高度近视眼发生黄斑裂孔伴与不伴有视网膜脱离的临床观察

Objective To study the clinical features and the pathogenesis of macular hole with and without retina detachment(RD)in high myopic eyes.Methods It was a retrospective series case study.The charts of high myopic patients with macular hole at our hospital from June 2006 to February 2007 were retrospectively reviewed and analyzed. Patients were divided into two groups (the RD group and non-RD group) depending on the presence of RD or not. Their clinieal data and optic coherence tomography (OCT)results were further analyzed. SPSS 13.0 was used for the statistic analysis. When comparing the quantitative aspects like age, axial length and refraction, t-test was used. Categorical data, such as sex ratio, occurrence of vitreous traction, posterior staphyloma and retinoschisis were compared by using X2 test. Fisher's test was used in comparing eye laterality, incidence of white hole, visual acuity and posterior vitreous detachment (PVD). Results During this period, there were 43 patients fitting the including criteria. Among them,36 patents (37 eyes) were in the RD group and 7 patients (7 eyes) in the no-RD group. In the RD group,the average age was 56. 1,24. 3% of them (9/37) were male;percentage of left and right eyes was (11/37)and 70. 3% (26/37), respectively; average refraction was ( -8.9 ± 2. 2) D; average axial length was (28.7 ±2. 0) mm. Visual acuity was ≤0. 05 (72. 2% ) in 26 eyes and 0. 05-0. 2 (27. 8%) in 10 patients.The incidence of complete and non-complete PVD was 89. 2% (33/37) and 10. 8% (4/37), respectively.White hole presented in 35.1% (3/37) patients. Vitreous traction and retinoschisis presented in 27. 0%(10/37) and 35. 1% (13/37) patients, respectively. In the non-RD group, the average age was 47. 6;16. 7% of them (1/7) were male; left and right eyes were involved in 42. 9% (3/7) and 57. 1% (4/7),respectively. Average refraction was ( -9. 0 ± 1.9) D; average axial length was ( 28.9 ± 1.5 ) mm. Vision acuity was ≤0.05 in 3 patients (42.9%); between 0.05-0.2 in 3 eyes (42.9%) and ≥0.2 in 1 eye (14. 3% ). Incidence of complete and non-complete PVD was 85.7% (6/7) and 14. 3% (1/7),respectively. White hole was observed in 14. 3% (1/7) patients; 42. 9% (3/7) patients were accompanied with vitreous traction and 71.4% (5/7) with retinoschisis. B-scan ultrasenography showed posterior staphyloma in all 44 eyes. The results of statistical analysis showed that the gender (X2 = 0.008) and eye laterality (X2=0.449) as well as refraction (t=0.193), axial length (t=-0.25) and visual acuity (X2=4.509) of these two groups were similar (P>0.05). The incidences of vitreous traction (X2=0. 709), white hole (X2=1.179 ), PVD (X2=0.071) and retinoschisis (X2=3.207) were also similar (P>0. 05). But the age of the non-RD group is significantly younger than the RD group (t=1.66,P<0. 05). Conclusions Various pathogenesis may involved in the occurrence of retinal detachment in highly myopic eyes with macular hole. Further study is required to improve our understanding of this entity.     

