高度近视黄斑裂孔性视网膜脱离的再次手术

目的 评价高度近视黄斑裂孔性视网膜脱离再次手术的治疗效果。方法 对需再次手术的黄斑裂孔性视网膜脱离17例17眼，其中11例是第1次经玻璃体切割联合膨胀气体填充后黄斑裂孔未闭合，6例是黄斑裂孔闭合后晚期复发的患者行玻璃体切割，彻底黄斑前膜剥离，2例行视网膜内界膜剥离，全部病例联合硅油内填充，11例术后补充氩激光光凝。结果 17例17眼黄斑裂孔闭合，视网膜全部复位，最终视力较术前提高。随访3—24个月，视网膜复位良好，无1眼复发。结论 黄斑裂孔性视网膜脱离再次手术中彻底剥离黄斑前膜，剥离视网膜内界膜，硅油填充和激光光凝可有效封闭黄斑裂孔。     

Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study

Purpose

To evaluate postoperative outcomes after macular buckling together with pars plana vitrectomy (PPV) in previously untreated and recurrent retinal detachment secondary to macular hole (MH) in highly myopic eyes.

Methods

In a retrospective cohort study, 42 eyes of 42 high myopic patients with retinal detachment due to MH were evaluated. Patients were divided into previously untreated retinal detachment (group 1, 21 eyes) and recurrent retinal detachment (group 2, 21 eyes). Macular buckling and PPV were performed in all patients. Main outcomes included retinal reattachment rate, macular hole closure rate and best-corrected visual acuity (BCVA) at 3, 6, and 12 months. Optical coherence tomography (OCT) was performed both pre- and postoperatively in all patients to assess the anatomical status of the macula.

Results

Primary retinal reattachment rate in group 1 was 95% (20/21), which increased to 100% (21/21) after a second surgery. MH closure was achieved in 81% of patients (17/21) after one surgery. The mean preoperative BCVA (logarithm of the minimum angle of resolution, LogMAR) improved from 1.32 (95% CI 1.19;1.44) to 0.76 (95% CI 0.56;0.96) 12 months postoperatively. In all except one case, gas tamponade was preferred. Primary reattachment and MH closure rate in group 2 were 90.5% (19/21) and 57% (12/21) respectively, and did not improve after a second surgery. Preoperative BCVA (LogMAR) was 1.39 (95% CI 1.29;1.49) and improved to 0.95 (95% CI 0.75;1.15) at 12 months. Silicone oil tamponade was used in seven of 21 patients, and finally was removed in five of them.

Conclusions

Macular buckling combined with PPV should be considered a preferred surgical approach both in primary and recurrent retinal detachment secondary to MH in high myopic eyes. Nevertheless, visual outcomes seem to be better when macular buckling is chosen as first-line treatment.     

Gas tamponade and macular grid laser photocoagulation in the management of recurrent retinal detachment

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of intraocular gas tamponade and macular grid laser photocoagulation to manage recurrent macular hole retinal detachment after an initially successful reattachment by gas tamponade in highly myopic eyes. PATIENTS AND METHODS: Five patients with high myopia and macular hole retinal detachment were treated by gas tamponade at the initial operation. Gas tamponade and macular grid laser photocoagulation were performed to treat recurrent retinal detachment at the second surgery. Demographic information, anatomic reattachment of the retina, and final visual acuity were studied. RESULTS: Final successful retinal reattachment at the end of follow-up was obtained in all five eyes. Improvement of postoperative visual acuity with respect to preoperative visual acuity was observed in all patients. CONCLUSION: Intraocular gas tamponade and grid laser photocoagulation in the macula for the management of recurrent macular hole retinal detachment provides good long-term anatomic success and acceptable functional results.     

