高度近视黄斑劈裂玻璃体切除联合内界膜剥离

目的探讨23G玻璃体切除术联合内界膜剥离和全氟丙烷（c,F。）填充治疗高度近视黄斑劈裂的效果。方法25例（28只眼）高度近视黄斑劈裂23G玻璃体切除和C,F。填充术,分为A组13例（15只眼）剥离内界膜组,B组12例（13只眼）未剥离内界膜组。术后随访6～11个月。观察术前及术后1、3、6个月最佳矫正视力（BCVA）以及黄斑中心凹厚度。结果术后1、3、6个月两组13CVA均较术前提高（A组t=-6．167,-10．724,-9．510,B组t=-7．426,-7．754,-9．381,P〈0．05）,差异有统计学意义,术后1、3、6个月两组间BCVA比较（t=0．239,P=0．813;t=-0．408,P=0．686;t=-759,P=0．455）,差异无统计学意义。OCT显示术后1、3、6个月两组黄斑中心凹厚度均较术前下降（P〈0．05）,差异有统计学意义;术后3、6个月两组间黄斑中心凹厚度比较,A组下降较B组明显,（t=-2．998,P=0．006,t=-3．800,P=0．001）,差异有统计学意义。随访中,A组1眼术后1个月发现黄斑孔视网膜脱离。结论23G玻璃体切除术联合或不联合剥离内界膜全氟丙烷填充治疗高度近视黄斑劈裂都是安全、有效的,剥离内界膜有助于劈裂的复位,同时也增加了黄斑孔风险。     

Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis

Purpose

To evaluate the efficacy of vitrectomy including internal limiting membrane (ILM) peeling without gas tamponade for myopic foveoschisis (MF).

Method

In this retrospective study, 15 eyes of 13 consecutive patients with MF underwent pars plana vitrectomy and ILM peeling without gas tamponade. The main outcomes were measured using best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT).

Result

The mean refractive error was ?11.0?±?8.2 diopters and mean axial length was 30.8?±?2.6?mm. The mean BCVA increased from 0.78?±?0.53 to 0.61?±?0.75 logMAR unit (p?=?0.05), and the mean CMT decreased from 405?±?143?μm to 255?±?47?μm (p?=?0.002) during a follow-up of 11.8?months. OCT showed a complete resolution of the MF, with foveal reattachment in all eyes. Full-thickness macular hole developed in two eyes during follow-up.

Conclusion

ILM peeling without gas tamponade results in favorable anatomical and visual outcomes.     

Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis

AIM: To evaluate the clinical and anatomical outcomes of pars plana vitrectomy and gas tamponade without internal limiting membrane (ILM) peeling in symptomatic patients caused by myopic foveoschisis. METHODS: Nine eyes in eight highly myopic patients who had myopic foveoschisis with foveal detachment underwent vitrectomy without ILM peeling followed by gas tamponade. Main outcome measures include change in best corrected visual acuity (BCVA) and changes in height of the foveal detachment and resolution of the myopic foveoschisis measured by optical coherence tomography (OCT). RESULTS: After surgery, BCVA improved in eight eyes with the median BCVA improved from 20/80 to 20/50 (p=0.012). The mean line of visual improvement was 3.6 lines. OCT showed complete resolution of myopic foveoschisis with complete foveal reattachment in seven (77.8%) eyes with partial resolution in two (22.2%) eyes. The mean height of foveal detachment decreased from 505 mum preoperatively to 21 mum postoperatively (p<0.001). CONCLUSIONS: Vitrectomy without ILM peeling followed by gas tamponade appeared to result in favourable visual and anatomical outcomes for treating myopic foveoschisis in highly myopic eyes. The results are comparable with studies in which ILM removal was performed. Further controlled study will be useful to determine the role of ILM peeling in these patients.     

玻璃体切割联合内界膜剥除术治疗高度近视继发黄斑劈裂的观察

目的：探讨和评价玻璃体切割联合内界膜剥除治疗高度近视继发黄斑劈裂的疗效和安全性。
　　方法：将2011-03/2013-03高度近视继发黄斑劈裂患者30例30眼随机分为治疗组(16眼)和对照组(14眼),治疗组给予玻璃体切割联合内界膜剥除,对照组给予玻璃体切割但未联合内界膜剥除,观察术后2 mo视网膜复位率、视力提高率。
　　结果：治疗组视网膜复位率、视力提高率均高于对照组(P<0.05)。
　　结论：玻璃体切割联合内界膜剥除是治疗高度近视继发黄斑劈裂的有效手段。     

Ultrastructure of internal limiting membrane in myopic foveoschisis

PURPOSE: To reveal the pathogenesis of myopic foveoschisis (MF). DESIGN: Clinicopathological report. METHODS: Internal limiting membranes (ILMs) were collected from ten patients with MF and five patients with idiopathic macular hole (IMH) as a control. Samples were subjected to transmission electron microscopic study. Characteristics of the ILM were compared between the two groups. RESULTS: Collagen fiber and cell debris were identified on the inner surface of ILM in seven eyes (70%) with MF, significantly more (P < .05) than found in IMH subjects (0%). More fibrous glial cells were likely to be found on the inner surface of ILM. No significant difference in fibroblast-like cell adhesion was observed. CONCLUSIONS: Collagen fiber and cellular component are suggested to play an important role in developing MF. ILM peeling may be essential for vitrectomy for MF.     

