视网膜内界膜剥离手术治疗高度近视黄斑裂孔视网膜脱离的疗效观察

目的 观察视网膜内界膜剥离治疗高度近视黄斑裂孔视网膜脱离的疗效. 方法 回顾分析25例25只眼高度近视黄斑裂孔伴视网膜脱离患者的临床资料.根据治疗方法 分为2组,A组为单纯玻璃体切割手术,13例13只眼;B组为玻璃体切割手术加吲哚青绿染色内界膜剥离,12例12只眼.所有患者行惰性气体填充,手术后保持面朝下体位7～15 d.观察最佳矫正分辨角对数(LogMAR)视力,检查眼底,光相干断层扫描(OCT)、B型超声检查视网膜复位及黄斑裂孔闭合情况,比较两组间疗效差异.手术后随访6～18个月,平均随访时间10个月. 结果 A组13只眼中,7只眼手术后视网膜复位,占53.8%;B组12只眼中,11只眼手术后视网膜复位,占91.7%.B组视网膜复位率明显优于A组(X2=4.427,P=0.046);25只眼中,手术后黄斑裂孔闭合者17只眼,占68.0%.其中,A组13只眼中,6只眼黄斑裂孔闭合,占A组患者的46.2%;B组12只眼中,11只眼黄斑裂孔闭合,占B组患者的91.7%.两组患者手术后黄斑裂孔闭合率比较,差异有统计学意义(X2=5.940,P=0.020).A组手术后最佳矫正LogMAR视力提高平均0.32,与手术前比较,差异有统计学意义(Z=-2.045,P=0.041),B组手术后最佳矫正LogMAR视力提高平均0.53,与手术前比较,差异有统计学意义(Z=-2.481,P=0.012).两组间手术后视力差异无统计学意义(U=51.5,P=0.16). 结论玻璃体切割联合视网膜内界膜剥离手术可能通过完全解除玻璃体黄斑牵引、增加视网膜顺应性而提高高度近视黄斑裂孔视网膜脱离的治疗效果.显著增加视网膜复位率及黄斑裂孔闭合率.     

亮蓝辅助内界膜剥离治疗特发性黄斑裂孔的临床观察

目的观察亮蓝(BBG)辅助视网膜内界膜(ILM)剥离治疗特发性黄斑裂孔的临床效果及影响因素。方法对2009年6月至2011年7月在我院就诊的一组III、IV期特发性黄斑裂孔患者行玻璃体切割亮蓝辅助内界膜剥离治疗的37例(37只眼)患者的临床资料进行回顾性分析,将术后黄斑裂孔I型闭合眼分为A组,黄斑裂孔II型闭合眼分为B组,所有病例术前均行常规最佳矫正视力(BCVA)、眼压、裂隙灯显微镜+90D前置镜眼底检查、B型超声、相干光断层扫描(OCT)检查。手术后随访6～16个月,观察患者手术后视力、裂孔闭合形式以及黄斑裂孔直径、厚度对术眼愈后的影响。结果 37例(37只眼)特发性黄斑裂孔均闭合,占100%,其中Ⅰ型闭合29只眼(A组),占78.4%,Ⅱ型闭合8只眼(B组),占21.6%,A、B两组手术后的视力较术前视力均提高,差异有统计学意义(P﹤0.01),且A组术后视力较B组好(P﹤0.05)。A组患眼手术前的黄斑裂孔直径小于B组,两者比较差异有统计学意义(P﹤0.01),A组患眼手术前的黄斑裂孔厚度小于B组,两者比较差异有统计学意义(P﹤0.05)。结论亮蓝辅助视网膜内界膜剥离治疗特发性黄斑裂孔是非常有效的手术方法,黄斑裂孔的直径和厚度是黄斑裂孔愈合的影响因素。     

