CAJ | 학술논문

目的：观察高度近视黄斑裂孔视网膜脱离(MHRD)行玻璃体切割手术二期内界膜剥除治疗患眼的临床特征和疗效。方法回顾性分析行二期 PPV 联合内界膜剥除手术的高度近视 MHRD 患者15例15只眼的临床资料。其中,男性3例3只眼,女性12例12只眼；平均年龄(60.80±5.85)岁。均行最佳矫正视力(BCVA)、裂隙灯显微镜联合+90D 前置镜、间接检眼镜、A 型超声、光相干断层扫描(OCT)检查。第一次手术后,硅油填充状态下眼底检查黄斑区视网膜复位,OCT 检查见黄斑裂孔周围视网膜浅脱离,尤以葡萄肿较深的部位明显。第二次硅油取出手术时,联合内界膜剥除玻璃体腔填充 C3 F8。分析患眼病程、屈光度、眼轴、后巩膜葡萄肿类型与第一、二次手术后 BCVA、黄斑区视网膜复位及黄裂孔愈合情况。结果患眼平均屈光度(-12.6±1.86)D；平均眼轴长度(29.82±0.993)mm；平均病程(5.20±1.24)个月。第一次手术前视网膜4个象限全脱离,同时合并脉络膜脱离和黄斑区视网膜脉络膜萎缩。后巩膜葡萄肿类型均为Ⅱ型(黄斑区)。第二次手术后,所有患眼眼底检查见视网膜复位；OCT 检查,黄斑裂孔闭合7只眼,黄斑裂孔贴附且视网膜复位8只眼。第一、二次手术后患眼 BCVA 均较手术前提高,差异有统计学意义(P =0.000)；第二次手术后 BCVA 较手术前及第一次手术后提高,差异有统计学意义(P =0.038)。结论患眼主要临床特征为病程长、伴脉络膜脱离、Ⅱ型后巩膜葡萄肿；二期内界膜剥除、C3 F8填充可提高患眼视力及视网膜解剖复位率。
목적：관찰고도근시황반렬공시망막탈리(MHRD)행파리체절할수술이기내계막박제치료환안적림상특정화료효。방법회고성분석행이기 PPV 연합내계막박제수술적고도근시 MHRD 환자15례15지안적림상자료。기중,남성3례3지안,녀성12례12지안；평균년령(60.80±5.85)세。균행최가교정시력(BCVA)、렬극등현미경연합+90D 전치경、간접검안경、A 형초성、광상간단층소묘(OCT)검사。제일차수술후,규유전충상태하안저검사황반구시망막복위,OCT 검사견황반렬공주위시망막천탈리,우이포도종교심적부위명현。제이차규유취출수술시,연합내계막박제파리체강전충 C3 F8。분석환안병정、굴광도、안축、후공막포도종류형여제일、이차수술후 BCVA、황반구시망막복위급황렬공유합정황。결과환안평균굴광도(-12.6±1.86)D；평균안축장도(29.82±0.993)mm；평균병정(5.20±1.24)개월。제일차수술전시망막4개상한전탈리,동시합병맥락막탈리화황반구시망막맥락막위축。후공막포도종류형균위Ⅱ형(황반구)。제이차수술후,소유환안안저검사견시망막복위；OCT 검사,황반렬공폐합7지안,황반렬공첩부차시망막복위8지안。제일、이차수술후환안 BCVA 균교수술전제고,차이유통계학의의(P =0.000)；제이차수술후 BCVA 교수술전급제일차수술후제고,차이유통계학의의(P =0.038)。결론환안주요림상특정위병정장、반맥락막탈리、Ⅱ형후공막포도종；이기내계막박제、C3 F8전충가제고환안시력급시망막해부복위솔。
Objective The aim of this study is to observe the clinical characteristics and surgical effects of macular hole retinal detachment in high myopia patients with pars plana vitrectomy (PPV)and secondary internal limiting membrane (ILM)peeling.Methods This was a retrospective study.The clinical data of 1 5 patients (1 5 eyes)with macular hole retinal detachment and high myopia,who underwent primary PPV and secondary ILM peeling,were analyzed,including disease history,refraction diopter,ocular axis length,posterior scleral staphyloma,BCVA,macular reattachment and macular hole heeling.There were 3 males (3 eyes)and 12 female (12 eyes),the average age was (60.80 ± 5.85 )years.All patients were examined by best corrected visual acuity (BCVA ), slit lamp microscopy with 90D pre-lens, indirect ophthalmoscopy,A scan and optical coherence tomography (OCT).After the first PPV and silicone oil tamponade,a shallow retinal detachment around the macular hole,especially around the scleral staphyloma was detected by OCT.During the 2nd surgery to remove the silicone oil,ILM peeling and C3 F8 tamponade were performed.Results The average refraction diopter was (- 12.6 ± 1.86)D,the average ocular axial length (29.82±0.993)mm and the average disease duration was (5.20±1.24)months.All eyes had total retinal detachment of all four quadrants,choroid detachment and macular choroidal atrophy,and type ⅡCurtin posterior scleral staphyloma. After the second surgery, all had retina attached by fundus examination.OCT examination indicated that macular hole closure in 7 eye,macular hole attached and retinal attached in 8 eyes.Their BCVA improved after both the first and second surgery (P =0.000),the BCVA after second surgery was better than that after first surgery (P =0.038).Conclusions The clinical characteristic of our series of patients were as follows:long history,with choroidal detachment and type ⅡCurtin posterior scleral staphyloma.All 1 5 eyes showed retinal attached after secondary ILM peeling.The secondary ILM peeling and C3 F8 tamponade may improve the visual outcome and retinal reattachment rate.