high myopics with RRD (n=29). The first-order kernels N1, P1, N2 response density and latency were analyzed.Results When compared with the emmetropes group, the high myopes group had significantly reduced N1, P1, and N2 wave response densities in rings 1 to 6 (P<0.05), delayed N1 wave latency in rings 3 to 6, and P1 wave latency in rings 3 to 5 (P<0.05). The fellow eyes group had significantly reduced N1, P1, and N2 wave response densities in rings 1 to 6 and significantly delayed N1 and P1 wave latencies in rings 3 to 6 (P<0.05) compared with the emmetropes group. Compared with the high myopes group, P1 wave response densities in rings 1 to 6, N1 wave response densities in rings 1, 3, 4, and 6, and N2 wave response density in ring 1 were significantly decreased in the fellow eyes group (P<0.05); whereas there were no significant differences in latencies between the two groups (P>0.05). Conclusion MfERG can sensitively assess the early changes in visual function in fellow eyes in patients with RRD.

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia

AIMTo report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia.

Macular hole following phakic intraocular lens implantation:A case report

BACKGROUND Phakic intraocular lens(pIOL)implantation has been commonly prescribed and is considered as a safe and effective option for correcting high myopia.However,it is associated with multiple complications.CASE SUMMARY This report describes a case of full-thickness macular hole(MH)in a patient with a history of bilateral pIOL implantation for the correction of myopia of–12.00 diopters in both eyes 7 mo ago.The MH closed after pars plana vitrectomy with internal limiting membrane removal and the best-corrected visual acuity improved to 20/40 in the left eye.CONCLUSION In rare cases,MH can occur following pIOL.In this present case report,we analyzed the formation process of MH following the surgery and emphasized that it is important to inform highly myopic patients about the risk of MH occurrence while being aware of the symptoms of this complication.

Posterior vitreous cortex contributes to macular hole in highly myopic eyes with retinal detachment

Background It was well known that tangential vitreoretinal traction and epiretinal membrane play important roles during the formation of macular hole （MH） associated with retinal detachment （RD） in highly myopic eyes. But it was not clear about the correlations between anteroposterior traction, posterior vitreous cortex （PVC） and MH-RD. The vitreous status in highly myopic eyes were analyzed to explore the effect of PVC in the role of MH-RD formation. Methods Sixteen consecutive highly myopic eyes with RD due to MH were retrospectively analyzed from January 2009 to April 2009. The preoperative examinations for detecting posterior vitreous detachment （PVD） and vitreoretinal traction included B-mode ultrasonography and optical coherence tomography （OCT）. The residual PVC and PVD were confirmed intraoperatively during triamcinolone acetonide （TA） assisted vitrectomy. Results Under ultrasonography, the preoperative PVD patterns were stratified as： complete PVD in three （19%） eyes, partial PVD in eight （50%） eyes, and no PVD in five （31%） eyes. OCT confirmed vitreoretinal traction and no complete PVD in 10 （63%） eyes, including anteroposterior traction in four eyes and tangential traction in six eyes. During TA-assisted vitrectomy, it was confirmed that no complete PVD existed in 16 eyes, including six eyes （38%） finally diagnosed of partial PVD, and five （31%） eyes with vitreoschisis. Anteroposterior vitreoretinal traction around MH is always in conjunction with partial PVD （67%）, and high proportion （80%） of vitreoschisis is associated with tangential vitreoretinal traction. Comparing with the precision of TA staining of PVD diagnosis, the coincidence rate of ultrasonography was 69% （P=0.02）, and that of OCT was 63% （P 〈0.01）. Conclusions The residual PVC due to partial PVD or vitreoschisis may cause the anteroposterior or tangential traction of macular area, which contributes to the formation of MH and subsequent RD in highly myopic eyes. And it is necessary to realize the vitreoretinal relationship and assess the status of PVC synthetically for surgery by combined ultrasonography and OCT preoperatively and TA staining intraoperatively.