视网膜内界膜剥离手术治疗高度近视黄斑裂孔视网膜脱离的疗效观察

目的 观察视网膜内界膜剥离治疗高度近视黄斑裂孔视网膜脱离的疗效. 方法 回顾分析25例25只眼高度近视黄斑裂孔伴视网膜脱离患者的临床资料.根据治疗方法 分为2组,A组为单纯玻璃体切割手术,13例13只眼;B组为玻璃体切割手术加吲哚青绿染色内界膜剥离,12例12只眼.所有患者行惰性气体填充,手术后保持面朝下体位7～15 d.观察最佳矫正分辨角对数(LogMAR)视力,检查眼底,光相干断层扫描(OCT)、B型超声检查视网膜复位及黄斑裂孔闭合情况,比较两组间疗效差异.手术后随访6～18个月,平均随访时间10个月. 结果 A组13只眼中,7只眼手术后视网膜复位,占53.8%;B组12只眼中,11只眼手术后视网膜复位,占91.7%.B组视网膜复位率明显优于A组(X2=4.427,P=0.046);25只眼中,手术后黄斑裂孔闭合者17只眼,占68.0%.其中,A组13只眼中,6只眼黄斑裂孔闭合,占A组患者的46.2%;B组12只眼中,11只眼黄斑裂孔闭合,占B组患者的91.7%.两组患者手术后黄斑裂孔闭合率比较,差异有统计学意义(X2=5.940,P=0.020).A组手术后最佳矫正LogMAR视力提高平均0.32,与手术前比较,差异有统计学意义(Z=-2.045,P=0.041),B组手术后最佳矫正LogMAR视力提高平均0.53,与手术前比较,差异有统计学意义(Z=-2.481,P=0.012).两组间手术后视力差异无统计学意义(U=51.5,P=0.16). 结论玻璃体切割联合视网膜内界膜剥离手术可能通过完全解除玻璃体黄斑牵引、增加视网膜顺应性而提高高度近视黄斑裂孔视网膜脱离的治疗效果.显著增加视网膜复位率及黄斑裂孔闭合率.     

玻璃体视网膜手术治疗病理性近视黄斑劈裂的疗效观察及视力预后影响因素分析

目的 观察玻璃体视网膜手术治疗病理性近视黄斑劈裂的临床效果,分析视力预后的影响因素.方法 临床确诊为病理性近视黄斑劈裂并接受玻璃体视网膜手术治疗的23例患者27只眼纳入研究.患者均行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜、直接检眼镜、双目间接检眼镜、眼底照相、A型超声、B型超声及光相干断层扫描等检查并行23G或25G经结膜无缝合微创玻璃体切割手术治疗.手术后随访6.00～36.00个月,平均随访时间(19.40±10.03)个月.观察视网膜劈裂复位、视力预后以及手术并发症发生情况.采用多因素Logistic回归分析法分析患者年龄、性别、病程、屈光度、眼轴长度、手术前BCVA、是否合并黄斑前膜、周边视网膜裂孔以及手术中是否注气、是否剥除内界膜和手术后末次随访时光感受器内外节连接(IS/OS)是否连续与视力预后的关系.结果 27只眼中,首次手术后视网膜解剖复位成功21只眼,占77.78％;未完全解剖复位6只眼,占22.22％.视力提高24只眼,占88.89％;未提高3只眼,占11.11％.随访期间,所有患者均未发生眼底出血、低眼压、高眼压、眼内炎等并发症.多因素Logistic回归分析显示,手术前BCVA(OR=9.11,P=0.007)、眼轴长度(OR=0.31,P=0.038)及末次随访IS/OS层连续性(OR=4.32,P=0.001)与视力预后密切相关.结论 玻璃体视网膜手术治疗病理性近视黄斑劈裂,能使大部分患者视网膜解剖复位成功,视力提高.手术前BCVA、眼轴长度及末次随访IS/OS连续性是影响视力预后的重要因素.     