高度近视眼发生黄斑裂孔伴与不伴有视网膜脱离的临床观察

Objective To study the clinical features and the pathogenesis of macular hole with and without retina detachment(RD)in high myopic eyes.Methods It was a retrospective series case study.The charts of high myopic patients with macular hole at our hospital from June 2006 to February 2007 were retrospectively reviewed and analyzed. Patients were divided into two groups (the RD group and non-RD group) depending on the presence of RD or not. Their clinieal data and optic coherence tomography (OCT)results were further analyzed. SPSS 13.0 was used for the statistic analysis. When comparing the quantitative aspects like age, axial length and refraction, t-test was used. Categorical data, such as sex ratio, occurrence of vitreous traction, posterior staphyloma and retinoschisis were compared by using X2 test. Fisher's test was used in comparing eye laterality, incidence of white hole, visual acuity and posterior vitreous detachment (PVD). Results During this period, there were 43 patients fitting the including criteria. Among them,36 patents (37 eyes) were in the RD group and 7 patients (7 eyes) in the no-RD group. In the RD group,the average age was 56. 1,24. 3% of them (9/37) were male;percentage of left and right eyes was (11/37)and 70. 3% (26/37), respectively; average refraction was ( -8.9 ± 2. 2) D; average axial length was (28.7 ±2. 0) mm. Visual acuity was ≤0. 05 (72. 2% ) in 26 eyes and 0. 05-0. 2 (27. 8%) in 10 patients.The incidence of complete and non-complete PVD was 89. 2% (33/37) and 10. 8% (4/37), respectively.White hole presented in 35.1% (3/37) patients. Vitreous traction and retinoschisis presented in 27. 0%(10/37) and 35. 1% (13/37) patients, respectively. In the non-RD group, the average age was 47. 6;16. 7% of them (1/7) were male; left and right eyes were involved in 42. 9% (3/7) and 57. 1% (4/7),respectively. Average refraction was ( -9. 0 ± 1.9) D; average axial length was ( 28.9 ± 1.5 ) mm. Vision acuity was ≤0.05 in 3 patients (42.9%); between 0.05-0.2 in 3 eyes (42.9%) and ≥0.2 in 1 eye (14. 3% ). Incidence of complete and non-complete PVD was 85.7% (6/7) and 14. 3% (1/7),respectively. White hole was observed in 14. 3% (1/7) patients; 42. 9% (3/7) patients were accompanied with vitreous traction and 71.4% (5/7) with retinoschisis. B-scan ultrasenography showed posterior staphyloma in all 44 eyes. The results of statistical analysis showed that the gender (X2 = 0.008) and eye laterality (X2=0.449) as well as refraction (t=0.193), axial length (t=-0.25) and visual acuity (X2=4.509) of these two groups were similar (P>0.05). The incidences of vitreous traction (X2=0. 709), white hole (X2=1.179 ), PVD (X2=0.071) and retinoschisis (X2=3.207) were also similar (P>0. 05). But the age of the non-RD group is significantly younger than the RD group (t=1.66,P<0. 05). Conclusions Various pathogenesis may involved in the occurrence of retinal detachment in highly myopic eyes with macular hole. Further study is required to improve our understanding of this entity.     

高度近视眼发生黄斑裂孔伴与不伴有视网膜脱离的临床观察

目的 探讨高度近视眼发生黄斑裂孔伴与不伴有视网膜脱离的临床特点及其发生机制.方法 回顾性病例对照研究.对2006年6月至2007年2月43例(44只眼)高度近视眼发生黄斑裂孔患者的临床资料进行回顾性分析.根据患者是否伴有视网膜脱离分为脱离组与非脱离组,对两组各项观察指标进行对比分析,同时对非脱离组黄斑裂孔患者的相干光断层扫描(OCT)图像进行分析.采用SPSS 13.0统计软件进行数据处理.对两组患者的计量资料如年龄、眼轴长度、屈光度数进行比较,采用t检验;对两组患者的计数资料如性别构成比,裂孔周围玻璃体牵引、后巩膜葡萄肿及视网膜劈裂的发生率进行比较,采用X2检验;对两组患者左右眼的构成比和白孔、玻璃体后脱离的发生率进行比较,采用Fisher's确切概率法检验.结果 43例(44只眼)患者中,视网膜脱离组37例(37只眼),非脱离组7例(7只眼).视网膜脱离组患者平均年龄56岁;男性9例(24.3%),女性28例(75.7%);11只左眼(29.7%),26只右眼(70.3%);平均屈光度数(-8.9±2.2)D,平均眼轴长度(28.7±2.0)mm;视力≤0.05者26只眼,视力0.05～0.2者11只眼;玻璃体完全后脱离33只眼(89.2%),玻璃体不完全后脱离4只眼(10.8%),白孔13只眼(35.1%),裂孔周围玻璃体牵引10只眼(27.0%),视网膜劈裂13只眼(35.1%).非脱离组患者平均年龄48岁;男性1例(14.3%),女性6例(85.7%);左眼3只眼(14.3%),右眼4只眼(57.1%);平均屈光度数(-9.0±1.9)D,平均眼轴长度(28.9±1.5)mm;视力≤0.05者3只眼,视力0.05～0.2者3只眼,视力≥0.2者1只眼;玻璃体完全后脱离6只眼(85.7%),玻璃体不完全后脱离1只眼(14.3%),白孔1只眼(14.3%),裂孔周围玻璃体牵引3只眼(42.9%),视网膜劈裂5只眼(71.4%).B超检查显示所有患者均有后巩膜葡萄肿.OCT检测结果显示,非脱离组患者的黄斑裂孔周围大多有视网膜水肿、劈裂或脱离晕等与特发性黄斑裂孔相似的改变,但局部后巩膜葡萄肿的膨隆并不明显.统计分析结果显示,视网膜脱离组与非脱离组患者性别比(X2=0.008)、左右眼构成比(X2=0.449)、屈光度数(t=0.193)、眼轴(t=-0.25)、视力(X2=4.509)、玻璃体后脱离(X2=0.071)、白孔(X2=1.179)、孔缘部玻璃体牵引(X2=0.709)及视网膜劈裂发生率(X2=3.207)差异均无统计学意义(P>0.05);但视网膜脱离组患者年龄明显大于非脱离组,差异有统计学意义(t=1.66,P<0.05).结论 高度近视眼发生黄斑裂孔伴有视网膜脱离的原因可能有多种.高度近视眼患者在年龄增长过程中玻璃体和视网膜的改变可能是发生黄斑裂孔继而引起视网膜脱离的重要原因.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