Optical Coherence Tomography’s Contribution to the Diagnosis of the Pathologies of the Vitreoretinal Interface in Lomé

Purpose: To identify the pathologies of the vitreoretinal interface by Optical Coherence Tomography OCT of the retina in Lomé. Methodology: This is a retrospective analytical study, carried out in a specialized liberal center in Lomé. It was based on the analysis of OCT images of the retina, carried out with patients between October 2012 and October 2014. The variables collected were the socio-demographic characteristics, which were the various pathologies of the vitreoretinal interface. Results: 303 eyes of 164 patients were analyzed. The population was predominantly female (sex ratio = 0.95) aged 9 to 84 years with an average of 52.93 years. 121 eyes (39.9%) had posterior vitreous detachment with 66.1% in the 50 - 70 age group. 42 eyes (13.86%) presented vitreomacular traction with 66.6% in the 50 - 70 age group. 31 eyes (10.23%) presented an epi-retinal membrane with 61.2% in the 50 - 70 age group. 33 eyes (10.89%) had a full-thickness macular hole with 69.6% in the 50 - 70 age group. 4 eyes had a lamellar hole and 1 eye had a pseudo hole. Conclusion: OCT is an excellent tool for non-invasive exploration of the vitreoretinal interface. It gives precise information on the various pathologies of this interface. The need to evaluate the functional impact of these abnormalities, calls for other studies, especially prospective studies to assert their reality of those disease.

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

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。

人羊膜填塞与内界膜翻转填塞对高度近视黄斑裂孔性视网膜脱离疗效比较

目的对比玻璃体切割(PPV)联合人羊膜填塞术或内界膜翻转填塞术治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。方法采用非随机对照临床研究方法,纳入2020年7月至2021年8月就诊于上海交通大学医学院附属第九人民医院的高度近视MHRD患者15例16眼。所有患者均接受PPV,根据术中黄斑裂孔填塞材料的不同将患者分为人羊膜填塞组7例7眼和内界膜填塞组8例9眼。分别于术前及术后1周、1个月、3个月和6个月测定术眼最佳矫正视力(BCVA)、眼压;采用裂隙灯显微镜联合前置镜、激光扫描检眼镜及光学相干断层扫描(OCT)检查眼底情况并判定黄斑裂孔闭合及视网膜复位情况。结果人羊膜填塞组6眼初次手术后视网膜即复位,内界膜填塞组所有术眼均实现一次手术后视网膜复位。初次手术后,人羊膜填塞组5眼黄斑裂孔闭合,内界膜填塞组8眼黄斑裂孔闭合,2个组间黄斑裂孔闭合率比较差异无统计学意义(P>0.05)。2个组患者手术前后不同时间点间BCVA总体比较差异有统计学意义(F_(时间)=4.420,P<0.05);术后不同时间点BCVA均优于术前值,但差异无统计学意义(均P>0.05)。2个组间BCVA总体比较差异无统计学意义(F_(组别)=0.183,P>0.05)。人羊膜填塞组和内界膜填塞组分别有2眼和4眼出现术后一过性高眼压,给予降眼压治疗1周后均恢复正常。结论PPV联合人羊膜填塞术及内界膜填塞术治疗高度近视MHRD均安全有效,且人羊膜填塞术在伴随复杂的眼底情况时也能保持良好的视网膜解剖学复位及功能恢复。