内界膜剥除联合硅油填充治疗高度近视黄斑裂孔视网膜脱离的临床观察

目的 观察玻璃体切割联合视网膜前膜剥除(ERMP)和(或)内界膜剥除(ILMP)及硅油填充治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔视网膜脱离(MHRD)的疗效.方法 高度近视MHRD患者85例85只眼纳入研究.所有患者均采用国际标准视力表行矫正视力检查以及裂隙灯显微镜加前置镜、间接检眼镜、A/B型超声、光相干断层扫描(OCT)、眼压检查.患者平均眼轴长度(29.1±1.8) mm.后极部脉络膜弥漫性萎缩24只眼;部分性萎缩61只眼.将小数视力换算成最小分辨角对数(logMAR)视力进行统计学处理.平均logMAR矫正视力为1.93±0.37.均行玻璃体切割曲安奈德(TA)或吲哚青绿(ICG)辅助的ILMP和(或)ERMP以及硅油填充手术.85只眼均联合TA辅助行ERMP.其中,单纯TA辅助行ERMP 21只眼;ICG辅助行ILMP 56只眼;TA辅助行ILMP 8只眼.平均硅油填充时间(6.2±1.6)个月.观察患眼手术后矫正视力、视网膜复位、黄斑裂孔闭合情况以及手术后并发症.手术前后视力行t检验;对影响手术后视力的相关因素行相关性分析;视网膜脱离复发行logistic多元回归分析,黄斑区视网膜劈裂对裂孔闭合的影响行x2检验.结果 患眼手术后平均logMAR矫正视力为1.34±0.48.与手术前平均logMAR矫正视力比较,差异有统计学意义(t=39.38,P＜0.01).手术后矫正视力与患眼眼轴长度(r=0.142)、后极部脉络膜萎缩程度(t=0.23、-0.165)、黄斑裂孔是否闭合(t=0.12、-0.005)均无相关性(P＞0.05).首次手术后视网膜复位79只眼,占92.9％.视网膜脱离复发6只眼,占7.1％.Logistic多元回归分析结果显示,视网膜脱离复发与患眼手术前脉络膜是否脱离、增生型玻璃体视网膜病变程度、眼轴长度、后极部脉络膜萎缩程度以及是否行ILMP均无相关性(比值比=1.428、5.039、0.815、2.578、0.432,P＞0.05).85只眼中,黄斑裂孔闭合10只眼,占11.8％;黄斑裂孔未闭合75只眼,占88.2％.手术后2周,出现高眼压24只眼,占28.2％,给予降低眼压药物治疗后眼压控制.硅油取出手术前出现高眼压12只眼,占14.1％,硅油取出手术后眼压均得到控制.结论 玻璃体切割联合ERMP和(或)ILMP及硅油填充可在伴有后巩膜葡萄肿的MHRD患者中获得较高的首次手术复位率.     

不同轴长高度近视眼黄斑白孔性视网膜脱离玻璃体手术后疗效比较

目的比较不同轴长黄斑白孔性视网膜脱离行曲安奈德(TA)染色辅助玻璃体切除联合内界膜(ILM)剥离及硅油填充联合手术后的疗效。方法 32例黄斑白孔性视网膜脱离住院患者32只眼纳入研究。患者分为两组,其中A组为常规长眼轴(26 mm≤眼轴<29 mm)组患者18例(18只眼),B组为超长眼轴(眼轴≥29mm)组患者18例(18只眼)。两组患者均行TA染色辅助玻璃体切除联合ILM剥离及硅油填充联合手术治疗,以手术后6个月为疗效判定时间点,比较两组患者视网膜复位率、黄斑裂孔闭合率及视力情况。结果与治疗前相比,两组在术后6个月视力均有显著提高,差异均有统计学意义(t A=6.81,t B=6.81,P<0.05)。两组术后6个月视力比较差异无统计学意义(t=0.856,P>0.05)。术后A组视网膜复位17只眼(94.44%),术后B组视网膜复位11只眼(61.11%),两组术后视网膜复位率间比较有统计学意义(P=0.041)。术后A组黄斑裂孔闭合5只眼(27.78%),术后B组黄斑裂孔闭合1只眼(5.56%),两组术后视网膜复位率间比较无统计学意义(P=0.177)。结论对于常规眼轴的黄斑白孔性视网膜脱离患眼,TA染色辅助玻璃体切除联合ILM剥离及硅油填充联合手术,能提高视网膜复位率并获得相对好的黄斑孔闭合率;但对于超长眼轴的黄斑白孔性视网膜脱离患眼,该手术方式对黄斑裂孔闭合作用相对有限。     

病理性近视黄斑裂孔患者黄斑区视网膜前膜的组织学观察

目的 观察病理性近视内界膜表面结构的组织学变化与黄斑裂孔发生发展的关系.方法 同顾分析行玻璃体切割手术的病理性近视黄斑裂孔患者34例34只眼的临床资料.患眼屈光度均超过-6.00 D,眼轴26.00～33.12 mm,平均眼轴长度27.74 mm.5只眼为黄斑裂孔无视网膜脱离(黄斑裂孔组),29只眼为黄斑裂孔合并后极部视网膜浅脱离(视网膜脱离组).对入选患眼行睫状体平坦部三切口的玻璃体切割手术,手术中观察Weiss环以判断玻璃体后脱离程度,获取34只眼的视网膜前膜及19只眼的内界膜组织标本,行苏木精-伊红(HE)及醋酸铀-枸橼酸铅双染色,采用光学及透射电子显微镜观察.结果 玻璃体切割手术中,5只眼出现Weiss环,24只眼的视网膜表面有多层玻璃体组织残留.光学显微镜观察发现,内界膜表面的视网膜前膜主要由玻璃体胶原纤维.星形胶质细胞及细胞外基质组成.透射电子显微镜观察发现,19只眼的内界膜标本中,5只眼可她内界膜一玻璃体胶原纤维-细胞的"三明治"样结构,1只眼可见内界膜损伤、表面组织牵引和星形胶质细胞移行.结论病理性近视玻璃体后界面劈裂、内界膜表面组织结构的变化是黄斑裂孔发生发展直至视网膜脱离的重要原因.     

