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。     

高度近视黄斑裂孔性视网膜脱离术式选择

黄斑裂孔在孔源性视网膜脱离中约占15%,其中高度近视引起的黄斑裂孔占大部分。对这种患者的治疗要注意保留黄斑的中心视力,还要注意高度近视引起的解剖改变。所以要选择什么样的手术方式进行治疗成为近年来人们关注的焦点,我们就此进行综述。     

玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离

目的　观察玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离患者术后视网膜的解剖复位率和黄斑裂孔的闭合率。方法　收集自２０１２年１月至２０１４年１２月在我院手术的高度近视合并黄斑裂孔性视网膜脱离的患者６４例（６４眼）,根据手术方式不同分成２组:一组行单纯玻璃体切割术为单纯玻切组,另一组行玻璃体切割联合黄斑加固术为联合手术组,观察两组视力及视网膜解剖复位率和黄斑裂孔闭合率。结果　６４例６４眼中,单纯玻切组３６例,术前视力平均为０．９０ｌｏｇＭＡＲ,术后平均为０．４１ｌｏｇＭＡＲ;联合手术组２８例,术前视力平均为０．８９ｌｏｇＭＡＲ,术后平均为０．６２ｌｏｇＭＡＲ;两组术前视力差异无统计学意义,术后差异有统计学意义（Ｐ＝０．０４）。两组患者术后视网膜复位均率为１００％;联合手术组的黄斑裂孔闭合率较高,为９２．９％,单纯玻切组为４１．７％,两组比较差异有统计学意义（Ｐ＝０．０２）。结论　在高度近视合并黄斑裂孔性视网膜脱离的患者中,联合行黄斑加固术较单纯玻璃体切割术患者的黄斑裂孔闭合率要高。     

高度近视黄斑裂孔性视网膜脱离裂孔闭合意义及影响因素

目的 探讨高度近视黄斑裂孔性视网膜脱离的手术效果,裂孔闭合的意义,以及影响因素.方法临床病例回顾性研究.对2007年6月至2009年10月在山东眼科研究所就诊的一组接受玻璃体切除联合内界膜剥除术治疗的连续性病例共49例49只眼,记录屈光度,最佳矫正视力,眼轴,黄斑裂孔直径,剥除内界膜范围.统计分析影响黄斑裂孔闭合的相关因素.结果 47只眼(95.92％)视网膜复位.18只眼(36.73％)黄斑裂孔闭合(A组);31只眼(63.27％)裂孔未闭合(B组).A、B两组术后视力均较术前有显著提高,A组术后视力好于B组;原始裂孔大小是影响黄斑裂孔闭合的因素.结论 高度近视黄斑裂孔性视网膜脱离患者裂孔闭合几率低.裂孔闭合提高视功能预后.裂孔大小是黄斑裂孔闭合的影响因素.     

Amniotic membrane for covering high myopic macular hole associated with retinal detachment following failed primary surgery

AIM: To evaluate the therapeutic effect of amniotic membrane (AM) for covering high myopic macular hole associated with retinal detachment following failed primary surgery. METHODS: Seventeen eyes of 17 patients whose axial length was more than 29 mm suffered from macular hole (MH) or MH associated with retinal detachment (RD), and had previously surgery of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and silicone oil (SO) tamponade. Half a year after the surgery, optical coherence tomography (OCT) showed that MH did not heal in all 17 eyes and RD was still maintained in 13 eyes of these 17 eyes. We performed SO removal combined with AM covering on macular area and C3F8 tamponade, and phacoemulsification combined with intraocular lens implantation simultaneously cataract eyes. We followed up these patients for one year. RESULTS: In all 17 eyes, SO was removed successfully, MHs were healed and RDs were reattached. One eye (5.89%, 1/17) had AM shifted half a month after surgery and underwent a second surgery to adjust the position of the AM and supplement C3F8. After surgery, the visual acuity (VA) improved in 15 eyes (88.24%, 15/17), no change in two eyes (11.76%, 2/17). No serious complications occurred in all eyes. CONCLUSION: AM covering is helpful to rescue the previous failure surgery of high myopic MH.     

高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离治疗的临床研究

目的:研究高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离的临床治疗效果及不同手术方式的有效性。方法:回顾性分析2003-05/2008-05诊断治疗的高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离91眼,分析视网膜复位情况及最佳矫正视力。结果:在这些视网膜脱离的治疗中,有6种手术方式:单纯黄斑区巩膜外垫压12眼,5眼(42%)首次术后视网膜回贴;单纯玻璃体腔气体充填15眼,6眼(40%)首次术后视网膜回贴;平坦部玻璃体切除联合球内气体充填20眼,14眼(70%)首次术后视网膜回贴;平坦部玻璃体切除、视网膜前膜剥离联合球内气体充填16眼,11眼(69%)首次术后视网膜回贴;巩膜环扎、玻璃体切除、视网膜前膜剥离联合球内气体充填25眼,18眼(72%)首次术后视网膜回贴;巩膜环扎、玻璃体切除联合硅油填充13眼,10眼(77%)首次术后视网膜回贴。64眼(70%)首次手术治疗后视网膜回贴,85眼(93%)视网膜回贴。结论:玻璃体切除联合球内惰性气体或硅油填充是治疗高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离的最有效方法。     