高度近视眼黄斑裂孔视网膜脱离临床特征及其手术方法

目的　观察高度近视眼黄斑裂孔视网膜脱离的临床特征与手术方法的关系。方法　检查 30例 (31只眼 )高度近视眼黄斑裂孔视网膜脱离 ,并根据手术方法分两组。第一组 (14只眼 ) ,行环扎术、玻璃体腔内注气或C3 F8。第二组 (17只眼 ) ,行环扎术、玻璃体切除术和 C3 F8眼内填充术。结果　 31只眼中玻璃体后脱离 6 1.2 9%,周边部破孔 5 1.6 1%,后巩膜葡萄肿“白孔”眼 5 8.0 6 %。术后复发 8只眼 (第一组 5只眼 ,第二组 3只眼 ) ,复发率2 5 .8%。再手术 7只眼痊愈 ,1只眼拒绝手术 ,属未愈。痊愈 30只眼 ,痊愈率 96 .77%。结论　第一组没有玻璃体手术 ,复发率虽较高 ,但两组复发病例统计学处理无显著差异 (P >0 .0 5 )。两组中 3只眼第一次手术未做环扎术 ,术后复发 ,占复发眼 (8只眼 ) 37.5 %。玻璃体切除术和眼内气体填充术虽为视网膜脱离广泛应用之手术 ,但也应重视环扎术对高度近视眼黄斑裂孔视网膜脱离治疗的作用。     

Results of high-density silicone oil as a tamponade agent in macular hole retinal detachment in patients with high myopia

BACKGROUND: To evaluate the use of high-density silicone oil (HDSO) as a tamponade agent for retinal detachment secondary to myopic macular hole. METHODS: 12 eyes of 12 patients with macular hole retinal detachment underwent pars plana vitrectomy, internal limiting membrane peeling and HDSO tamponade. No posturing was required postoperatively and HDSO was removed 3-4 months later. Outcome measures included macular hole closure and retinal attachment rates, best-corrected visual acuity (BCVA), and intraoperative and postoperative complications. RESULTS: The mean age of the patients was 67.8 years and the mean spherical equivalent refractive error was -13.4 diopters. After the removal of HDSO, 10 (83%) eyes had macular hole closure with retinal reattachment without any tamponade. One eye had retinal reattachment after re-operation and the other refused further surgery. At the last follow-up, the median BCVA improved from 20/800 to 20/600 (p = 0.046). A transient increase in intraocular pressure was observed in 5 (42%) eyes and one eye each developed mild oil emulsification and transient peripheral choroidal detachment. None of the eyes was found to have severe intraocular inflammation postoperatively. CONCLUSIONS: HDSO seemed to be an effective tamponade agent for myopic macular hole retinal detachment. Further prospective controlled studies seem warranted.     

空气填充联合内界膜翻转治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔性视网膜脱离

目的：评估空气填充联合内界膜翻转及自体血治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。

方法：回顾性非对照研究分析高度近视眼MHRD患者的治疗效果。玻璃体切割术中使用曲安奈德染色清除玻璃体后皮质,内界膜翻转后应用自体血固定翻转的内界膜后空气填充。记录术后黄斑裂孔闭合率、视网膜复位率及术后最佳矫正视力(BCVA)。

结果：研究共纳入高度近视MHRD患者24例24眼。患者随访至少6mo,平均13.58±7.00mo。末次随访时21眼(88%)黄斑裂孔闭合,20眼(83%)视网膜复位。其中17眼(71%)黄斑裂孔闭合且视网膜复位,3眼(13%)黄斑裂孔未闭合但视网膜复位,4眼(17%)黄斑裂孔闭合但仍有视网膜下液。所有病例无需接受二次玻璃体切割手术。末次随访BCVA(LogMAR)较术前显著提高(0.65±0.34 vs 1.36±0.49,P<0.001)。12眼(50%)的BCVA提高大于等于2行。

结论：玻璃体切割术联合内界膜翻转、自体血及空气填充是治疗高度近视眼MHRD的有效方法。     

Pars plana vitrectomy and perfluoropropane (C3F8) tamponade for retinal detachment due to myopic macular hole: a prognostic factor analysis