亮蓝与吲哚菁绿辅助内界膜染色治疗特发性黄斑裂孔效果对比

目的 比较亮蓝(BBG)与吲哚菁绿(ICG)辅助内界膜(ILM)染色治疗特发性黄斑裂孔(IMH)的效果.方法 回顾性临床病例对照研究.对2009年1月至2010年6月在郑州大学第一附属医院眼科就诊44例(46只眼)IMH,随机分为两组:20只眼使用0.25％BBG染色(BBG组);26只眼使用0.25％ICG染色(ICG组).比较两组术中染色效果、剥膜率,术后两组患者的裂孔闭合率、最佳矫正视力(BCVA)(术后3月时)等改变.结果 两组患者的年龄、患病时间、术前BCVA差异均无统计学意义(P＞0.05).术中BBG或ICG使所有患眼ILM染色,均有效增加了ILM的可见度,染色率为100％.BBG将ILM染成淡蓝色,ICG将ILM染成淡绿色,但后者染色效果更清晰.两组均顺利剥除ILM,剥除率为100％.分析两组间的裂孔闭合率(P=0.926)和BCVA提高程度(t=-0.359,P=0.721)差异均无统计学意义(P＞0.05).两组BCVA与术前相比均显著提高(t=-25.947,-16.595,P值均=0.000),差异具有统计学意义.两组病例均未发生严重手术并发症.结论 在特发性黄斑孔患者,0.25％BBG与0.25％ICG均使所有的ILM染色并剥离,染色率、剥膜率均为100％;两组术后裂孔闭合率、BCVA提高程度差异无统计学意义(P＞0.05).     

病理性近视黄斑裂孔患者黄斑区视网膜前膜的组织学观察

目的 观察病理性近视内界膜表面结构的组织学变化与黄斑裂孔发生发展的关系.方法 同顾分析行玻璃体切割手术的病理性近视黄斑裂孔患者34例34只眼的临床资料.患眼屈光度均超过-6.00 D,眼轴26.00～33.12 mm,平均眼轴长度27.74 mm.5只眼为黄斑裂孔无视网膜脱离(黄斑裂孔组),29只眼为黄斑裂孔合并后极部视网膜浅脱离(视网膜脱离组).对入选患眼行睫状体平坦部三切口的玻璃体切割手术,手术中观察Weiss环以判断玻璃体后脱离程度,获取34只眼的视网膜前膜及19只眼的内界膜组织标本,行苏木精-伊红(HE)及醋酸铀-枸橼酸铅双染色,采用光学及透射电子显微镜观察.结果 玻璃体切割手术中,5只眼出现Weiss环,24只眼的视网膜表面有多层玻璃体组织残留.光学显微镜观察发现,内界膜表面的视网膜前膜主要由玻璃体胶原纤维.星形胶质细胞及细胞外基质组成.透射电子显微镜观察发现,19只眼的内界膜标本中,5只眼可她内界膜一玻璃体胶原纤维-细胞的"三明治"样结构,1只眼可见内界膜损伤、表面组织牵引和星形胶质细胞移行.结论病理性近视玻璃体后界面劈裂、内界膜表面组织结构的变化是黄斑裂孔发生发展直至视网膜脱离的重要原因.     