玻璃体切割联合后巩膜加固术治疗高度近视眼黄斑裂孔性视网膜脱离

目的：探讨玻璃体切割联合后巩膜加固治疗高度近视眼黄斑裂孔伴视网膜脱离的方法与疗效。
　　方法：于2012-01/2013-12间收集高度近视性黄斑裂孔伴视网膜脱离患者45例45眼,分为玻璃体切割内界膜撕除联合后巩膜加固组( A组)28眼和玻璃体切割内界膜撕除组( B组)17眼。术前分别行视力、眼压、间接检眼镜、OCT检查,术后随访6~12mo,行视力、OCT检查,分别对视力、视网膜复位情况、黄斑裂孔闭合情况进行统计比较。
　　结果：(1)视力检查：术后视力：A 组1.19±0.39, B 组1.51±0.34,二者比较有显著性差异(P<0.05);(2)术后视网膜复位率：A组100%,B组88.24%,两者比较无统计学差异;(3)术后黄斑裂孔闭合率：A 组82%,B 组53%,两者比较有统计学差异(P<0.05)。
　　结论：玻璃体切割术联合后巩膜加固术治疗高度近视眼黄斑裂孔伴视网膜脱离的手术方法安全可行,可更好的改善视力,提高黄斑裂孔的闭合率。     

高度近视眼黄斑裂孔治疗的研究进展

黄斑裂孔是高度近视常见的并发症。但由于常伴有广泛的视网膜脉络膜萎缩，手术后裂孔愈合困难。我们对黄斑裂孔的当代认识做一总结，并比较各黄斑裂孔治疗方法的优缺点。     

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。     

高度近视黄斑裂孔性视网膜脱离玻璃体手术56例

目的：评价高度近视黄斑裂孔性视网膜脱离玻璃体手术治疗效果。方法：高度近视黄斑裂孔性视网膜脱离患56例,行玻璃体切除。PVRC110眼,C214眼,C332眼,伴周边部裂孔7眼,白孔11眼。手术中彻底清除玻璃体后皮质,或人工玻璃体后脱离剥膜,气液交换使视网膜复位,眼内填充200mL／L C3F845眼,白孔眼内硅油填充。并发周边部裂孔病例后行巩膜外环扎裂孔冷凝。术后给予抗炎降眼压处理。气泡变小裂孔愈合不佳,裂孔周围氪黄激光封闭或再次补充气体。注气俯卧位14d以上。所有患随访3～12mo。结果：黄斑裂孔闭合、视网膜复位53例,周边裂孔闭合7例。术后视力提高46眼(82．1％),黄斑裂孔术后视力无变化10眼。结论：玻璃体切除联合眼内填充C3F8或硅油治疗高度近视黄斑裂孔性视网膜脱离是安全有效的。     

高度近视眼黄斑裂孔性视网膜脱离的治疗

目的:探讨玻璃体手术治疗高度近视眼黄斑裂孔引起的视网膜脱离的疗效。方法:回顾性分析2001-03/2007-02的1组病例31例(32眼)。纳入标准为屈光不正≥-6.00D,黄斑下视网膜脉络膜萎缩的白色黄斑裂孔引起的原发性视网膜脱离,经过玻璃体手术联合硅油填充术治疗的病例,随访时间≥6mo。结果:随访时间6～12(平均8.4)mo。所有病例均行玻璃体切除联合硅油填充术、自体浓缩血小板封黄斑裂孔。8眼进行了内界膜剥除。术后最终视网膜复位29眼(91%),未复位3眼;术后视力提高22眼(69%),不变7眼(22%),下降3眼(9%)。结论:玻璃体切除术,自体浓缩血小板封孔是治疗高度近视眼黄斑裂孔性视网膜脱离的一种有效方法。     

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia

AIM: To observe the clinical effect of pars plana vitrectomy (PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma (PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment (MHRD) with PS. METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS (62 eyes) were enrolled in the study. Patients were divided into 23G PPV combined with PS marginal retina intraoperative photocoagulation group (combined group) and conventional surgery group (conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane (ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity (BCVA) and average number of operations were observed and compared between the two groups. RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7% (29/31) and 67.7% (21/31), respectively (χ2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2% (23/31) and 67.7% (21/31), respectively (χ2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group (t=-41.962, P≤0.001). Postoperative logMAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the logMAR BCVA before surgery, each group was improved (t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the logMAR BCVA between the eyes of the two groups (t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average (t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.     