PURPOSE: To determine the prognostic factors associated with anatomical success in the treatment of retinal detachment (RD) due to myopic macular hole by pars plana vitrectomy (PPV) and perfluoropropane (C3F8) gas tamponade. DESIGN: Retrospective, interventional, comparative case series. METHODS: In an institutional setting, 57 eyes with myopic macular hole RDs treated by PPV and C3F8 tamponade, with or without concomitant internal limiting membrane (ILM) peeling, endolaser photocoagulation, and/or phacoemulsification, were analyzed. Outcome measures were anatomical success, defined as closure of macular hole with reattachment of the surrounding retina, and postoperative best-corrected visual acuity (BCVA). RESULTS: The mean postoperative follow-up was 26.9 +/- 16.5 months. The anatomical success rate after primary PPV and C3F8 tamponade was 63.2%. Regression analysis showed that shorter axial lengths (odds ratio [OR] = 6.73, 95% confidence interval [95% CI] 1.86 to 12.22, P = .010), concomitant ILM peeling (OR 1.59, 95% CI 1.14 to 2.38, P = .013), and shorter duration of macular hole RD (OR 0.81, 95% CI 0.67 to 0.98, P = .033) were associated with a higher anatomical success. The mean pre- and postoperative BCVAs were 1.430 +/- 0.273 (range, 0.523 to 1.700) and 1.403 +/- 0.271 (range, 0.699 to 1.800) logarithm of minimal angle of resolution units, respectively. The postoperative BCVA was significantly better in eyes with macular hole closure than in eyes without (P = .021). CONCLUSIONS: Axial length, concomitant ILM peeling, and duration were important prognostic factors for PPV and C3F8 tamponade in the treatment of myopic macular hole RDs.     

后巩膜加固术治疗高度近视黄斑裂孔性视网膜脱离

目的：探讨改进的后巩膜加固术对高度近视黄斑裂孔性视网膜脱离的治疗效果。 方法：1993年3月至1995年11月对住院的20例高度近视黄斑裂孔性视网膜脱离患者的20只眼，采用后巩膜加固术治疗，有关临床资料进行回顾分析。 结果：眼轴可对比的14只眼，术前与出院时的均值为28.22mm与26.87mm，17只眼视网膜复位，获得0.02一0.2的矫正视力，3只眼失败，增殖性玻璃体视网膜病变(proliferative vitreous retinopathy，PVR)加重。 结论：后巩膜加固术可有效治疗无严重PVR的高度近视黄斑裂孔所致的视网膜脱离，不必采用视网膜粘连法以尽量保存残留的中心视力。 （中华眼底病杂志，1996，12：214-216）     

Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes

PURPOSE: To evaluate the surgical outcome of retinal detachment resulting from a posterior staphyloma-associated macular hole in highly myopic eyes. METHODS: Fifty-seven consecutive highly myopic eyes with retinal detachment resulting from a posterior staphyloma-associated macular hole diagnosed between January 1993 and June 2003 were retrospectively studied. Anatomical reattachment of the retina and best-corrected visual acuity were measured. RESULTS: Six different operative methods were used to treat this condition with diverse retinal reattachment rates: long-acting gas tamponade only (12.5%); pars plana vitrectomy (PPV) with long-acting gas tamponade (42.8%); PPV with epiretinal membrane (ERM) peeling and long-acting gas tamponade (50.0%); encircling scleral buckling combined with PPV and long-acting gas tamponade (57.1%); encircling scleral buckling combined with PPV, ERM peeling, and long-acting gas tamponade (40.0%); and encircling scleral buckling combined with PPV and silicone oil tamponade (75.0%). Overall, successful retinal reattachment was achieved in 25 (43.9%) of 57 eyes after the first surgery. However, the ultimate success rate of retinal reattachment was 77.2% (44 of 57 eyes) after subsequent surgery. The mean preoperative visual acuity +/- SEM (in logarithm of the minimal angle of resolution units) was 2.08 +/- 0.55, and the mean postoperative visual acuity +/- SEM was significantly increased to 1.87 +/- 0.54 at the last follow-up (P = 0.038). The major cause of recurrent retinal detachment in the long-acting gas tamponade group was nonclosure of the macular hole. For vitrectomized eyes, the major cause was reopening of the macular hole, even with ERM formation and proliferative vitreoretinopathy. There was no obvious correlation between the extent of the detachment or lens status and the reattachment rate. CONCLUSIONS: The major causes of recurrent retinal detachment in the long-acting gas tamponade and vitrectomized groups were nonclosure of the macular hole and reopening of the macular hole, respectively. Furthermore, a lesser extent of retinal detachment was not associated with a higher anatomical success rate. More aggressive treatment such as silicone oil tamponade may need to be performed to overcome reduced natural adhesion due to posterior staphyloma with marked chorioretinal atrophy. Failure to initiate aggressive treatment can result in an unsatisfactory outcome and repeated surgery.     