曲安奈德辅助玻璃体后脱离联合不染色剥除内界膜治疗Ⅱ、Ⅲ期特发性黄斑裂孔的临床观察

目的 评价曲安奈德(TA)辅助玻璃体后脱离(PVD)联合不染色剥除内界膜(ILM)治疗Ⅱ、Ⅲ期特发性黄斑裂孔(IMH)的解剖和视力预后.方法 对Ⅱ、Ⅲ期IMH患者23例23只眼常规行最佳矫正视力(BCVA)、晶状体状态、光相干断层扫描(OCT)检查并进行黄斑裂孔分期.手术前BCVA为0.04～0.40,最小视角对数(logMAR)视力为0.398～1.398,平均0.846±0.310.患者均先在TA辅助下行人工PVD,然后在无染色条件下剥除黄斑区ILM.手术中联合白内障摘除手术5只眼.手术后随访时间6～16个月,平均随访时间9个月.统计分析黄斑裂孔解剖成功率、手术前后BCVA、手术并发症.结果 手术后1个月OCT检查显示,黄斑裂孔闭合22只眼,占95.7%;黄斑裂孔未闭合1只眼,占4.3%,再行气液交换后黄斑裂孔成功闭合.至随访期末,均未见黄斑裂孔重新开放.手术后6个月BCVA为0.12～0.90,logMAR视力为0.046～0.921,平均视力为0.410±0.209,手术前后BCVA比较,差异有统计学意义(t=6.636,P＜0.000 1).视力提高21只眼,占91.3%;视力不变者2只眼,占8.7%;无视力下降者.剥除ILM 时视网膜表面出现1～3个点状自限性出血者5只眼.手术后未发生视网膜脱离或玻璃体积血等严重并发症.手术后晶状体核密度增加9只眼,一过性眼压升高6只眼.结论 TA辅助PVD联合不染色剥除ILM治疗Ⅱ、Ⅲ期IMH是一种安全有效的方法.

Abstract：

Objective To evaluate the anatomic and visual outcomes of idiopathic macular holes treated with triamcinolone (TA)-assisted posterior vitreous detachment (PVD) and then internal limiting membrane (ILM) peeling without any dye. Methods Twenty-three patients (23 eyes) with stage Ⅱand Ⅲidiopathic macular holes were enrolled. The best-corrected visual acuity (BCVA), the lens, the duration,stage and size of the macular holes were measured before and after the surgery. The preoperative BCVA was 0.04 to 0.40; the logMAR was 0.398 to 1.398 with the mean of 0.846±0.310. All surgery involved TA-assisted PVD and then ILM peeling without any dye.Combined cataract extraction with vitrectomy was performed on 5 eyes.The follow-up ranged from 6 to 16 months with the mean of 9 months. Results Anatomic macular hole closure was achieved in 22 eyes (95.7%) at the first month after surgery and in 23eyes (100.0%) finally. At the 6th months after surgery, the BCVA was 0.12 to 0.90, logMAR was 0.046 to 0.921 with the mean of 0.410±0.209, compared with preoperative BCVA, the difference was statistically significant (t=6.636, P＜0.0001). BCVA increased in 21 eyes (91.3%) and kept unchanged in 2 eyes (8.7%). There are 1-3 spots self-limited bleeding on the retinal surface when the ILM was peeled in 5 eyes. Postoperative complications included progression of cataract in 9 patients and transient intraocular pressure elevation in 6 patients. Conclusions TA-assisted PVD and then ILM peeling without any dye is an effective and safe surgical technique in stage Ⅱ and Ⅲ idiopathic macular hole.     

Efficacy of internal limiting membrane removal for retinal detachments resulting from a myopic macular hole

PURPOSE: To evaluate the efficacy of internal limiting membrane (ILM) or epiretinal membrane removal during pars plana vitrectomy for a retinal detachment resulting from a macular hole in myopic eyes. METHODS: A retrospective study was conducted in a single institution. Twenty-six highly myopic eyes with a retinal detachment resulting from a macular hole were studied. During pars plana vitrectomy, ILM peeling (ILM-peeled group) was performed on 13 eyes, and the ILM was not removed (ILM-preserved group) in 12 eyes. Main outcome measures were anatomic reattachment, optical coherence tomography-determined macular hole closure, and visual acuity. Follow-up periods were longer than 12 months in all cases. RESULTS: The anatomic reattachment rate after the initial surgery was significantly higher in the ILM-peeled group (92.3%) than in the ILM-preserved group (50%). The macular holes of 8 (72.7%) of the 11 ILM-peeled and reattached eyes and 2 (50%) of the 4 ILM-preserved and reattached eyes were successfully closed by the initial surgery. No significant difference was found in the postoperative visual acuity and the improvement of visual acuity between the ILM-peeled group and the ILM-preserved group. There was also no significant difference of the postoperative visual acuity and improvement of the visual acuity between the two groups in cases with an initial anatomic success. CONCLUSION: These results indicate that removal of the ILM contributes to a successful reattachment and is an effective treatment for macular hole and retinal detachment in highly myopic eyes. The authors suggest that the higher success rate after ILM peeling resulted from the release of the traction of the prefoveal vitreous and the epiretinal membrane over the detached retina.     