高度近视合并视盘旁脉络膜空腔患者患眼黄斑区视网膜血流密度与厚度的相关性

目的研究高度近视(HM)合并视盘旁脉络膜空腔(PICC)患者患眼黄斑区视网膜血流密度与厚度的相关性。方法以回顾性分析为法,观察对象为2020年1月至2023年1月眉山市人民医院收治的108例(108只眼)HM合并PICC患者,将其设为A组;同时,选取同一时期入院的单纯HM患者(108只眼)与108名体检健康者(108只眼)分别设为B组与C组。3组受检者均行光相干断层扫描血管成像仪(OCTA)检查,扫描范围为受检眼黄斑区3 mm×3 mm。比较3组受检者黄斑区全层视网膜厚度(上半侧、下半侧、整体平均值)、视网膜神经节细胞复合体(mGCC)厚度(上半侧、下半侧、平均值)、视网膜浅层毛细血管层(SCP)血流密度(上半侧、下半侧、整体平均、中心凹区、旁中心凹区、鼻侧、颞侧、上方、下方区域)、深层毛细血管层(DCP)血流密度(上半侧、下半侧、整体平均、中心凹区、旁中心凹区、鼻侧、颞侧、上方、下方区域),并分析A组患眼黄斑区各区域SCP、DCP血流密度与对应区域全层视网膜厚度、mGCC厚度的相关性。结果(1)3组受检者全层视网膜厚度比较:A组、B组全层视网膜厚度上半侧、下半侧、平均值均明显低于C组;A组全层视网膜厚度下半侧明显低于B组,差异均有统计学意义(P<0.05)。(2)3组mGCC厚度比较:A组mGCC厚度上半侧、下半侧、平均值均明显低于B、C组,差异均有统计学意义(P<0.05)。(3)3组黄斑区SCP血流密度比较:A组黄斑区上半侧、下半侧、整体平均、旁中心凹区、鼻侧、颞侧、上方、下方区域SCP血流密度均明显低于B、C组,中心凹区SCP血流密度明显高于C组,中心凹区SCP血流密度明显低于B组,差异均有统计学意义(P<0.05)。(4)3组黄斑区DCP血流密度比较:A组黄斑区上半侧、下半侧、整体平均、旁中心凹区、鼻侧、颞侧、上方、下方区域DCP血流密度明显低于C组,中心凹区DCP血流密度明显高于C组;A组黄斑区中心凹区DCP血流密度明显低于B组,差异均有统计学意义(P<0.05)。(5)黄斑区视网膜血流密度与厚度相关性分析:A组患眼黄斑区各区域SCP血流密度与对应区域全层视网膜厚度、mGCC厚度呈正相关(P<0.05)。A组患眼黄斑区下半侧区域DCP血流密度与下半侧区域全层视网膜厚度呈正相关(P<0.05)。结论HM合并PICC患者患眼黄斑区各个区域mGCC厚度、SCP血流密度与下半侧区域全层视网膜厚度明显低于单纯HM患者患眼,变化最为明显的为黄斑区下半侧区域SCP血流密度、mGCC厚度,且黄斑区视网膜血流密度与厚度呈正相关。

内界膜翻转填塞与内界膜剥除在高度近视黄斑裂孔性视网膜脱离中的应用

目的探讨高度近视MHRD患者的治疗方法。方法将80例高度近视MHRD患者以手术方式的不同分成两组,各40例。两组均行玻璃体切除术,A组联合内界膜翻转填塞术,B组联合内界膜剥除术。对比两组黄斑裂孔闭合率、视网膜复位率、视力恢复及眼压变化情况。结果A组黄斑裂孔闭合率高于B组(χ^(2)=5.17,P=0.023);两组视网膜复位率、logMAR BCVA下降幅度及高眼压发生率比较无统计学意义(P>0.05)。结论在高度近视MHRD患者治疗中,采用玻璃体切除+内界膜翻转填塞手术、玻璃体切除+内界膜剥除术均可有效促进视网膜复位以及视力恢复,但前者可有效提升黄斑裂孔闭合率,可预防视网膜再脱离。

玻璃体切除联合硅油填充治疗复发性黄斑裂孔视网膜脱离的疗效分析

目的 分析玻璃体切除联合硅油填充治疗复发性黄斑裂孔视网膜脱离(macular hole retinal detachment, MHRD)的疗效。方法 采取计算机随机分组法,将本院于2020年1月-2022年1月收治的100例复发性MHRD患者分为50例/组,均接受玻璃体切除术治疗,对照组联合14%C3F8气体填充,观察组联合硅油填充治疗。对比术后视网膜复位率、黄斑裂孔闭合率、logMAR-BCAV值、并发症发生率。结果 两组术后视网膜复位率、并发症发生率差异不大(P>0.05),观察组黄斑裂孔闭合率高于对照组,术后logMARBCAV值低于对照组(P<0.05)。结论 在复发性MHRD的临床治疗中,采取玻璃体切除联合硅油填充治疗方案效果理想。