高度近视黄斑裂孔性视网膜脱离手术的治疗进展

黄斑裂孔性视网膜脱离(macular hole retinal detachment,MHRD)常常引起严重的视力损害,主要发生于伴有后巩膜葡萄肿的高度近视患者。高度近视患者MHRD的发病机制尚不明确,目前普遍认为其发生涉及多种复杂牵拉力。许多学者尝试了多种手术方法解除视网膜牵拉,促进视网膜复位和黄斑裂孔闭合。本文对目前临床上用于治疗高度近视患者MHRD的手术方法进行综述。     

Comparison of anatomical and functional outcomes of different surgical techniques in myopic macular hole without retinal detachment

AIM: To define the anatomic and functional outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, inverted ILM flap and free ILM patch graft technique for the treatment of myopic macular hole (MH) without retinal detachment. METHODS: Sixty-four eyes of 64 patients who underwent PPV for myopic MH were included. Group 1 consists of patients underwent ILM peeling (n=26), and Groups 2 and 3 consists of patient underwent free ILM patch graft (n=20) and inverted ILM flap procedure (n=18) respectively. Outcomes following surgery were MH closure and best corrected visual acuity (BCVA) in logMAR at 6mo. RESULTS: Closure of MH was obtained in 20 eyes (76.9%) of the Group 1, in 16 eyes (80%) of the Group 2 and in 16 eyes (88.9%) of the Group 3. The mean preoperative and postoperative BCVA was 1.60±0.53 logMAR and 1.27±0.58 logMAR, respectively (P<0.05). There was no significant difference in the postoperative BCVA and anatomical closure rates in the three groups. Although the anatomical closure rate did not differ significantly in the groups, closure of MH tended to be better in the inverted ILM flap technique group at 6mo. CONCLUSION: Different surgical techniques may provide favorable visual and anatomical results for myopic MH surgery. ILM flap techniques offer higher closure rates compared to ILM peeling technique. However, in terms of visual outcomes, the study reveals no difference in three surgical techniques.     

Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment

PURPOSE: To investigate the natural course of macular retinoschisis in highly myopic patients. DESIGN: A prospective, observational case series. METHODS: Seven consecutive patients (eight eyes) with macular retinoschisis without macular hole or retinal detachment determined by optical coherence tomography (OCT) were followed at least two years without surgical intervention. The changes in the OCT findings and best-corrected visual acuity (BCVA) were analyzed. RESULTS: During follow-up, two eyes that had vitreoretinal adhesions developed a macular hole, one with and one without retinal detachment (RD), and two eyes without detectable vitreoretinal adhesion developed RD without a macular hole. BCVA in these four eyes was significantly reduced. The remaining four eyes did not develop complications, although the thickness of the macula increased significantly. CONCLUSIONS: These findings suggest that macular retinoschisis might be a progressive condition, and that complications appeared to be related to the presence of vitreoretinal tractions.     

