中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2015年
4期
324-328
,共5页
张娅萍%毛广运%王毓琴%宋宗明%薛安全
張婭萍%毛廣運%王毓琴%宋宗明%薛安全
장아평%모엄운%왕육금%송종명%설안전
近视,退行性/并发症%视网膜穿孔/外科学%巩膜成形术
近視,退行性/併髮癥%視網膜穿孔/外科學%鞏膜成形術
근시,퇴행성/병발증%시망막천공/외과학%공막성형술
Myopia,degenerative/complications%Retinal perforations/surgery%Scleroplasty
目的：观察后巩膜加固手术治疗病理性近视黄斑劈裂(MF)的临床效果。方法前瞻性临床研究。临床确诊为 MF 的36例患者36只眼纳入研究。自愿接受后巩膜加固手术治疗者24例24只眼作为手术组；同意定期随访,但不愿意接受手术治疗者12例12只眼作为对照组。两组患者年龄、性别、眼轴长度、等效球镜度数、最佳矫正视力(BCVA)、黄斑劈裂类型、黄斑中心凹视网膜劈裂高度(CFT)、劈裂最高值(MxFT)比较,差异均无统计学意义(P >0.05)。手术组患眼治疗后3、6、9个月时随访；对照组患眼首诊后每隔3个月随访。均随访9个月。对比观察患眼 BCVA、CFT 和 MxFT 变化以及视网膜复位情况。同时观察手术组患眼并发症发生情况。结果手术组24只眼中,劈裂腔消失、视网膜完全复位6只眼,占25.0%；劈裂腔隙不同程度缩小、视网膜层间积液吸收、视网膜部分复位16只眼,占66.7%；视网膜未复位2只眼,占8.3%。视网膜未复位2只眼分别表现为黄斑裂孔、劈裂腔高度增加。对照组12只眼视网膜均未复位,其中2只眼在随访后第6、8个月时出现黄斑裂孔性视网膜脱离,占16.7%。与治疗前比较,手术组患眼治疗后 BCVA (Z =-3.430)明显提高,CFT(Z =-2.707)明显降低,差异均有统计学意义(P <0.05)；MxFT 无明显变化,差异无统计学意义(Z =-0.670,P >0.05)。与首诊时比较,对照组患眼随访第9个月时 BCVA 无明显变化,差异无统计学意义(Z =-1.840,P >0.05)；CFT、MxFT 均明显提高,差异有统计学意义(Z =-2.803、-2.040,P <0.05)。手术组患眼均未发生眼压增高、眼底出血、黄斑前膜、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。结论后巩膜加固手术治疗 MF,可提高患眼视力,降低 CFT；未见手术相关并发症发生。
目的：觀察後鞏膜加固手術治療病理性近視黃斑劈裂(MF)的臨床效果。方法前瞻性臨床研究。臨床確診為 MF 的36例患者36隻眼納入研究。自願接受後鞏膜加固手術治療者24例24隻眼作為手術組；同意定期隨訪,但不願意接受手術治療者12例12隻眼作為對照組。兩組患者年齡、性彆、眼軸長度、等效毬鏡度數、最佳矯正視力(BCVA)、黃斑劈裂類型、黃斑中心凹視網膜劈裂高度(CFT)、劈裂最高值(MxFT)比較,差異均無統計學意義(P >0.05)。手術組患眼治療後3、6、9箇月時隨訪；對照組患眼首診後每隔3箇月隨訪。均隨訪9箇月。對比觀察患眼 BCVA、CFT 和 MxFT 變化以及視網膜複位情況。同時觀察手術組患眼併髮癥髮生情況。結果手術組24隻眼中,劈裂腔消失、視網膜完全複位6隻眼,佔25.0%；劈裂腔隙不同程度縮小、視網膜層間積液吸收、視網膜部分複位16隻眼,佔66.7%；視網膜未複位2隻眼,佔8.3%。視網膜未複位2隻眼分彆錶現為黃斑裂孔、劈裂腔高度增加。對照組12隻眼視網膜均未複位,其中2隻眼在隨訪後第6、8箇月時齣現黃斑裂孔性視網膜脫離,佔16.7%。與治療前比較,手術組患眼治療後 BCVA (Z =-3.430)明顯提高,CFT(Z =-2.707)明顯降低,差異均有統計學意義(P <0.05)；MxFT 無明顯變化,差異無統計學意義(Z =-0.670,P >0.05)。與首診時比較,對照組患眼隨訪第9箇月時 BCVA 無明顯變化,差異無統計學意義(Z =-1.840,P >0.05)；CFT、MxFT 均明顯提高,差異有統計學意義(Z =-2.803、-2.040,P <0.05)。手術組患眼均未髮生眼壓增高、眼底齣血、黃斑前膜、眼內炎、渦靜脈迴流障礙、眼前部缺血綜閤徵等併髮癥。結論後鞏膜加固手術治療 MF,可提高患眼視力,降低 CFT；未見手術相關併髮癥髮生。
목적：관찰후공막가고수술치료병이성근시황반벽렬(MF)적림상효과。방법전첨성림상연구。림상학진위 MF 적36례환자36지안납입연구。자원접수후공막가고수술치료자24례24지안작위수술조；동의정기수방,단불원의접수수술치료자12례12지안작위대조조。량조환자년령、성별、안축장도、등효구경도수、최가교정시력(BCVA)、황반벽렬류형、황반중심요시망막벽렬고도(CFT)、벽렬최고치(MxFT)비교,차이균무통계학의의(P >0.05)。수술조환안치료후3、6、9개월시수방；대조조환안수진후매격3개월수방。균수방9개월。대비관찰환안 BCVA、CFT 화 MxFT 변화이급시망막복위정황。동시관찰수술조환안병발증발생정황。결과수술조24지안중,벽렬강소실、시망막완전복위6지안,점25.0%；벽렬강극불동정도축소、시망막층간적액흡수、시망막부분복위16지안,점66.7%；시망막미복위2지안,점8.3%。시망막미복위2지안분별표현위황반렬공、벽렬강고도증가。대조조12지안시망막균미복위,기중2지안재수방후제6、8개월시출현황반렬공성시망막탈리,점16.7%。여치료전비교,수술조환안치료후 BCVA (Z =-3.430)명현제고,CFT(Z =-2.707)명현강저,차이균유통계학의의(P <0.05)；MxFT 무명현변화,차이무통계학의의(Z =-0.670,P >0.05)。여수진시비교,대조조환안수방제9개월시 BCVA 무명현변화,차이무통계학의의(Z =-1.840,P >0.05)；CFT、MxFT 균명현제고,차이유통계학의의(Z =-2.803、-2.040,P <0.05)。수술조환안균미발생안압증고、안저출혈、황반전막、안내염、와정맥회류장애、안전부결혈종합정등병발증。결론후공막가고수술치료 MF,가제고환안시력,강저 CFT；미견수술상관병발증발생。
