玻璃体后皮质与高度近视性黄斑裂孔视网膜脱离

目的 了解玻璃体后皮质在高度近视性黄斑裂孔视网膜脱离形成中的作用。 方法 2009年1月至4月在我院接受玻璃体手术的16例高度近视黄斑裂孔视网膜脱离患眼纳入本回顾性研究。所有患眼术前均接受了裂隙灯显微镜、间接检眼镜、B型超声、光学相干断层成像术（OCT）检查，以发现玻璃体后脱离和玻璃体视网膜牵引的状况；玻璃体手术中采用曲安奈德(TA)进行玻璃体后皮质染色，以确认残留的玻璃体后皮质和玻璃体后脱离的状况。综合各项观察的结果进行比较分析。结果 在检眼镜和超声检查之后，确定16例患眼术前玻璃体后脱离的状况分为：3眼（18.75%）完全性玻璃体后脱离，8眼（50%）部分性玻璃体后脱离，5眼（31.25%）无玻璃体后脱离。OCT检查发现有10/16(62.5%)眼不存在完全性玻璃体后脱离，而且在裂孔边缘存在玻璃体视网膜牵引，包括4眼的前后方向玻璃体牵引，6眼的切线方向牵引。TA辅助的玻璃体手术中证实16眼均不存在完全性玻璃体后脱离，其中有6/16（37.5%）眼最终诊断为部分性玻璃体后脱离，5/16（31.25%）眼诊断为玻璃体劈裂。综合比较后发现66.7%的部分性玻璃体后脱离患眼在OCT检查中发现存在前后方向的玻璃体视网膜牵引，80%的玻璃体劈裂患眼在OCT检查中发现存在切线方向的玻璃体视网膜牵引。在玻璃体后脱离的诊断符合率方面，超声检查为68.7%（P=0.02），OCT为62.5%（P<0.01）。结论 部分性玻璃体后脱离或玻璃体劈裂引起的玻璃体后皮质残留，可能会导致黄斑区前后方向或者切线方向的玻璃体视网膜牵引，进而影响高度近视性黄斑裂孔的形成和视网膜脱离的发展。术前综合超声和OCT等检查，加上术中TA辅助玻璃体后皮质染色，对于了解玻璃体视网膜的关系、综合评价玻璃体后皮质的状况是十分必要的。

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

Purpose: To investigate the effect of posterior vitreous cortex(PVC) to macular hole (MH) associated with retinal detachment (RD) formation in highly myopic eyes.Methods: Sixteen consecutive highly myopic eyes with RD due to MH were included in a retrospective analysis of prospective clinical trial from January to April in 2009. The peroperative 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 3(18.75%) eyes, partial PVD in 8(50%) eyes, and no PVD in 5(31.25%) eyes. OCT confirmed vitreoretinal traction and no complete PVD in 10(62.5%) eyes, including anteroposterior traction in 4 eyes and tangential traction in 6 eyes. During TA-assisted vitrectomy, it was confirmed that no complete PVD exist in 16 eyes, including 6/16 eyes (37.5%) finally diagnosed partial PVD, and 5/16(31.25%) eyes with vitreoschisis. Anteroposterior vitreoretinal traction around MH is always in conjunction with partial PVD(66.7%), and high proportion(80%) of vitreoschisis is associated with tangential vitreoretinal traction. For PVD diagnosis the coincidence rate of ultrasonography was 68.7%(P=0.02), and that of OCT was 62.5%(P<0.01).Conclusion: 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 vitreoretinal relationship and assess the status of PVC synthetically for surgery by combined ultrasonography and OCT preoperatively and TA staining intraoperatively.