摘要
目的探讨玻璃体切除(PPV)联合保留视网膜下液(SRF)的内界膜(ILM)瓣填塞治疗高度近视黄斑孔视网膜脱离(MHRD)的疗效。方法回顾性病例研究。纳入华中科技大学同济医学院附属协和医院眼科2020年8月至2023年6月的30例高度近视MHRD(32眼),伴后巩膜葡萄肿及脉络膜视网膜萎缩,眼轴长度为(30.32±1.71)mm。均接受PPV,保留SRF,黄斑孔(MH)鼻上起瓣(借助视盘的力量,固定脱离的视网膜),制作MH边缘带蒂的ILM瓣,反转填塞MH,手术结束时采用硅油填充,观察SRF吸收、视网膜再附着、MH闭合及视力变化。结果术后1周内OCT检查,25眼MH闭合SRF吸收,6眼MH闭合残留SRF,1眼MH未愈合。随访期间,7眼残留的SRF吸收时间分别为术后1年内5例,18月和21月各1例。32眼一次硅油取出后视网膜再附着,视网膜复位率为100%。MHⅠ型闭合者90.62%(29/32),其中U形闭合22眼、V形闭合5眼、W形转变为U形瘢痕闭合2眼;MHⅡ型(W形)闭合者9.38%(3/32)。术后最佳矫正视力(BCVA)有改善,从术前(1.90±0.34)[最小分辨角的对数(logMAR)]提高到(1.14±0.37)(log MAR),差异有统计学意义(t=11.11,P<0.01)。结论在残留SRF的情况下,使用ILM瓣反转填塞技术成功关闭了MH。PPV联合保留SRF、ILM瓣填塞和硅油填充,为长眼轴伴后巩膜葡萄肿的高度近视MHRD提供了一种首选治疗方法。
Objective To investigate the efficacy of pars plana vitrectomy(PPV)combined with internal limiting membrane(ILM)flap filling preserving subretinal fluid(SRF)in treatment of macular hole retinal detachment(MHRD)in patients with high myopia.Methods A retrospective case study was conducted.Thirty patients with high myopia MHRD(total of 32 eyes)with posterior staphyloma and chorioretinal atrophy from department of ophthalmology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology between August 2020 and June 2023 were included in the study.The mean axial length was(30.32±1.71)mm.All patients underwent PPV,SRF preservation,and macular hole(MH)nasal flap creation(utilizing the optic disc as a support to fix the detached retina).The ILM flap was inverted to fill MH,and the surgery ended with silicone oil tamponade.The patients were observed for SRF absorption,retinal reattachment,MH closure,and visual acuity changes in the follow-up.Results OCT examination within 1 week after the operation showed that 25 eyes had MH closure and SRF absorption,6 eyes had MH closure with residual SRF,and 1 eye had MH non-closure.During the follow-up period,residual SRF in 7 eyes was fully absorbed within 1 year(5 cases),18 months(1 case),and 21 months(1 case)after the operation.All 32 eyes had retinal reattachment after a single silicone oil removal,and the retinal reattachment rate was 100%.Among the 32 eyes,90.62%(29/32)had MH typeⅠclosure,including 22 eyes with U-shaped closure,5 eyes with V-shaped closure,and 2 eyes with W-shaped transformation into U-shaped scar closure;9.38%(3/32)had MH typeⅡ(W-shaped)closure.There was an improvement in the postoperative best-corrected visual acuity(BCVA,logMAR)from(1.90±0.34)to(1.14±0.37),with a statistically significant difference(t=11.11,P<0.01).Conclusion In the presence of residual SRF,the ILM flap inversion filling technique achieves MH closure successfully.The combination of PPV,SRF preservation,ILM flap filling,and silicone oil tamponade provides a preferred treatment for highly myopic MHRD with long eye axis and posterior staphyloma.
作者
曾爱萍
刘欣
纪蒙蒙
杜雅丽
Zeng Aiping;Liu Xin;Ji Mengmeng(Department of Ophthalmology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2024年第4期501-506,共6页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
基金
湖北省卫生健康委员会科研项目(No.WJ2023M025)。
关键词
高度近视
黄斑孔视网膜脱离
内界膜
视网膜下液
玻璃体切除术
high myopia
macular hole retinal detachment
internal limiting membrane
subretinal fluid
vitrectomy
