CAJ | 학술논문

目的观察玻璃体切割联合视网膜前膜剥除(ERMP)和(或)内界膜剥除(ILMP)及硅油填充治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔视网膜脱离(MHRD)的疗效.方法高度近视MHRD患者85例85只眼纳入研究.所有患者均采用国际标准视力表行矫正视力检查以及裂隙灯显微镜加前置镜、间接检眼镜、A/B型超声、光相干断层扫描(OCT)、眼压检查.患者平均眼轴长度(29.1±1.8) mm.后极部脉络膜弥漫性萎缩24只眼；部分性萎缩61只眼.将小数视力换算成最小分辨角对数(logMAR)视力进行统计学处理.平均logMAR矫正视力为1.93±0.37.均行玻璃体切割曲安奈德(TA)或吲哚青绿(ICG)辅助的ILMP和(或)ERMP以及硅油填充手术.85只眼均联合TA辅助行ERMP.其中,单纯TA辅助行ERMP 21只眼；ICG辅助行ILMP 56只眼；TA辅助行ILMP 8只眼.平均硅油填充时间(6.2±1.6)个月.观察患眼手术后矫正视力、视网膜复位、黄斑裂孔闭合情况以及手术后并发症.手术前后视力行t检验；对影响手术后视力的相关因素行相关性分析；视网膜脱离复发行logistic多元回归分析,黄斑区视网膜劈裂对裂孔闭合的影响行x2检验.结果患眼手术后平均logMAR矫正视力为1.34±0.48.与手术前平均logMAR矫正视力比较,差异有统计学意义(t=39.38,P＜0.01).手术后矫正视力与患眼眼轴长度(r=0.142)、后极部脉络膜萎缩程度(t=0.23、-0.165)、黄斑裂孔是否闭合(t=0.12、-0.005)均无相关性(P＞0.05).首次手术后视网膜复位79只眼,占92.9％.视网膜脱离复发6只眼,占7.1％.Logistic多元回归分析结果显示,视网膜脱离复发与患眼手术前脉络膜是否脱离、增生型玻璃体视网膜病变程度、眼轴长度、后极部脉络膜萎缩程度以及是否行ILMP均无相关性(比值比=1.428、5.039、0.815、2.578、0.432,P＞0.05).85只眼中,黄斑裂孔闭合10只眼,占11.8％；黄斑裂孔未闭合75只眼,占88.2％.手术后2周,出现高眼压24只眼,占28.2％,给予降低眼压药物治疗后眼压控制.硅油取出手术前出现高眼压12只眼,占14.1％,硅油取出手术后眼压均得到控制.结论玻璃体切割联合ERMP和(或)ILMP及硅油填充可在伴有后巩膜葡萄肿的MHRD患者中获得较高的首次手术复位率. 目的觀察玻璃體切割聯閤視網膜前膜剝除(ERMP)和(或)內界膜剝除(ILMP)及硅油填充治療伴有後鞏膜葡萄腫的高度近視黃斑裂孔視網膜脫離(MHRD)的療效.方法高度近視MHRD患者85例85隻眼納入研究.所有患者均採用國際標準視力錶行矯正視力檢查以及裂隙燈顯微鏡加前置鏡、間接檢眼鏡、A/B型超聲、光相榦斷層掃描(OCT)、眼壓檢查.患者平均眼軸長度(29.1±1.8) mm.後極部脈絡膜瀰漫性萎縮24隻眼；部分性萎縮61隻眼.將小數視力換算成最小分辨角對數(logMAR)視力進行統計學處理.平均logMAR矯正視力為1.93±0.37.均行玻璃體切割麯安奈德(TA)或吲哚青綠(ICG)輔助的ILMP和(或)ERMP以及硅油填充手術.85隻眼均聯閤TA輔助行ERMP.其中,單純TA輔助行ERMP 21隻眼；ICG輔助行ILMP 56隻眼；TA輔助行ILMP 8隻眼.平均硅油填充時間(6.2±1.6)箇月.觀察患眼手術後矯正視力、視網膜複位、黃斑裂孔閉閤情況以及手術後併髮癥.手術前後視力行t檢驗；對影響手術後視力的相關因素行相關性分析；視網膜脫離複髮行logistic多元迴歸分析,黃斑區視網膜劈裂對裂孔閉閤的影響行x2檢驗.結果患眼手術後平均logMAR矯正視力為1.34±0.48.與手術前平均logMAR矯正視力比較,差異有統計學意義(t=39.38,P＜0.01).手術後矯正視力與患眼眼軸長度(r=0.142)、後極部脈絡膜萎縮程度(t=0.23、-0.165)、黃斑裂孔是否閉閤(t=0.12、-0.005)均無相關性(P＞0.05).首次手術後視網膜複位79隻眼,佔92.9％.視網膜脫離複髮6隻眼,佔7.1％.Logistic多元迴歸分析結果顯示,視網膜脫離複髮與患眼手術前脈絡膜是否脫離、增生型玻璃體視網膜病變程度、眼軸長度、後極部脈絡膜萎縮程度以及是否行ILMP均無相關性(比值比=1.428、5.039、0.815、2.578、0.432,P＞0.05).85隻眼中,黃斑裂孔閉閤10隻眼,佔11.8％；黃斑裂孔未閉閤75隻眼,佔88.2％.手術後2週,齣現高眼壓24隻眼,佔28.2％,給予降低眼壓藥物治療後眼壓控製.硅油取齣手術前齣現高眼壓12隻眼,佔14.1％,硅油取齣手術後眼壓均得到控製.結論玻璃體切割聯閤ERMP和(或)ILMP及硅油填充可在伴有後鞏膜葡萄腫的MHRD患者中穫得較高的首次手術複位率.