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。     

不同类型黄斑裂孔周边视网膜变性的比较

目的 比较高度近视性(＞-6.00 D)黄斑裂孔和外伤性黄斑裂孔的患眼周边视网膜变性区的发生情况.方法 行玻璃体切割术的黄斑裂孔患者106例(106眼),分为两组:A组为高度近视性黄斑裂孔组,68例(68眼);B组为外伤性黄斑裂孔组,38例(38眼).所有患者均进行术前三面镜和玻璃体切割术中对周边视网膜检查,以确认周边视网膜的变性情况.结果 A组中周边视网膜有变性区者52眼,占76.47％;B组中周边视网膜有变性区者8眼,占21.05％.两组周边视网膜变性区的发生率比较,差异有统计学意义(x2=30.48,P=0.000).A组周边视网膜有变性区的52眼中,非压迫变白者42眼,检出率为61.76％;格子样变性44眼,检出率为64.71％;囊样变性19眼,检出率为27.94％;其他类型变性15眼,检出率为22.06％.B组周边视网膜有变性区的8眼中,非压迫变白者6眼,检出率15.79％;格子样变性7眼,检出率18.42％;囊样变性4眼,检出率10.53％;其他类型变性2眼,检出率5.26％.结论 外伤性黄斑裂孔其周边视网膜变性的发生率比高度近视黄斑裂孔明显较少.     

三维光学相干断层扫描在高度近视黄斑裂孔视网膜脱离复位术后的应用

目的探讨三维光学相干断层扫描（3D-OCT）在高度近视黄斑裂孔视网膜脱离复位术后的应用价值。方法应用3D-OCT观察12例12眼高度近视黄斑裂孔视网膜脱离术后黄斑裂孔的愈合状况。手术采用玻璃体切割、气液交换、硅油填充复位视网膜,术中黄斑裂孔均不行激光封闭。9例均行晶状体切除,保留晶状体前囊膜。术后1周,1、2、3、4、5、6个月应用3D-OCT观察黄斑裂孔愈合情况。黄斑裂孔未完全愈合者,在3D-OCT定位模式引导下确认裂孔位置,给予激光封闭。结果随访6～24个月,6例术后1～4个月黄斑裂孔愈合,其中2例术后1.5～2个月出现黄斑前膜;6例术后黄斑裂孔未完全愈合,其中4例黄斑裂孔边缘翘起,在3D-OCT定位模式引导下激光封闭未愈合黄斑裂孔边缘。所有患者在确认黄斑裂孔愈合后2～5个月行硅油取出术,硅油取出眼已随访3～20个月,视网膜在位。结论 3D-OCT可清晰观察黄斑裂孔全周的愈合状况。     

Episcleral macular buckling for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole

AIM:To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole.METHODS: Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post-EMB. The duration of follow-up time after removal of silicone oil was more than 3 months.RESULTS: Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08.CONCLUSION: Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome.     

黄斑裂孔视网膜脱离手术疗效分析

目的 探讨黄斑裂孔视网膜脱离的手术方法,以提高手术成功率和疗效。方法 采用单纯注气术、环扎加压注气术、玻璃体切割联合手术,并对手术疗效进行统计、分析。结果 １１６例黄斑裂孔视网膜脱离手术,治愈９９例,治愈率为８４．５％,其中Ⅰ级膜治愈率１００％,Ⅱ级膜治愈率９２．５％。Ⅲ级膜治愈率７６．６％。结论 依据膜形成程度选择合适的手术方法,可提高手术成功率及术后视力。     

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。     

曲安奈德在高度近视眼黄斑裂孔性视网膜脱离手术中应用

目的:观察高度近视眼黄斑裂孔性视网膜脱离手术中使用曲安奈德(triamcinolone acetonide,TA)的作用及效果。方法:2006-01/12,对高度近视眼黄斑裂孔性视网膜脱离的15例患者,在行玻璃体切除手术中使用TA辅助玻璃体完全切除及视网膜前膜剥除。结果:手术后黄斑裂孔闭合视网膜全部复位,视力保留或有提高。结论:TA使清除残留玻璃体后皮质及视网膜前膜成为可能,提高了手术的成功率,同时也减轻了手术后的反应。     

Surgical management of retinal detachment resulting from macular hole in a setting of high myopia

 PURPOSE:To evaluate the anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and use of retinal tamponade for retinal detachments resulting from macular hole (MHRD) in highly myopic eyes. METHODS: Twenty-nine highly myopic patients (29 eyes) underwent PPV with ILM peeling and retinal tamponade for MHRD were enrolled. Demographics and best-corrected visual acuity (BCVA) were measured preoperatively and at final follow-up. Anatomical success and macular hole closure were analyzed. RESULTS:Patients' mean age of patients was 58.7 ± 10.6 years, mean follow-up was 11.7 ± 7.4 months. Twenty three eyes (23/26, 88.5%) undergoing primary PPV combined with ILM peeling had successful initial retinal reattachment, including 19 eyes (19/19, 100%) with silicone oil tamponade and in 4 eyes (4/7, 57.1%) with sulfur hexafluoride (C3F8) tamponade. Overall anatomical success was achieved in 27 eyes (27/29, 93.1%). The macular hole closure was observed in 17 eyes (17/26, 65.4%) with final anatomical success. Compared to preoperative BCVA, the mean postoperative BCVA in the eyes with anatomical success was significantly improved (P = 0.007, Wilcoxon signed rank test). CONCLUSION:As a primary or secondary procedure, PPV combined with ILM peeling and usage of retinal tamponade serves as an effective method for MHRD in highly myopic eyes.