玻璃体切割联合硅油填充与C3F8填充治疗高度近视黄斑裂孔视网膜脱离临床效果比较

背景 高度近视黄斑裂孔视网膜脱离(MHRD)可造成严重的视力下降,经睫状体平坦部的玻璃体切割术联合眼内填充术已应用于该病的临床治疗,目前常用的眼内填充物包括硅油及可膨胀性气体C3F8,两种填充物的效果比较仍缺少相关研究证据. 目的 评价玻璃体切割联合硅油填充与C3F8填充治疗高度近视黄斑裂孔视网膜脱离的手术效果.方法 采用回顾性病例对照设计.对采用玻璃体切割联合眼内填充术治疗的51例高度近视MHRD患者,根据术中眼内填充物的不同将患者分为硅油填充组和C3F8填充组,两组患者基线资料一致.对两组术眼术后的最佳矫正视力(BCVA)、视网膜复位率、黄斑裂孔闭合情况及视网膜脱离复发率进行分析和比较. 结果 两组患者术前视力差异无统计学意义(U=266.000,P=0.286),基线视力一致,术中不同眼内填充物治疗后视力差异亦无统计学意义(U=205.000,P=0.029);应用硅油填充及C3F8填充患者BCVA术后与术前相比均有显著提高,差异均有统计学意义(Z=-2.729,P=0.006;Z=-3.273,P=0.001),两组患者术后视网膜脱离发生率及黄斑裂孔解剖闭合率差异均无统计学意义(P=0.894、1.000).患者除白内障外无其他并发症发生. 结论 应用C3F8填充治疗高度近视MHRD与硅油填充治疗效果相同,且均安全、有效.     

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.     

Inverted internal limiting membrane flap technique for myopic macular hole: A meta-analysis

A macular hole (MH) may be a significant complication in patients with high myopia. The recently reported inverted internal limiting membrane (ILM) flap technique is a promising alternative to treat myopic MHs. We performed a meta-analysis of the published anatomical and functional results of the “inverted ILM flap” technique for the treatment of myopic MH with or without retinal detachment (RD). Our results showed that the inverted ILM flap technique, either covering or insertion, is an effective method for treating myopic MH with or without RD and provides high MH closure, ranging from 91.8% to 97.1%. Despite the high MH closure rate, the pooled visual acuity improvement rate was 77.3% and 66.2% in patients with myopic MH without RD, while it was 95% and 80.3% in patients with myopic MHRD, using “covering” and “insertion” ILM flap technique, respectively. Potential complications included reopening or persistence of MH, development of RD, choroidal detachment, ocular hypertension, and chorioretinal atrophy.     

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.     

无染色剂辅助的玻璃体联合手术治疗高度近视黄斑裂孔视网膜脱离的临床观察

目的 观察无染色剂辅助下玻璃体切除联合内界膜剥除（ILMP）及硅油填充治疗高度近视黄斑裂孔视网膜脱离的疗效.方法 对2011年7月至2013年7月在我院就诊的一组高度近视黄斑裂孔视网膜脱离病变患者行玻璃体切除联合ILMP及硅油填充术的14例（14只眼）患者的临床资料进行回顾性分析.手术后随访1~6个月,观察手术后视力、视网膜复位情况及裂孔闭合形式.结果 黄斑裂孔闭合、视网膜复位14只眼（100%）（其中1只眼为单纯注入C3F8复发后再次手术的）.术后视力提高11只眼（78.6%）,无变化3只眼.结论 玻璃体切除联合ILMP及硅油填充是治疗高度近视黄斑裂孔视网膜脱离的有效手术方式.术中不使用染色剂辅助,减少了视网膜毒性反应.     