Anatomical and visual outcomes after episcleral macular buckling compared with those after pars plana vitrectomy for retinal detachment caused by macular hole in highly myopic eyes

PURPOSE: To report anatomical and visual outcomes after episcleral macular buckling (EMB) and pars plana vitrectomy (PPV) for retinal detachment caused by macular hole in highly myopic eyes with posterior staphyloma. PATIENTS AND METHODS: This retrospective, interventional case series included 58 eyes of 58 patients with retinal detachment caused by macular hole in highly myopic eyes with posterior staphyloma and geographic chorioretinal atrophy. The cases were assigned to 2 groups according to the surgical technique: the EMB group (30 eyes) underwent posterior episcleral buckling using a solid silicone plate specifically designed for macular indentation, and the PPV group (28 eyes) underwent PPV combined with fluid-gas exchange. Baseline clinical data including age, sex, refractive errors, and degree of retinal detachment did not differ between EMB and PPV groups. Main outcome measures included ophthalmoscopy findings, three-mirror contact lens biomicroscopy results, and visual acuity at the end of follow-up (mean follow-up, 52.8 months in the EMB group and 44.1 months in the PPV group). Optical coherence tomography was performed in selected cases in the EMB group. RESULTS: In the EMB group, the retinal reattachment rate was 93.3% after primary surgery and 100% after secondary surgery. In the PPV group, the retinal reattachment rate was 50% after primary surgery and 86% after secondary surgery using the EMB procedure, thus indicating a better anatomical success rate after primary EMB than after primary PPV. The mean logarithm of the minimum angle of resolution (logMAR) visual acuity +/- SD in the EMB group increased significantly from 1.45 +/- 0.50 before surgery to 0.92 +/- 0.42 at the end of follow-up (P < 0.001). The mean logMAR visual acuity in the PPV group increased significantly from 1.70 +/- 0.45 before surgery to 1.35 +/- 0.61 at the end of follow-up (P < 0.02). Visual acuity improvement at the end of follow-up was significantly better after EMB than after PPV (P < 0.005). Optical coherence tomography revealed that 10 of 12 eyes with successful indentation of the macular hole area after EMB had complete closure of the macular hole as well as reattachment of the retina, and the remaining 2 eyes had persistent retinal reattachment with the foveal defect. CONCLUSIONS: EMB is a preferred surgical procedure for the repair of retinal detachment and macular hole closure in highly myopic eyes with posterior staphyloma.     

Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole

PURPOSE: To determine the effectiveness of scleral buckling with a macular plombe in eyes with myopic macular retinoschisis and retinal detachment without a macular hole. DESIGN: A prospective, consecutive interventional case series. METHODS: Setting: Clinical practice at university hospitals. Patient Population: Six eyes of five consecutive patients with myopic macular retinoschisis and retinal detachment without a macular hole. Intervention Procedure: Scleral buckling with a macular plombe. Main Outcome Measures: The best-corrected visual acuity (BCVA), ophthalmoscopic appearance of fundus, and optical coherence tomographic images were recorded preoperatively, and at two weeks, at one, three, and six months, and then every three months thereafter. RESULTS: The mean retinal thickness was reduced significantly by the macular plombe (P < .05). The BCVA was improved by 2 lines or more in four eyes (66%), and remained within 2 lines of the preoperative BCVA in two eyes (34%). The complications were subretinal hemorrhage without choroidal neovascularization in one eye, and a progression of choroidal neovascularization with subretinal hemorrhage, which caused a transient visual impairment in one eye. CONCLUSIONS: We recommend that macular scleral buckling with a macular plombe be considered for eyes with myopic macular retinoschisis and retinal detachment without a macular hole.     

