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。

Efficacy of 25G vitrectomy and internal limiting membrane peeling with room air tamponade for myopic foveoschisis

Objective To evaluate visual and anatomical outcomes in patients with myopic foveoschisis who underwent vitrectomy and internal limiting membrane (ILM) peeling with room air tamponade. Design Retrospective case series. Participants 24 eyes of 20 patients with myopic foveoschisis were included. Methods Pars plana vitrectomy (25 Gauge) and ILM peeling with room air tamponade were performed in all patients. 6 eyes which combined with cataract were simultaneously accepted phacoemulsification with intraocular lens implantation. All recruits were accepted best-corrected visual acuity (BCVA) testing (logMAR), slit lamp, indirect ophthalmoscope and optical coherence tomography scans. Central foveal thickness (CFT) detected by OCT in pre-operation and 3, 6 months after surgery. According to the ETDRS, CFT was recorded in 5 areas (C, central; S, superior; I, inferior; N, nasal; T, temporal). All patients completed follow-up for more than 3 months (20.54±38.63 weeks). Main Outcome Measures BCVA and CFT. Results Preoperative and postoperative CFT was (1.41±0.51) and (0.58±0.69) LogMAR units respectively (P=0.001). The CFT of the postoperative eyes in the areas of C, S, I, N,T (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) were significantly thinner than the corresponding areas of preoperative eyes (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)(all P=0.000). Conclusion Vitrectomy combined ILM peeling and room air tamponade results in favorable visual and anatomical outcomes in myopic foveoschisis.