光学相干断层扫描引导下黄斑裂孔性视网膜脱离硅油取出术的疗效评估

背景 黄斑裂孔性视网膜脱离行硅油取出后视网膜脱离复发率高,如何降低术后复发率是研究的热点.光学相干断层扫描(OCT)检查可确认适宜的取油时机,是否有助于提高手术成功率有待进一步临床观察. 目的 OCT观察高度近视黄斑裂孔性视网膜脱离行硅油取出术前黄斑区视网膜的解剖形态,分析影响硅油成功取出的因素. 方法 收集2005年1月至2008年12月经玻璃体切割术治疗的高度近视黄斑裂孔性视网膜脱离患者49例55眼的临床资料,其中联合硅油填充术者40例45眼,术后3～6个月,OCT检查黄斑区形态,行硅油取出术,随访时间均为硅油取出术后1年以上.比较玻璃体切割联合硅油填充术前、硅油取出术前和硅油取出术后1年患眼黄斑区的OCT表现以及最佳矫正视力(BCVA).OCT检查黄斑裂孔愈合标准分为一类愈合及二类愈合.结果 硅油取出前OCT示40眼视网膜成功复位,占88.89％,其中2眼裂孔愈合,裂孔边缘消失,属于一类愈合;38眼裂孔边缘平贴于视网膜色素上皮( RPE)层,但中心凹处神经纤维层存在缺损及RPE层暴露,属于二类愈合.硅油取出术后,二类愈合眼中l眼于术后2年发现视网膜脱离复发;联合硅油填充术者40例45眼术前BCVA为1.93±0.06,硅油取出后1年BCVA为1.16±0.07,术后视力较术前明显提高,差异有统计学意义(P=0.00). 结论 OCT检查可以作为硅油取出的术前评估.OCT证实黄斑裂孔闭合或黄斑裂孔的贴附眼可行硅油取出术;OCT检查示黄斑裂孔未闭合的贴附眼行硅油取出后预后较差,是视网膜再脱离的危险因素之一,需长期进行随访.     

Scleral resection technique combined with vitrectomy for a macular hole retinal detachment in highly myopic eyes

PURPOSE: To evaluate scleral resection technique combined with vitrectomy for macular hole retinal detachment of highly myopic eyes. MATERIALS AND METHODS: Seventeencases (17 eyes) of macular hole retinal detachment in highly myopic eyes, in which the patient underwent vitrectomy combined with scleral resection technique formacular hole retinal detachment between January 1996 and December 2003 at Fukuoka University Chikushi Hospital, were studied.Following pars plana vitrectomy, as much as possible of the residual vitreous and/or epiretinal membrane was removed. A scleral resection was performed in 2 quadrants of the equatorial region of the temporal sclera. Finally, a fluid-air exchange with SF(6) gas injection was performed to achieve retinal attachment. Pre- and postoperative axial length of the eyeballs were measured by B-scan ultrasonography. RESULTS: All cases had the retina reattached at the initial surgery, and visual acuities were stabilized or improved after the surgery. The posterior staphyloma became obscure in 13 out of 17 eyes (76.8%). The macular hole closed in 14 of 17 eyes (82.4%) ophthalmoscopically. There were no cases in which retinal redetachment occurred during follow-up periods of more than 6 months. CONCLUSION: In cases of macular hole retinal detachment of a highly myopic eye, scleral resection technique combined with vitrectomy changed the shape of the eyeballs and allowed successful retinal reattachment at the initial surgery.     

Late recurrences after successful surgery for retinal detachment with macular hole

Six myopic eyes affected by retinal detachment with macular hole which had been successfully reattached developed recurrent retinal detachment 7–78 months postoperatively. The mean interval between surgery and the recurrent retinal detachment was 13.4 months in five eyes managed with gas tamponade and no choroidal irritation. In an eye managed by scleral buckling with choroidal irritation, the recurrent retinal detachment occurred 78 months postoperatively. The retina was reattached following reoperation in all eyes. However, an eye successfully reattached without choroidal irritation developed four recurrences during the follow-up period. The pathogenesis of late recurrences after successful surgery for retinal detachment with macular hole remains speculative. A number of clinical findings suggest that vitreous traction plays a decisive role.     

术后不需低头位的玻璃体手术治疗黄斑裂孔性视网膜脱离

目的探讨术后不需低头位的玻璃体手术疗效.方法对27例(27只眼)近视性黄斑裂孔视网膜脱离患者,经闭合式玻璃体切除、剥膜后气液交换,以16%C3F8全玻璃体腔填充;3例同时行晶状体超声乳化吸出术,其中2例植入人工晶状体,术后早期避免仰卧位,其他体位不受限.结果 21例(78%)患者术后不需低头位即获黄斑裂孔闭合、视网膜复位.另6例分别因惰性气体吸收较快、视网膜黄斑白孔及视网膜下组织增生,而致黄斑裂孔未闭并伴下方视网膜脱离;其中3例气泡吸收较快者于术后10 d改嘱低头位,2例获视网膜复位.随访时间＞6个月.22例(81%)保持视网膜平伏,黄斑裂孔愈合;视力≥0.1者19例;主要并发症为晶状体混浊(6/19)和一过性高眼压(3/27).结论术后不需低头位的玻璃体手术,并以16% C3F8气体填充全玻璃体腔,治疗黄斑裂孔视网膜脱离的效果良好,尤其适用于老年或体弱患者.     