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

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。

高度近视非黄斑裂孔的后极部孔源性视网膜脱离临床分析

目的:初步观察高度近视后极部视网膜脱离患者的后极部裂孔(非黄斑裂孔)的形态及相关因素,探讨玻璃体切除手术治疗的临床效果。方法:回顾性分析高度近视非黄斑裂孔的后极部孔源性视网膜脱离患者19例19眼的病例资料,观察裂孔的形态、位置、玻璃体牵拉和后巩膜葡萄肿的形态。所有病例行玻璃体切除联合裂孔周围视网膜内界膜剥除术,术中眼内激光光凝封闭裂孔,根据患者病情给予不同的辅助处理,如玻璃体腔内填充消毒空气、C3F8、硅油等,术后3~5个月行硅油取出手术。术后随访观察患者最佳矫正视力和视网膜复位情况。结果:19只眼中后极部裂孔呈裂隙状12只眼(63.2%),小马蹄形3只眼(15.8%),小圆形4只眼(21.0%)。其中<1/4 PD者10眼(52.6%),1/2~1/4 PD者7眼(36.8%),1~1/2 PD者2眼(10.5%)。裂孔位于下方血管弓旁9只眼(占47.4%),上方血管弓旁4只眼(占21.1%),视盘下方1-4个视盘直径距离5只眼(占26.3%),视盘上方2个视盘直径距离1只眼(占5.2%)。后巩膜葡萄肿18只眼(占94.7%),其中Ⅰ型(宽基底黄斑型)11只眼(占61.1%),Ⅱ型(窄基底黄斑型)5只眼(占27.8%),Ⅲ型(盘周型)2只眼(占11.1%)。术后6个月最佳矫正视力LogMAR较术前降低,差异有统计学意义(Z=-3.162,P=0.002)。术后6个月视网膜复位率94.7%。结论:导致高度近视视网膜脱离的后极部裂孔的形成可能与后巩膜葡萄肿、血管延伸性、玻璃体皮质牵拉有关,以裂隙状和细小裂孔为主,玻璃体切除手术中仔细寻找裂孔,联合裂孔周围视网膜内界膜剥除,可促进视网膜复位,提高术后视力。

PPV联合内界膜翻转填塞术治疗高度近视黄斑裂孔性视网膜脱离

目的:探究玻璃体切除(PPV)联合内界膜翻转填塞术治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的临床疗效。方法:回顾性临床研究。选取2017-10/2021-10本院收治的高度近视MHRD患者63例64眼为研究对象,根据手术方式的不同分为A组(34例35眼,接受PPV联合内界膜翻转填塞术治疗)和B组(29例29眼,接受PPV联合内界膜剥除术治疗)。术后随访6mo,比较两组患者的裂孔闭合率、视网膜脱离复位率;术前,术后1wk,1、3、6mo时最佳矫正视力(BCVA);记录术后并发症发生情况。结果:术后6mo内,A组的裂孔闭合率明显高于B组(P<0.05);两组患者的视网膜脱离复位率比较无差异(P>0.05)。术后随着时间的延长,两组患者的BCVA较术前明显改善(P<0.05);术前,术后1wk,1、3、6mo时,两组患者的BCVA比较无明显差异(P>0.05)。术后两组患者均出现一定并发症,但两组患者的并发症发生率比较无差异(P<0.05)。结论:PPV联合内界膜翻转填塞术治疗高度近视MHRD具有良好的临床疗效,能有效改善患者的BCVA,提高裂孔闭合率,且不会影响患者眼压,安全有效。