高度近视黄斑裂孔性视网膜脱离的玻璃体视网膜手术治疗进展

黄斑裂孔性视网膜脱离(macular hole retinal detachment,MHRD)是高度近视眼常见的并发症,常造成不可逆的视力损害。玻璃体视网膜手术(vitreoretinal surgery,VRS)是MHRD的主要治疗方式,但是由于此类患者伴有视网膜脉络膜萎缩、后巩膜葡萄肿、眼轴增长等异常解剖结构,故手术难度大、患者视力预后差,易复发。近年来,随着眼内填充物选择的多样化、内界膜处理技巧的发展以及眼科机器人等新技术的兴起,VRS治疗高度近视MHRD取得了令人满意的视网膜解剖复位率。如何在提高视网膜复位率及黄斑裂孔闭合率的基础上实现患者视功能的改善是目前VRS治疗高度近视MHRD的重点与难点。本文现就高度近视MHRD的VRS治疗进展进行综述。     

玻璃体手术治疗高度近视眼黄斑裂孔引起的原发性视网膜脱离

目的 报告一组高度近视眼由黄斑裂孔引起的原发性视网膜脱离经玻璃体手术治疗的结果。 方法 回顾性分析自1996年3月至2004年3月连续进行的一组病例，纳入标准为原有屈光不正≥－6.00 D，或眼轴≥26 mm，未发现周边视网膜裂孔，且经玻璃体手术治疗、由黄斑裂孔引起的原发性视网膜脱离。 结果 本组患者83例， 其中女63例，男20例，85只眼，平均年龄54.1岁。手术前视力光感~数指49只眼，0.01~0.1者33只眼，0.12~0.2者3只眼。视网膜脱离范围仅限于黄斑部15只眼，1~2个象限11只眼，3 ~4个象限59只眼。手术中同时做晶状体切除或超声粉碎62只眼（72.9%），黄斑前膜切除37只眼，注入C3F829只眼（34.1%），注入硅油56只眼（65.9%）。手术后视网膜复位77只 眼（90.6%），未复位8只眼。手术后视力改善47只眼（55.3%），不变25只眼（29.4%），下降13只眼（15.3%）。 结论 由于黄斑裂孔引起的原发性视网膜脱离多发生在年龄较大、女性高度近视眼，玻璃体手术具有同时进行玻璃体后皮质和黄斑前膜切除、晶状体摘除和眼内填充的优势，手术后大多数眼能改善或保持视力。 （中华眼底病杂志， 2006，22：287-290）     

Vitreous surgery in highly myopic retinal detachment resulting from a macular hole

Purpose: This study aimed to assess the therapeutic effect of vitreous surgery in conjunction with photocoagulation for highly myopic retinal detachment resulting from a macular hole. Methods: Sixty‐two consecutive highly myopic patients (65 eyes) with retinal detachment from macular holes underwent vitreous surgery. Gas tamponade in conjunction with laser photocoagulation was performed in 46 eyes (44 cases, group 1); gas tamponade only was performed in 12 eyes (11 cases, group 2); and silicone oil tamponade only was performed in seven eyes (seven cases, group 3). Additional laser photocoagulation was given in group 1 if necessary. The anatomical and functional success rates were compared between the groups. Results: Primary retinal reattachment was achieved in 43 eyes (93.5%) in group 1, seven eyes (58.3%) in group 2 and four eyes (57.1%) in group 3. Final visual acuity was 6/60 or more in 24 eyes (52.2%) in group 1, in six eyes (50.0%) in group 2 and in three eyes (42.9%) in group 3. The initial retinal reattachment rate was significantly higher in group 1 than in group 2 (P = 0.0075) and group 3 (P = 0.0248). The macular hole was completely closed in 18 eyes in group 1 and one eye in group 2 after 2 months or longer. A thin fibrous membrane and scar could be easily noticed beneath the macula in 15 eyes. Conclusion: Vitreous surgery in conjunction with laser photo­coagulation can improve the surgical success rate for highly myopic retinal detachment resulting from a macular hole.     

高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗

目的 探讨高度近视黄斑裂孔视网膜脱离患者玻璃体手术联合激光光凝治疗的成功率及并发症。 方法 高度近视黄斑裂孔视网膜脱离患者35例38只眼，11例12只眼单行经睫状体平部的玻璃体手术及惰性气体眼内填充，未作激光光凝治疗；24例26只眼在玻璃体手术术中及术后作黄斑裂孔缘激光光凝。术后均作6个月以上的随访(平均随访时间21．7个月)。 结果 非光凝组5只眼黄斑裂孔性视网膜脱离复发，占41．7%，术后0．1以上视力6只眼，占50.0%；光凝组2只眼黄斑裂孔复发，占7.7%，1只眼因周边新裂孔形成而复发视网膜脱离，术后有13只眼视力在0.1以上，占50.0%。统计学检验两组黄斑裂孔复发率概率P=0.024,视网膜脱离复发率概率P=0.0487。两组患者术后视力无显著差异。 结论 玻璃体手术联合黄斑区激光光凝治疗可提高高度近视黄斑裂孔视网膜脱离的手术成功率。 (中华眼底病杂志,1998,14:199-201)     

