后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离

目的　探讨后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离（ｍａｃｕｌａｒｈｏｌｅｒｅｔｉｎａｌｄｅｔａｃｈｍｅｎｔ，ＭＨＲＤ）的可行性及疗效。方法　选取２０１１年６月至２０１４年６月硅油填充术后的复发性超高度近视性ＭＨＲＤ患者３６例（３６眼），所有患者均由同一术者行黄斑区改良后巩膜加固术，术后３个月取出硅油。术后随访１２个月，观察记录术后并发症、视网膜脱离复位情况、黄斑裂孔闭合情况、术后视力、眼轴长度等指标。结果　３６眼视网膜完全复位，视网膜复位率为１００％；末次随访ＳＤ-ＯＣＴ示２２眼黄斑裂孔完全闭合，占６１．１％，１１眼黄斑部分闭合，占３０．６％，３眼仍未闭合，占８．３％；３１眼术后最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｖｉｓｕａｌａｃｕｉｔｙ，ＢＣＶＡ）较术前提高，占８６．１％，５眼ＢＣＶＡ较术前无明显改变，占１３．９％；术前患者ＢＣＶＡ为（１．４８±０．９２）ｌｏｇＭＡＲ，术后ＢＣＶＡ为（０．９３±０．３８）ｌｏｇＭＡＲ，差异有统计学意义（Ｐ＜０．０５）；术前患者眼轴长度为（３０．９５±１．１６）ｍｍ，术后为（２８．４６±１．３４）ｍｍ，差异有统计学意义（Ｐ＜０．００１）。所有患眼均未发生眼底出血、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。结论　改良后巩膜加固术是治疗硅油填充术后复发性超高度近视ＭＨＲＤ安全有效的手术方法，能提高视网膜解剖复位率、黄斑裂孔闭合率、视力及减少并发症。

Posterior scleral reinforcement for recurrent macular hole retinal detachment with silicone oil tamponade in severe highly myopic eyes

Objective To investigate the efficacy and feasibility of posterior scleral reinforcement for recurrent macular hole retinal detachment with silicone oil tamponade in severe highly myopic eyes. Methods A retrospective study of 36 patients ( 36 eyes) with recurrent macular hole retinal detachment with silicone oil tamponade in severe highly myopic eyes from June 2011 to June 2014 was performed. All patients were treated with modified posterior scleral reinforcement. All patients underwent silicone oil removal at 3 months after the surgery, and were continuously followed for 12 months. The postoperative complication , macular hole heeling , anatomic retinal reattachment . best corrected visual acuity ( BCVA) and ocular axis length were observed. Results Retinal reattached completely in 36 eyes ( 100% ). SD-OCT revealed that the macular holes in 22 eyes (61. 1% ) were completely closed, 11 eyes ( 30. 6% ) were partly closed and 3 eyes ( 8. 3% ) was not closed in the last visit. Postoperative BCVA improved in 31 eyes ( 86. 1% ) , stabled in 5 eyes ( 13. g% ) ;The mean preoperative BCVA was ( 1. 48 + 0. 92 ) logMAR , whereas mean postoperative BCVA was ( 0. 93 + 0. 38 ) logMAR . the difference was statistically sigruficant ( P < 0. 05 ) . Preoperative ocular axis length was ( 30. 95 + 1. 16) mm. whereas postoperative ocular axis length was ( 28. 46 + 1. 34 ) mm , the difference was statistically significant ( P < 0. 001 ) . There was no complications such as subretinal hemorrhage ,vortex vein circumfluence obstacle and anterior ocular ischenua syndrome after surgery. Conclusion Posterior scleral reinforcement is a safe and effective operative method to treat recurrent macular hole retinal detachment with silicone oil tamponade in severe highly myopic eyes , can improve visual acuity , rate of the retinal anatomical reattachment and macular hole closure . and reduce the complications.