摘要
目的分析并评估微创玻璃体切割术联合黄斑外垫压治疗高度近视伴有后巩膜葡萄膜肿的黄斑白孔性视网膜脱离的临床疗效。方法对2010年3月至2012年3月在南京医科大学附属眼科医院就诊的35例（35只眼），接受微创玻璃体切割术联合黄斑外垫压治疗的高度近视伴有后巩膜葡萄肿的黄斑白孔性视网膜脱离患者进行回顾性分析，术前矫正视力为手动与眼前～数指／眼前，眼压6～10mmHg，屈光状态-12-19Ds，所有患者均进行23G玻切及黄斑前膜／ILM剥除手术，同时采用硅胶海绵作为黄斑外垫压材料，在25G吊顶灯直视下进行黄斑外垫压手术，保证垫压部位在黄斑区巩膜外。患者于术后5-6个月行硅油取出术，并随访1年。术前术后进行眼底照相、OCT、B超、眼MRI等检查，观察术后视力、眼压、B超、视网膜复位以及黄斑裂孔闭合情况。结果术后6～12个月时患者矫正视力为0．05～0．1不等，眼压14—18mmHg，其中32例（91．4％）黄斑区视网膜均完全复位，黄斑裂孔均与视网膜色素上皮层贴合良好；另3例（8．57％）尽管裂孔贴附于视网膜色素上皮层，但其周围（以颞侧或下方为著）神经上皮层和视网膜色素上皮层间仍有间隙，但范围仅位于后巩膜葡萄肿内。所有患者在5~6个月后行玻切硅油取出联合C3F8注入术，其中1例硅油取出后视网膜脱离复发（占2．9％），再次行硅油注人，再次取油后视网膜脱离未复发。随访1年所有患者未再出现视网膜脱离。术后FFA检查所有患者视网膜动静脉充盈时间正常，MRI显示加压物位置良好，均位于黄斑区巩膜外肌锥内。结论微创玻璃体切割术联合直视下黄斑外垫压可以提高伴有巩膜后葡萄肿的黄斑白孔性视网膜脱离的手术复位，减少视网膜脱离复发率，增加了手术的有效性和安全性，是治疗高度近视伴有巩膜后葡萄肿的黄斑白孔性视网膜脱离的可行方法。
Objective To analyze and evaluate the effect and safety of minimally invasive vitrec- tomy （MIV） with ILM peeling and macular buckle treating macular white hole retinal detachment with posterior staphyloma. Methods A total of 35 highly myopic eyes with macular white hole reti- nal detachment and posterior staphyloma were retrospective investigated. Corrected visual acuity was HM-CF, intraocular pressure was 6-10 mmHg, refractive status was-12--19DS, and ocular axial length was 28-32 mm before surgery. All patients were treated with additional scleral buckle on the basis of MIV, ILM peeling and silicone oil tamponde. All patients underwent silicone-oil removal 5- 6 months after the initial surgery and were continuously followed for 1 year. Post-operation correct- ed VA, IOP, FFA, MRI and complication were observed. Results The corrected visual acuity after surgery was 0.05-0.15. Successful retinal reattachment was achieved in 32 eyes （91.4%）. The macu-lar holes of another 3 cases were attached to RPE, but there was still a few subretinal fluid around. Only one eye among them had recurrent retinal detachment after silicone oil removal, and the retina was reattached after silicone oil reinjection. Finally, no retina detachment occurred in all cases. The location of sclcral buckle was demonstrated in MRI. FFA showed that the time of retinal circulation was normal. Conclusions Minimally invasive vitrectomy （MIV） with ILM peeling and macular buckle can increase the rate of retinal reattachment of macular white hole retinal detachment with posterior staphyloma~ decrease the rate of recurrent retinal detachment and ensure the effect and safe- ty. It is believed a good method to treat retinal detachment caused by macular white hole in highly myopic eyes.
出处
《中国实用眼科杂志》
2015年第6期660-663,共4页
Chinese Journal of Practical Ophthalmology
基金
南京市医学科技发展重点项目（ZKX12047）