剥离内界膜的玻璃体切除术治疗高度近视黄斑裂孔性视网膜脱离

目的评价剥离内界膜的玻璃体切除术治疗高度近视黄斑裂孔性视网膜脱离的临床疗效。方法选择16例(16眼)高度近视黄斑裂孔性视网膜脱离患者,行常规经平坦部玻璃体切除、气-液交换、裂孔区注射透明质酸钠、吲哚菁绿染色、液-气交换、内界膜剥离、再次气-液交换、14?F8填充玻璃体腔,术后保持头低位,随访1~6个月。结果16眼中,13眼黄斑裂孔愈合,视网膜复位,3眼裂孔未闭,其中1眼复发视网膜脱离;术后视力提高14眼,不变1眼,下降1眼。结论剥离内界膜的玻璃体切除术能有效治疗高度近视黄斑裂孔性视网膜脱离,并能促进黄斑裂孔的愈合。     

微创玻璃体切割术治疗高度近视性黄斑裂孔视网膜脱离的疗效

目的：观察微创玻璃体切割联合内界膜剥除术治疗高度近视性黄斑裂孔视网膜脱离(macular hole retinal detachment,MHRD)的临床效果。

方法：回顾性非随机临床研究。纳入2011-01/2016-12我院高度近视MHRD患者26例26眼,所有患者均行标准三通道经睫状体平坦部23G微创玻璃体切割联合内界膜剥除术。术后定期进行最佳矫正视力(best corrected visual acuity,BCVA)、眼压、裂隙灯眼前节和眼底检查,并用光学相干断层扫描(optical coherence tomography,OCT)检查黄斑裂孔解剖情况。以发病年龄、裂孔Gass分期、发病天数、裂孔闭合形态(W、V、U型)、初始视力5项作为自变量进行Logistic回归分析,探讨影响术后BCVA的因素。

结果：高度近视MHRD术后黄斑裂孔(macular hole,MH)闭合率为58%。依据OCT图像,将高度近视MHRD术后OCT闭合形态分为3类：U型(3眼),相对正常的中心凹形状; V型(4眼),黄斑中心凹较陡; W型(8眼),黄斑中心凹处神经上皮缺损,但裂孔缘未翘起,无囊腔形成。多因素Logistic回归分析结果表明,术后预后视力提高与裂孔闭合OCT形态和初始视力相关(P<0.05),术后U型裂孔闭合视力提高是W型的6.9倍。

结论：微创玻璃体切割联合内界膜剥除术是治疗高度近视MHRD的有效方式。高度近视MHRD术后视力提高与黄斑裂孔愈合的OCT形态和初始视力相关。     

Internal limiting membrane removal in macular hole surgery for severely myopic eyes: a case-control study

AIMS: To determine the surgical outcome of indocyanine green (ICG) assisted retinal internal limiting membrane (ILM) peeling in macular hole surgery for severely myopic eyes and compare the visual and anatomical outcomes with an emmetropic control group. METHODS: 10 severely myopic eyes (-6.0 D or greater) of 10 patients with macular holes without retinal detachment were recruited prospectively. All eyes received ICG assisted ILM removal of 3-4 disc diameters around the macular holes. Cases were matched with a prospective control group of 10 emmetropic macular hole patients who underwent identical ICG assisted ILM peeling surgery in the same period. RESULTS: The mean refractive error in the myopic and control group was -11.8 D and +0.3 D, respectively (two tailed t test, p < 0.001). The mean follow up duration for the myopic and control group was 12.1 and 13.3 months, respectively (two tailed t test, p = 0.63). The primary anatomical closure rate in both groups was 90% (Fisher's exact test, p = 1.0). For both the myopic and control groups, there were significant improvement in the mean log MAR visual acuity after the surgery with improvements from 0.86 to 0.57 for the myopic group (two tailed t test, p = 0.015) and 0.89 to 0.44 for the control group (two tailed t test, p = 0.002). The mean preoperative and postoperative visual acuity, rates of final visual acuity of 20/50 or better, and improvement of two or more lines were not statistically different between the two groups. CONCLUSION: ICG assisted ILM peeling in macular hole surgery for severely myopic eyes without retinal detachment gives promising anatomical and visual outcomes, which are comparable to that of non-severely myopic eyes.     