高度近视黄斑孔性视网膜脱离手术探讨

目的 评价黄斑加固联合内界膜剥离、注气治疗早期高度近视黄斑孔性视网膜脱离的效果.方法 10例10只眼早期高度近视黄斑孔性视网膜脱离进行了黄斑加固、玻璃体切除、内界膜剥离、玻璃体腔注气治疗.均有黄斑部视网膜脱离,眼轴长度均超过27.0 mm,均有黄斑全层破孔.视网膜已僵硬者排除在外.术后随访6～18个月.结果 10只眼初次手术后,视网膜全部复位.但1只眼1月后视网膜再次脱离,再次行玻璃体腔注气术后视网膜复位,黄斑孔未闭合.10只眼中有5只眼黄斑孔闭合;5只眼黄斑孔部分区域闭合,部分组织缺损（1个月后黄斑孔周围行激光封闭）.术中未见医源性裂孔形成,术后1只眼玻璃体积血,2周后自行吸收.余术后无眼内出血或眼内炎等严重并发症发生.结论 黄斑加固联合内界膜剥离注气术是治疗早期高度近视黄斑孔性视网膜脱离安全有效的手术方法.能提高视网膜解剖复位率、黄斑孔闭合率.     

高度近视眼黄斑裂孔性视网膜脱离手术方法的选择

目的　分析高度近视眼黄斑裂孔性视网膜脱离患者行玻璃体切除伴或不伴环扎术的疗效。方法　连续性高度近视眼黄斑裂孔性视网膜脱离 111例 ( 111只眼 ) ,均为单纯黄斑孔 ,行玻璃体切除术及气液交换术 ,术后随访 1～ 6月。对比分析环扎及无环扎组的 1次手术复位率及视力变化。结果　 111只眼中 ,环扎组 90只眼 ,1次手术治愈率 70 % ;不环扎组 2 1只眼 ,1次手术治愈率 90 .4%。两组 1次手术治愈率的差别有显著意义 ( P <0 .0 5 )。两组术后视力提高差别无显著意义。结论　对于近视度数高、眼轴长、又无严重赤道部病变的病例行玻璃体切除术无需同时行环扎术 ,不仅可避免环扎后可能发生的并发症 ,且提高 1次手术治愈率     

The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment

PURPOSE: To evaluate the anatomic and functional outcome of vitreoretinal surgery in eyes with pathologic myopia and macular hole and to determine if surgery improves visual acuity. METHODS: Twenty-four consecutive highly myopic eyes with full-thickness macular hole without posterior retinal detachment were treated by vitrectomy. Posterior hyaloid dissection, removal of epiretinal and internal limiting membranes (ILM) if thickened, instillation of platelet concentrate, and flushing with 25% sulfur hexafluoride were performed. RESULTS: Patients' refractive error ranged between -8.0 and -17.5 diopters, and axial length ranged from 27.1 to 31.4 mm. Two epimacular membranes and 10 macular ILM were removed. Ten patients also underwent phacoemulsification and intraocular lens implantation at the same procedure. Mean preoperative best-corrected visual acuity was 20/200. Successful anatomic macular hole closure occurred 6 months postoperatively in 100% of eyes after one (21 eyes, 87.5%) or two surgeries (3 eyes, 12.5%). Visual acuity improved three or more lines in 83.3% of patients. Mean postoperative visual acuity was 20/70. No retinal detachment was observed during the follow-up period, which ranged from 12 to 45 months. CONCLUSION: Our results suggest that vitreoretinal surgery may effectively manage myopic macular holes, thus improving anatomic and visual outcomes. By closing the hole, vitreoretinal surgery may decrease the risk of posterior retinal detachment in highly myopic eyes.