25G玻璃体切除联合内界膜剥除及空气填充治疗高度近视黄斑劈裂的临床观察

 目的 观察25G玻璃体手术联合内界膜剥除及空气填充治疗高度近视性黄斑劈裂的疗效。设计 回顾性病例系列。研究对象 北京爱尔英智眼科医院2010-2014年眼轴26 mm以上的高度近视性黄斑劈裂患者20例24眼。方法 采用25G三通道平坦部玻璃体切除联合内界膜剥除及空气填充。其中6眼合并白内障,术中同时行白内障超声乳化及人工晶状体植入。术前及术后检查矫正视力（LogMAR视力）、裂隙灯显微镜、间接检眼镜及相干光断层扫描（OCT）。OCT图像根据ETDRS分区分为黄斑中心、上方、下方、鼻侧及颞侧。术后随访3个月以上,平均随访时间（20.54±38.63）周。主要指标 矫正视力,OCT图像黄斑区视网膜厚度。结果 术前患眼平均视力1.41±0.51,术后3个月0.58±0.69 (P=0.001)。术前黄斑中心、上方、下方、鼻侧及颞侧视网膜厚度分别为（452.36±111.28）μm、（425.05±78.39）μm、（415.10±74.43）μm、（404.55±56.03）μm、 （451.45±93.49）μm,术后12周时分别为（233.09±78.72）μm、（260.18±41.04）μm、（260.36±29.85）μm、（289.41±28.38）μm、（237.55±53.57）μm（P均=0.000）。结论 玻璃体切除联合内界膜剥除及空气填充有助于近视性黄斑劈裂眼的视力提高及黄斑劈裂解剖复位。     

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.     

Valsalva视网膜病变的玻璃体手术治疗

目的:探讨玻璃体切除联合内界膜剥除术对Valsalva视网膜病变的疗效与安全性。方法:对因Valsalva视网膜病变接受玻璃体手术治疗的6例7眼的临床资料进行回顾分析。所有患眼均有不同程度的黄斑内界膜下积血,3眼伴少量玻璃体积血,均以玻璃体切除联合内界膜剥除术治疗。结果:患眼视力由术前的指数或手动提高至术后第1d的0.1~0.5,并在术后1mo内继续提高,术后3,6mo;1a随诊时仍维持稳定。随访期内未观察到严重并发症。结论:玻璃体切除联合内界膜剥除术是安全、有效的治疗严重Valsalva视网膜病变的方法。     

Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes

Purpose: To report the surgical outcome of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling in three highly myopic patients with macular retinoschisis and associated posterior staphyloma. Methods: We report three highly myopic patients with macular retinoschisis and foveal detachment who underwent simple PPV without ILM peeling, with long‐acting gas tamponade. Main outcome evaluations included best corrected visual acuity, biomicroscopic appearance and optical coherence tomography findings. Results: Pars plana vitrectomy without ILM peeling resulted in anatomic and functional improvement in all three operated eyes for follow‐up periods of ≥ 12 months. Conclusions: Pars plana vitrectomy without ILM peeling is effective for treating macular retinoschisis and foveal detachment in highly myopic eyes with posterior staphyloma. Visual and anatomic outcomes are comparable with those in previous studies in which ILM removal was performed.     

Efficiency comparison with fovea-sparing internal limiting membrane peeling and complete internal limiting membrane peeling for treating myopic traction maculopathy

Graefe's Archive for Clinical and Experimental Ophthalmology - To explore whether the efficacy of fovea-sparing internal limiting membrane peeling (FS-ILMP) is better than that of complete...     

保留中央凹或标准内界膜剥除联合玻璃体切割术治疗近视牵引性黄斑病变的Meta分析

目的:评估玻璃体切割术中保留中央凹(FSIP)或标准内界膜剥除(CMIP)治疗近视牵引性黄斑病变(MTM)的疗效及安全性。方法:计算机检索中国知网、万方、维普、PubMed、Embase、Cochrane Library、Web of Science数据库,搜集2000-01-01/2022-07-01玻璃体切割术中FSIP或CMIP治疗MTM的对比研究。比较两组患者术后最佳矫正视力(BCVA)的变化值和改善率、术后全层黄斑裂孔(FTMH)发生率、视网膜中央凹厚度(CFT)变化值、术后中心凹完全解剖复位率。结果:共12篇文献484眼纳入研究,其中FSIP组203眼,CMIP组281眼。Meta分析结果显示：FSIP组患者术后BCVA的变化值(SMD=0.52,95%CI:0.20～0.85,P=0.002)、BCVA改善率(RR=1.50,95%CI:1.22～1.85,P=0.0002)及术后FTMH发生率(RR=0.23,95%CI:0.10～0.54,P=0.0008)优于CMIP组,两组患者CFT变化值(SMD=0.04, 95%CI:-0.19～0.26,P=0.75)及术后...     

玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔

目的评价玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔的临床疗效。方法采用玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔17例17眼,对患者术前术后视功能、术后黄斑裂孔闭合及手术主要并发症等进行检查和随访。结果本组17眼均成功剥离内界膜。随访5～24个月,其中13眼黄斑裂孔完全闭合,4眼裂孔直径缩小,裂孔封闭成功率为76.47%;17眼中14眼视力提高,视力提高率为82.35%;视物变形等症状也有明显改善。并发症主要有术中毛细血管性出血、术后一过性高眼压及晶状体后囊下混浊。结论玻璃体切割联合内界膜剥离术可有效封闭特发性黄斑裂孔,提高视功能。     

Internal limiting membrane peeling combined with silicone oil or air tamponade for highly myopic foveoschisis

AIM: To compare the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) and silicone oil or sterile air tamponade for the treatment of myopic foveoschisis (MF) in highly myopic eyes. METHODS: This retrospective study included 48 myopic eyes of 40 patients with MF and axial lengths (ALs) ranging from 26-32 mm treated between January 2020 and January 2022. All patients were underwent PPV combined with ILM peeling followed by sterile air or silicone oil tamponade and followed up at least 12mo. Based on the features on spectral-domain optical coherence tomography (SD-OCT), the eyes were divided into the MF-only group (Group A, n=15 eyes), MF with central foveal detachment group (Group B, n=20 eyes), and MF with lamellar macular hole group (Group C, n=13 eyes). According to AL, eyes were further divided into three groups: Group D (26.01-28.00 mm, n=12 eyes), Group E (28.01-30.00 mm, n=26 eyes), and Group F (30.01-32.00 mm, n=10 eyes). The best-corrected visual acuity (BCVA), central foveal thickness (CFT), and complications were recorded. RESULTS: The patients included 16 males and 24 females with the mean age of 56±9.82y. The BCVA and CFT improved in all groups after surgery (P<0.01), while there was no significant difference of the CFT in Group A, B, and C postoperatively (P>0.05). The intergroup differences of BCVA and CFT postoperatively were statistically significant in Group D, E, and F. Twenty eyes were injected with sterile air, and 28 eyes were injected with silicone oil for tamponade based on the AL. However, there was no statistically significant difference among Groups D, E, and F in terms of the results of sterile air or silicone oil tamponade. The mean recovery time was 5.9mo for MF patients subjected to silicone oil tamponade and 7.7mo for patients subjected to sterile air tamponade, and the difference was not statistically significant. CONCLUSION: PPV and ILM peeling combined with silicone oil or sterile air tamponade can achieve good results for MF in highly myopic eyes with ALs≤32 mm.     

玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂的疗效及与视觉相关生存质量的评估

目的评估玻璃体切割联合内界膜剥除术对高度近视黄斑劈裂的疗效,并比较术前、术后与视觉相关生存质量的变化。方法研究设计为非对照病例观察研究。采用闭合式经睫状体平坦部三切口玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂患者19例20眼。术前及术后6个月对黄斑区视网膜进行光学相干断层扫描（OCT）检查,记录黄斑中心凹最小厚度和黄斑区90°方位视网膜劈裂处的最大厚度。术后6个月检查双眼最佳矫正视力（BCVA）并与术前进行比较;应用视力相关生存质量量表-25（VFQ-25）对与视觉相关生存质量进行评价,并与术前进行比较。结果术后随访超过6个月,手术眼黄斑中心凹厚度和黄斑区视网膜平均最大厚度分别从术前的（360.7±183.7）μm、（483.0±138.3）μm减小到术后的（180.2±75.2）μm、（328.1±82.2）μm,差异均有统计学意义（u=-3.211,P=0.001;u=-3.472,P=0.001）。术后BCVA提高2行以上者14眼（70%）。术后LogMAR视力平均值为0.59±0.46,明显好于术前的0.87±0.61,差异有统计学意义（u=-2.223,P=0.026）。患者VFQ-25评估统计表明,术后患者的总体视力、近距离活动、远距离活动、社会功能、精神健康、依赖程度、周边视力（视野）这7项维评分以及VFQ-25总分与术前相比明显改善,差异均有统计学意义（P〈0.05）;而术后整体健康、眼痛、社会角色限制、驾车、色觉这5项维评分与术前相比差异均无统计学意义（P〉0.05）。术后8例（42.1%）患者视力较好眼为手术眼。结论玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂安全、有效,手术治疗可明显改善患者的与视觉相关生存质量。