CAJ | 학술논문

目的比较曲安奈德(TA)玻璃体染色辅助玻璃体切除(PPV)联合吲哚青绿(ICG)染色内界膜撕除双重处理对高度近视黄斑裂孔性视网膜脱离(MHRD)视网膜复位及黄斑孔闭合的影响.方法选择43只适度长眼轴(≥26 mm、＜29 mm)、视网膜色素上皮(RPE)及脉络膜萎缩轻或不明显、无明显的巩膜后葡萄肿的高度近视MHRD眼,将其随机分为TA玻璃体染色辅助PPV联合ICG染色内界膜撕除组(A组,24只眼)和单纯PPV组(B组,19只眼),比较两组间最佳矫正视力(BC-VA)、视网膜复位及黄斑孔闭合率的差异.结果第一次手术,视网膜复位率:A组(91.67％)高于B组(78.95％),但差异无统计学意义(P=0.380);黄斑孔闭合率:A组58.33％,B组26.32％,差异有统计学意义(P =0.036);术后视网膜表面膜发生率:B组(26.32％)明显高于A组(4.17％).经第二次手术,视网膜最终复位率:A组95.83％,B组94.74％ (P=1.000);黄斑孔闭合率:A组58.33％,B组36.84％ (P =0.161);差异均无统计学意义;术后12个月,BCVA提高:A组(58.33％)高于B组(42.11％),但差异无统计学意义(P =0.476).结论在适度长眼轴、RPE及脉络膜萎缩轻或不明显、无明显的巩膜后葡萄肿的高度近视MHRD眼,TA玻璃体染色辅助PPV联合ICG染色内界膜撕除双重处理有很好的视网膜复位和黄斑孔闭合率.
목적 비교곡안내덕(TA)파리체염색보조파리체절제(PPV)연합신타청록(ICG)염색내계막시제쌍중처리대고도근시황반렬공성시망막탈리(MHRD)시망막복위급황반공폐합적영향.방법 선택43지괄도장안축(≥26 mm、＜29 mm)、시망막색소상피(RPE)급맥락막위축경혹불명현、무명현적공막후포도종적고도근시MHRD안,장기수궤분위TA파리체염색보조PPV연합ICG염색내계막시제조(A조,24지안)화단순PPV조(B조,19지안),비교량조간최가교정시력(BC-VA)、시망막복위급황반공폐합솔적차이.결과 제일차수술,시망막복위솔:A조(91.67％)고우B조(78.95％),단차이무통계학의의(P=0.380);황반공폐합솔:A조58.33％,B조26.32％,차이유통계학의의(P =0.036);술후시망막표면막발생솔:B조(26.32％)명현고우A조(4.17％).경제이차수술,시망막최종복위솔:A조95.83％,B조94.74％ (P=1.000);황반공폐합솔:A조58.33％,B조36.84％ (P =0.161);차이균무통계학의의;술후12개월,BCVA제고:A조(58.33％)고우B조(42.11％),단차이무통계학의의(P =0.476).결론 재괄도장안축、RPE급맥락막위축경혹불명현、무명현적공막후포도종적고도근시MHRD안,TA파리체염색보조PPV연합ICG염색내계막시제쌍중처리유흔호적시망막복위화황반공폐합솔.
Objective To compare the outcome of pars plana vitrectomy (PPV) with triamcinolone (TA) assistance and with Indocyanine green (ICG) staining internal limiting membrane (ILM) peeling for the treatment of highly myopic macular hole retinal detachment (MHRD).Methods PPV was performed using 2 different surgical procedures in 43 highly myopic MHRD eyes with moderate long axial lengths (AXL),"mild" chorioretinal atrophy,and posterior staphyloma:TA-assisted PPV and with ICG staining ILM peeling (group A,24 eyes),Non-TA assisted PPV and without ILM peeling (group B,19 eyes).Anatomic reattachment of the retina,macular hole closure,and best-corrected visual acuity (BCVA) were measured.Results The rates of retinal reattachment and macular hole closure were higher in group A (91.67％ and 58.33％) than that in group B (78.95％ and 26.32 ％) in the first surgery,especially in macular hole closure rate (P =0.036).The rates of retinal reattachment and macular hole closure were 95.83％ and 58.33％ (group A),94.74％ and 36.84％ (group B) in the second surgery,and no differences between them.There were no differences of BCVA in group A than that in group B (P =0.977).Conclusions PPV with TA assistance and ICG staining ILM peeling are effective for the treatment of highly myopic MHRD with moderate long AXL,"mild" chorioretinal atrophy,and posterior staphyloma.