CAJ | 학술논문

目的比较适度与极端高度近视黄斑裂孔性视网膜脱离(MHRD)曲安奈德(TA)染色辅助玻璃体切割及内界膜剥除联合长效气体眼内填充手术后的疗效.方法 41例高度近视MHRD住院患者41只眼纳入研究.其中,眼轴长度＜ 29 mm,视网膜色素上皮(RPE)及脉络膜萎缩轻,0～1级且深度≤2 mm的巩膜后葡萄肿者24只眼(适度组)；眼轴长度≥29 mm,RPE及脉络膜明显萎缩,2～3级且深度＞2 mm的巩膜后葡萄肿者17只眼(极端组).两组患者均行TA染色辅助玻璃体切割手术联合内界膜剥除手术治疗,手术完毕时行C3F8眼内填充.对手术后发生视网膜再脱离者行再次手术.以手术后12个月为疗效判定时间点,比较两组患者视网膜复位率、黄斑裂孔闭合率及视力情况.结果第1次手术后,适度组、极端组视网膜复位率分别为91.67％、64.71％,黄斑裂孔闭合率分别为58.33％、17.65％.两组第1次手术后视网膜复位率(P=0.049)、黄斑裂孔闭合率(x2=6.787,P=0.009)比较,差异均有统计学意义.第2次手术后,适度组、极端组视网膜复位率分别为95.83％％、88.24％,黄斑裂孔闭合率分别为58.33％、23.53％.两组比较,视网膜复位率间差异无统计学意义(P=0.560),黄斑裂孔闭合率间差异有统计学意义(x2=4.894,P=0.027).手术后12个月,适度组视力提高14只眼,视力不变9只眼,视力下降1只眼；极端组视力提高6只眼,视力不变8只眼,视力下降3只眼.两组视力情况比较,差异无统计学意义(x2 =0.209,P=0.647).结论 TA染色辅助玻璃体切割及内界膜剥除联合长效气体眼内填充手术后,适度高度近视MHRD患者视网膜复位率及黄斑孔闭合率较极端高度近视MHRD患者更高,但视力预后无明显差异.
목적 비교괄도여겁단고도근시황반렬공성시망막탈리(MHRD)곡안내덕(TA)염색보조파리체절할급내계막박제연합장효기체안내전충수술후적료효.방법 41례고도근시MHRD주원환자41지안납입연구.기중,안축장도＜ 29 mm,시망막색소상피(RPE)급맥락막위축경,0～1급차심도≤2 mm적공막후포도종자24지안(괄도조)；안축장도≥29 mm,RPE급맥락막명현위축,2～3급차심도＞2 mm적공막후포도종자17지안(겁단조).량조환자균행TA염색보조파리체절할수술연합내계막박제수술치료,수술완필시행C3F8안내전충.대수술후발생시망막재탈리자행재차수술.이수술후12개월위료효판정시간점,비교량조환자시망막복위솔、황반렬공폐합솔급시력정황.결과 제1차수술후,괄도조、겁단조시망막복위솔분별위91.67％、64.71％,황반렬공폐합솔분별위58.33％、17.65％.량조제1차수술후시망막복위솔(P=0.049)、황반렬공폐합솔(x2=6.787,P=0.009)비교,차이균유통계학의의.제2차수술후,괄도조、겁단조시망막복위솔분별위95.83％％、88.24％,황반렬공폐합솔분별위58.33％、23.53％.량조비교,시망막복위솔간차이무통계학의의(P=0.560),황반렬공폐합솔간차이유통계학의의(x2=4.894,P=0.027).수술후12개월,괄도조시력제고14지안,시력불변9지안,시력하강1지안；겁단조시력제고6지안,시력불변8지안,시력하강3지안.량조시력정황비교,차이무통계학의의(x2 =0.209,P=0.647).결론 TA염색보조파리체절할급내계막박제연합장효기체안내전충수술후,괄도고도근시MHRD환자시망막복위솔급황반공폐합솔교겁단고도근시MHRD환자경고,단시력예후무명현차이.
Objective To compare the outcome of pars plana vitrectomy (PPV) with triamcinolone (TA) assistance and internal limiting membrane (ILM) peeling for the treatment of moderate and extreme highly myopic macular hole retinal detachment (MHRD).Methods Fortyone highly myopic MHRD patients (41 eyes) who underwent PPV with TA assistance and ILM peeling were enrolled in this study.These eyes were divided into two groups according to different anatomic features:group A (24 eyes) had a consistent moderate long axial lengths (＜ 29 mm)," mild" retinal pigment epithelium (RPE) and chorioretinal atrophy,and posterior staphyloma (level 0-1 and depth ≤2 mm); while group B (17 eyes) had a consistent extreme long axial lengths (≥29 mm),"severe" RPE and chorioretinal atrophy,and posterior staphyloma (level 2 3 and depth＞2 mm).All the patients underwent C3F8 tamponade at the end of PPV.The anatomic reattachment of the retina,macular hole closure,and visual acuity were observed at 12 months after surgery.Results The rates of retinal reattachment and macular hole closure were 91.67％ and 58.33％ in group A,64.71％ and 17.65 ％ in group B in the first time of surgery.The differences of rates of retinal reattachment (P=0.049) and macular hole closure (x2 =6.787,P=0.009) between two groups were statistically significant.The rates of retinal reattachment and macular hole closure were 95.83％ and 58.33％ in group A,88.23％ and 29.53％ in group B in the second time of surgery.The difference of retinal reattachment rate between two groups was not statistically significant (P=0.560).The difference of macular hole closure rate between two groups was statistically significant (x2 =4.894,P=0.027).Twelve months after surgery,the vision acuity improved in 14 eyes,unchanged in nine eyes,and decreased in one eye in group A; the vision acuity improved in six eyes,unchanged in eight eyes,and decreased in three eyes in group B.The differences of vision result between two groups was not statistically significant (x2 =0.209,P=0.647).Conclusion After PPV with TA assistance and ILM peeling,the rates of retinal reattachment and macular hole closure in eyes with moderate highly myopic MHRD are higher than that in eyes with extreme highly myopic MHRD,but there is no difference in visual acuity.