목적 관찰파리체절할연합시망막전막박제(ERMP)화(혹)내계막박제(ILMP)급규유전충치료반유후공막포도종적고도근시황반렬공시망막탈리(MHRD)적료효.방법 고도근시MHRD환자85례85지안납입연구.소유환자균채용국제표준시력표행교정시력검사이급렬극등현미경가전치경、간접검안경、A/B형초성、광상간단층소묘(OCT)、안압검사.환자평균안축장도(29.1±1.8) mm.후겁부맥락막미만성위축24지안；부분성위축61지안.장소수시력환산성최소분변각대수(logMAR)시력진행통계학처리.평균logMAR교정시력위1.93±0.37.균행파리체절할곡안내덕(TA)혹신타청록(ICG)보조적ILMP화(혹)ERMP이급규유전충수술.85지안균연합TA보조행ERMP.기중,단순TA보조행ERMP 21지안；ICG보조행ILMP 56지안；TA보조행ILMP 8지안.평균규유전충시간(6.2±1.6)개월.관찰환안수술후교정시력、시망막복위、황반렬공폐합정황이급수술후병발증.수술전후시역행t검험；대영향수술후시력적상관인소행상관성분석；시망막탈리복발행logistic다원회귀분석,황반구시망막벽렬대렬공폐합적영향행x2검험.결과 환안수술후평균logMAR교정시력위1.34±0.48.여수술전평균logMAR교정시력비교,차이유통계학의의(t=39.38,P＜0.01).수술후교정시력여환안안축장도(r=0.142)、후겁부맥락막위축정도(t=0.23、-0.165)、황반렬공시부폐합(t=0.12、-0.005)균무상관성(P＞0.05).수차수술후시망막복위79지안,점92.9％.시망막탈리복발6지안,점7.1％.Logistic다원회귀분석결과현시,시망막탈리복발여환안수술전맥락막시부탈리、증생형파리체시망막병변정도、안축장도、후겁부맥락막위축정도이급시부행ILMP균무상관성(비치비=1.428、5.039、0.815、2.578、0.432,P＞0.05).85지안중,황반렬공폐합10지안,점11.8％；황반렬공미폐합75지안,점88.2％.수술후2주,출현고안압24지안,점28.2％,급여강저안압약물치료후안압공제.규유취출수술전출현고안압12지안,점14.1％,규유취출수술후안압균득도공제.결론 파리체절할연합ERMP화(혹)ILMP급규유전충가재반유후공막포도종적MHRD환자중획득교고적수차수술복위솔.
Objective To observe the effect of pars plana vitrectomy (PPV) with epiretinal membrane peeling (ERMP) and (or) internal limiting membrane peeling (ILMP) and silicone oil tamponade for highly myopic macular hole retinal detachment (MHRD) with posterior staphyloma.Methods Eighty-five highly myopic MHRD patients (85 eyes) were enrolled in this study.All the patients were examined for corrected visual acuity (CVA),slit lamp microscope and preset lens,indirect ophthalmoscope,A/B ultrasound,optical coherence tomography (OCT) and intraocular pressure examination.The average axial length was (29.1± 1.8) mm.There were 24 eyes with diffuse choroid atrophy and 61 eyes with partial choroid atrophy.The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis.The average logMAR CVA was 1.93± 0.37.All the patients were treated with PPV and triamcinolone acetonide (TA) or indocyanine green (ICG) assisted ILMP and (or) ERMP and silicone oil tamponade.TA assisted ERMP was performed in 21 eyes; with ICG assisted ILMP in 56 eyes and TA assisted ILMP in eight eyes.The duration of silicone oil tamponade was (6.2± 1.6) months.CVA,retina and macular hole status and complications were observed postoperatively.Differences between preoperative and postoperative CVA were evaluated by the t test and correlation analysis.Multiple logistic regression analysis was performed to assess the influence of individual preoperative factors on the initial anatomical success.Differences in the macular hole closure rate between eyes with or without macular schisis were evaluated for statistical significance using corrected chi square.Results The mean logMAR CVA was 1.34±0.48 after surgery,which significantly improved compared to that before surgery (t=39.38,P＜0.01).The CVA after surgery was independent of axial length (r=0.142,P＞0.05),choroidatrophy(t=0.23,-0.165,P＞0.05) and macular hole closure (t=0.12,-0.005,P＞0.05).The retina reattached in 79 eyes (92.9 ％) and recurrence of retinal detachment occurred in six eyes (7.1 ％).Multiple logistic regression analysis indicated that recurrence of retinal detachment was independent of choroid detachment,proliferative vitroretinopathy,axial length,choroid atrophy and IL MP (OR=1.428,5.039,0.815,2.578,0.432; P＞0.05).Of these 85 eyes,macular hole closed in ten eyes (11.8％),macular hole did not close in 75 eyes (88.2％).There were 24 eyes (28.2％) experienced high intraocular pressure during the first 2 weeks after surgery,allof them were under control with drugs.There were 12 eyes (14.1％) presented with high intraocular pressure before the silicone oil removal,all of them were under control only by silicone oil removal.Conclusion For the treatment of MHRD with posterior staphyloma,PPV combined with ERMP and (or) IL MP and silicone oil tamponade show a high retinal reattachment rate.