Corneal graft melting: a systematic review

AIM: To compare the outcomes of four adjuvants used for internal limiting membrane (ILM) peeling in macular hole surgery, including indocyanine green (ICG), brilliant blue G (BBG), triamcinolone (TA) and trypan blue (TB), through systematic review and random-effects Bayesian network Meta-analysis. METHODS: PubMed, Cochrane library databases and Web of science were searched until August 2017 for clinical trials comparing the above four adjuvants. ORs for postoperative best corrected visual acuity (BCVA) improvement and primary macular hole closure rates were compared between the different adjuvants. RESULTS: Twenty-seven eligible articles were included. For postoperative BCVA improvement, results of BBG-assisted peeling were significantly more favorable than those of ICG (OR 0.08, 95% credible interval 0.01-0.16) and TA ranked highest. No significant differences were found between any other two groups in postoperative BCVA improvement. For postoperative primary macular hole closure rates, BBG ranked highest. However, no significant differences were shown between any two groups. CONCLUSION: TA and BBG are the optimum adjuvants for achieving postoperative BCVA improvement macular hole surgery with adjuvant-assisted ILM peeling. Among all adjuvants, the use of BBG is associated with the highest postoperative macular hole closure rate.     

Outcomes of 4 surgical adjuvants used for internal limiting membrane peeling in macular hole surgery: a systematic review and network Meta-analysis

The aim of our study was to evaluate the mechanism of which Brimonidine tartrate 0.15% causes clinical hypersensitivity. This prospective case-control study compared 8 glaucoma patients with clinical hypersensitivity to brimonidine to a control group consisting 13 healthy volunteers. Blood samples were stimulated with brimonidine 0.15%, timolol 0.5% or brimonidine tartrate/timolol maleate 0.2%/0.5%. Premixed antibodies (CD63/FITC and aIgE/PE) were added for direct staining and whole-blood samples were lysed, ?xed and analyzed by a flow cytometer. The basophil population was defined by high IgE cell expression. Degranulation was identified by the expression of the activation molecule CD63. Basophil activation was not significant when comparing percent of activated basophils of patients and healthy controls after exposure to brimonidine (2.58%, 2.45%, respectively, P=0.72). There was a significant suppression of basophil activation when a combination of brimonidine-timolol (0.87%) was compared to timolol (2.27%; P=0.012) and to brimonidine alone (2.58%; P=0.017). The results of our study do not support the hypothesis that brimonidine induces an immediate allergic reaction. Basophil activation was suppressed by the presence of β-blockers in patients hypersensitive to brimonidine and in healthy individuals. This finding indicates that timolol suppress brimonidine drug reaction by a different mechanism.     

微创玻璃体切割联合内界膜剥除术治疗高度近视黄斑裂孔

目的　观察微创玻璃体切割联合内界膜剥除术治疗高度近视黄斑裂孔的临床效果。方法　回顾性非随机临床对照研究。收集２０１０年１月至２０１５年１月高度近视性黄斑裂孔患者２４例２４眼,同期收集特发性黄斑裂孔患者４３例４３眼作为对照组,两组均行标准三通道经睫状体平坦部２３Ｇ微创玻璃体切割联合内界膜剥除术。观察两组术前及术后最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）及光学相干断层扫描检查黄斑裂孔封闭情况。结果　高度近视性黄斑裂孔组与特发性黄斑裂孔组的解剖闭合率（７９．２％ 和８８．４％）及术后ＢＣＶＡ（ＬｏｇＭＡＲ）（０．５６±０．４２和０．６３±１．３８）比较,差异均无统计学意义（均为Ｐ＞０．０５）,两组末次随访时ＢＣＶＡ（ＬｏｇＭＡＲ）分别与治疗前比较,差异均有统计学意义（ｔ＝４．８８６、６．７３５,均为Ｐ＜０．００１）。两组术中均未见医源性裂孔形成,术后无眼内出血或眼内炎等严重并发症发生。结论　玻璃体切割联合内界膜剥除术是修复高度近视眼解剖和功能的有效方式。     

Técnica modificada del flap invertido superior con vitrectomía versus vitrectomía con pelado de membrana limitante interna para el desprendimiento de retina con agujero macular miópico

PurposeTo evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling.MethodsRetrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups.ResultsThere were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (P = .9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (P = .62).ConclusionsILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.     