Long-term follow-up of retinal detachment due to macular hole in myopic eyes treated by temporary silicone oil tamponade and laser photocoagulation.

PURPOSE: To determine the long-term anatomic and functional results of temporary silicone oil tamponade coupled with laser photocoagulation of the macular hole rim for retinal detachment due to macular hole in eyes with myopia higher than -10.0 diopters (D). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Eleven patients (9 female, 2 male; average age, 57+/-3 years) with spontaneous retinal detachment due to macular hole. All patients had a myopia higher than -10.0 D and had no proliferative vitreoretinopathy and no history of trauma. The average myopia amounted to -17.7+/-1.1 D, and in eight cases, a large posterior staphyloma was present. Follow-up was 69+/-17 months. INTERVENTION: Patients underwent pars plana vitrectomy, temporary silicone oil tamponade, and laser photocoagulation of the macular hole rim. Silicone oil removal was performed after 2.8+/-0.8 months. MAIN OUTCOME MEASURES: Anatomic attachment of the retina was determined and visual acuity was measured. RESULTS: Final successful retinal attachment at the end of follow-up was achieved in ten eyes (91 %). Average logarithm of the minimum angle of resolution (logMAR) visual acuity increased from 1.39+/-0.12 before surgery to 1.18+/-0.13 after surgery (P < 0.05, Student's t test for paired data). This corresponds to a mean increase of measured Snellen equivalents from 0.06+/-0.03 to 1.11+/-0.04. Intraocular pressures remained stable with 13.9+/-1.8 millimeters of mercury (mmHg) before surgery and 16.6+/-1.6 mmHg at the end of follow-up (P > 0.05). CONCLUSIONS: Primary vitrectomy with temporary silicone oil tamponade and laser photocoagulation of the macular hole rim for retinal detachment due to macular hole in highly myopic eyes appears to provide a good long-term anatomic success and acceptable functional results.     

视网膜分支静脉阻塞合并视网膜脱离的临床分析

目的 分析视网膜分支静脉阻塞(BRVO)合并视网膜脱离(RD)的临床特征及有效的治疗方法.方法 收集2004年11月至2007年10月治疗的有完整随访观察资料的18例(18只眼)BRVO合并RD的病例,采用常规三通道闭合式玻璃体切割手术,其中6例联合白内障超声乳化吸出术,合并黄斑裂孔的患眼行内界膜剥离,术后1、2周,1、2、3、6月随访,平均随访4.8月,观察患者的视力、眼底、眼压、玻璃体后脱离,术中术后并发症、及术后视网膜复位等情况.结果 全部病例于术中均发现裂孔,单个孔、多发孔各9例,孔源性视网膜脱离17例,牵引性视网膜脱离1例,黄斑孔5例,黄斑孔中合并黄斑囊样水肿1例,合并黄斑前膜2例.18例中发现纤维血管膜生长的15例,玻璃体不完全性后脱离粘连牵拉视网膜的12例,黄斑水肿6例,其中合并黄斑前膜2例.BRVO发生于颞上的6例,鼻上6例,上半侧3例,颞下2例,颢上合并颞下1例.18例中术后视力提高12例,视力稳定3例,视力下降3例,术后最佳矫正视力HM3例、0.1-0.39例、0.3以上6例.一次手术视网膜复位的16例,2例于硅油取出时发现局限性视网膜脱离,再次填充C3F8后视网膜复位.结论 视网膜分支静脉阻塞合并视网膜脱离的临床表现较复杂,术前眼底情况不明确,视网膜裂孔及多发性裂孔的发生率较高,多数病例玻璃体后脱离不完全粘连牵拉视网膜,且合并纤维血管膜的增生,玻璃体手术或联合手术是适合的治疗方法,可取得较好的临床疗效.