高度近视黄斑劈裂视网膜内界膜剥离手术联合全氟丙烷眼内填充疗效评价

目的 客观评价视网膜内界膜(ILM)剥离手术联合全氟丙烷(C3F8)眼内填充治疗高度近视黄斑劈裂的临床疗效.方法 随机选取高度近视黄斑劈裂患者31例33只眼,手术前屈光度-9.5～-21.0 D,平均屈光度(-13.1±-3.6)D,眼轴26～32 mm,平均眼轴长度(28.3±2.1)mm,均伴有黄斑部的巩膜葡萄肿而不伴有视网膜脱离.手术治疗采用常规20G玻璃体切割手术联合ILM剥离和10%C3F8眼内填充,手术中采用曲安奈德(TA)标记ILM.手术后1、2、3、4、8个月复查,对比观察手术前后最佳矫正中心视力和黄斑部的结构变化.结果 手术后1个月开始,黄斑部视网膜劈裂即已显著改善,最佳矫正中心视力获得相应提高,随时间的延长,黄斑部结构无明显变化.手术前及手术后1、2、3、4、8个月黄斑中心凹厚度分别为(327.6±51.7)、(165.2±22.6)、(159.3±28.7)、(167.7±17.1)、(142.7±13.8)、(169.1±19.6)μm.与手术前相比,手术后1～8个月黄斑中心凹的厚度均较手术前显著下降(t=9.21,9.23,9.21,10.67,9.21;P<0.05),手术后各时间段之间比较,黄斑中心凹厚度差异无统计学意义(P>0.05),手术后4个月至随访末期,黄斑部劈裂复发3只眼,占9.1%.结论视网膜ILM剥离手术联合C3F8眼内填充可有效治疗高度近视黄斑劈裂;手术后远期劈裂的复发是影响预后的主要因素.

Internal limiting membrane peeling and perfluoropropane tamponade for macular retinoschisis with high myopia

Objective To evaluate the efficacy of vitrectomy with internal limiting membrane(ILM) peeling and perfluoropropane tamponade (C3F8) to treat macular retinoschisis in high myopic eyes. Methods 33 eyes of 31 consecutive high myopia patients with macular retinoschisis were selected randomly; all had posterior staphyloma without retinal detachment. The preoperative refractive errors ranged from -9.5 D to -21.0 D with the mean of -(13.1±3.6) D. The preoperative axial lengths ranged form 26 mm to 32 mm with the mean of (28.3±2.1 mm. Conventional 20-G vitrectomy was performed with ILM peeling and 10 % C3 F8 infusion, ILM was labeled by Triamcinolone (TA). The best corrected visual acuity (BCVA) and macular structural changes were observed before the surgery, and at 1, 2, 3, 4, 8 months after the surgery. Results Beginning from 1 month after surgery all patients had significant improvement of the macular retinoschisis and BCVA. The macular structure changed very slightly along with the time. The foveal thickness were (327.62±51.7), (165.2±22. 6), (159.3±28.7), (167.7±17.1), (142.7±13.8) and (169.1±19.6) μm respectively before surgery and 1, 2, 3, 4, 8 months after surgery. The mean foveal thickness was reduced significantly at 1-8 months follow-up compared with the preoperational result (t = 9.21,9.23,9.21,10. 67,9.21; P<0.05). The foveal thickness had no significant change at each time-point after surgery. From 4 months after surgery, recurrence of macular retionoscbisis was found in 3 eyes (9.1%). Conclusion Vitrectomy with ILM peeling and C3F8 tamponade is useful to treat macular retinoschisis in high myopic eyes.