Objective To evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients.Methods A prospective study was conducted,in which 36 pathological myopia patients(36 eyes)with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes ) voluntarily underwent posterior scleral reinforcement (PSR,operation group)and 12 patients (12 eyes)didn′t receive operation (control group). There are no statistical differences (P > 0.05 )in age,gender,length of axis oculi,spherical equivalent between the 2 groups.All patients were examined by best corrected visual acuity (BCVA),macular retinoschisis types,central foveal thickness (CFT),maximum foveal thickness (MxFT).Patients in operation group were scheduled to a follow-up 3rd,6th,and 9th month after surgery respectively.Patients in control group all were followed up once every three months.A contrast observation was made on the changes of BCVA,CFT,MxFT,findings of the foveoschisis and the complications of the surgery between groups.Results Compared with the preoperation after 9 month follow-up:in the operation group,the BCVA was significantly increased postoperatively (Z =-3.43,P =0.01),the mean CFT was significantly decreased postoperatively (Z =-2.71,P =0.007),while the MxFT which was not significantly decreased postoperatively (Z =-0.67,P =0.503).In the control group,there was no significant change in BCVA (Z =-1.840,P >0.05),the CFT and the MxFT were signi? cant increased respectively (Z = - 2.803,-2.04;P <0.05).In the operation group,there were 6 (25.0%)of the 24 eyes get complete resolution of the foveoschisis;1 6 (66.7%)of them is not completely attached however the retinoschisis was significantly decreased;only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased.In the control group no one get complete resolution of the myopic foveoschisis,and 2 eyes developed to retinal detachment in 6 and 8 month respectively.There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis,vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery.Conclusions Posterior scleral reinforcement surgery was found effective in improving the visual acuity,reducing the CFT.No obvious complications were found during and after the surgery.