非内界膜剥离的玻璃体切除术联合长效气体填充治疗病理性近视继发黄斑劈裂

目的 探讨非内界膜剥离的玻璃体切除术联合长效气体填充治疗病理性近视继发黄斑劈裂的临床疗效.方法 前瞻性临床研究.对49例(52只眼)病理性近视继发黄斑劈裂患者采用随机数字表法分组,非注气组(接受非内界膜剥离的玻璃体切除术)22例(24只眼);注气组(接受非内界膜剥离的玻璃体切除联合玻璃体腔内长效气体填充)15例(16只眼);对照组(非手术组,接受定期随访观察治疗)12例(12只眼).分别比较各组患者首次诊疗及术后第3、6、9个月的最佳矫正视力及光相干断层扫描(OCT)显示的视网膜劈裂高度变化.3组间不同随访时段的最佳矫正视力、黄斑中心凹厚度、黄斑区视网膜劈裂高度的比较采用Wilcoxon秩和检验,组内手术前后上述3个指标的比较采用配对符号秩和检验.结果 患者术后随访9个月,最佳矫正logMAR视力(四分位数间距)中位数(Q1,Q3):非注气组为0.5(0.3,0.8),较术前的0.7(0.4,1.1)有明显改善(t=2.57,P<0.05);注气组为0.5(0.3,0.7),较术前的0.8(0.5,1.0)有显著改善(t=3.58,P＜0.05);对照组为0.5(0.3,1.3),与术前的0.4(0.1,0.6)比较,差异无统计学意义(t=1.84,P>0.05);术后3组间最佳矫正视力比较,差异无统计学意义(χ2 =0.24,P>0.05).术后9个月OCT检测:非注气组和注气组患者平均视网膜劈裂高度均较术前显著下降.术后9个月视网膜完全复位率:对照组0.0%(0/12)、非注气组66.7%(16/24)、注气组81.3%(13/16),组间差异有统计学意义(χ2=20.50,P＜0.05),表明非内界膜剥离的玻璃体切除术可显著促进病理性近视继发黄斑劈裂的视网膜复位.并发症:对照组中有2只眼分别在随访的6个月和8个月出现黄斑裂孔性视网膜脱离,另10只眼随观察时间延长视网膜劈裂高度逐渐增加;非注气组术后未见明显并发症;注气组3只眼出现一过性眼压增高,经药物治疗后2周眼压控制平稳,1只眼术后2个月出现黄斑裂孔性视网膜脱离,经再次手术和玻璃体腔注油后视网膜复位.结论 非内界膜剥离的玻璃体切除术是治疗病理性近视继发黄斑劈裂的安全有效术式,术中联合玻璃体腔内长效气体填充可提高手术的成功率.(中华眼科杂志,2011,47:497-503)

Abstract：

Objective To evaluate the efficacy of vitrectomy without internal limiting membrane (ILM) peeling associated with gas tamponade in eyes with myopic foveoschisis. Methods A prospective study was conducted, in which 49 pathological myopia patients (52 eyes) with myopic foveoschisis were enrolled and divided into three groups according to the different therapeutic procedures: 22 patients (24 eyes) underwent vitrectomy without internal limiting membrane (non-gas tamponade group), 15 patients (16 eyes) received vitrectomy without internal limiting membrane peeling but combined with gas tamponade (gas tamponade group) and 12 patients (12 eyes) did not receive surgical treatments (control group) . SAS 9.13 was used for the statistic analysis.Best-corrected visual acuity (BCVA) and optical coherence tomographic (OCT) findings of the foveal thickness before and after the operation (the 3rd, 6th, and 9th month postoperatively) were obtained and compared by the Wilcoxon Rank-Sum test. Non-parameters Wilcoxon symbols test was used to compare the BCVA,the central foveal thickness (CFT) and maximum foveal thickness (MxFT) of each group before and after the surgery.Results Postoperative visual acuity was significantly increased in the two operation groups (t=2.57,P<0.05;t=3.58,P<0.05) but not increased in the control group (t=1.84;P>0.05). The difference of BCVA between these three groups was not significant (χ2 =0.24,P>0.05). OCT showed the mean foveal thickness was significantly decreased postoperatively. Vitrectomy without peeling of the ILM significantly promoted the retinal reattachment in eyes with myopic foveoschisis. No retinal reattachments was found in the control group while 16 and 13 retinal reattachments were found in the non-gas tamponade (66.7%) and gas tamponade group (81.3%), the difference between these two operation groups and the control was statistically significant (χ2=20.50, P<0.05). During the follow-up, two eyes in the control group developed a macular hole and both developed retinal detachment (RD) in the 6 and 8 month, respectively . The remaining 10 eyes did not develop any complications, although the thickness of the macula increased significantly. A transient increase of intraocular pressure occurred in three eyes and had been cured by medications within 2 weeks after gas tamponaded. A macular hole was recognized in one eye 2 months after surgery and the retina was reattached at the fovea 1 month after reoperation. Conclusions Vitrectomy without ILM peeling could be a safe and effective surgical approach for the treatment of foveoschisis in pathologic myopia. In addition, gas tamponade can improve the success rate of the operation.