玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂患者的临床研究
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摘要
目的观察玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂的临床效果。方法选择2016年1月至2017年5月在我院诊断为高度近视黄斑劈裂者23例(30眼),所有患者均行23G玻璃体切割术,吲哚菁绿染色后剥除黄斑区内界膜2～3 PD。术后随访6个月,比较术前与术后最佳矫正视力、眼轴长度、黄斑区视网膜劈裂的最高值(MxFT)、b波振幅及黄斑区最小及最大视网膜厚度,评估手术效果。结果 23例(30眼)均顺利完成手术。术后6个月,30眼最佳矫正视力均较术前明显提高,差异具有统计学意义(P=0.006)。术后6个月患眼眼轴长度明显短于术前,差异有统计学意义(P=0.033)。与术前MxFT相比,术后6个月MxFT明显降低,差异具有统计学意义(P=0.001),其中6眼(20.0%)基本恢复正常。术后6个月患眼b波振幅高于术前,差异具有统计学意义(P=0.040),其中24眼(80.0%)较术前显著提高,三维地形图中央峰逐步恢复,位于旁中心凹区域的不规则低反应区变少或消失。与术前相比,术后6个月黄斑中心区最小、最大视网膜厚度均明显减小(均为P<0.05)。末次随访时,VFQ-25评分高于术前,差异具有统计学意义(P=0.021)。结论玻璃体切割联合内界膜剥除术可显著提高高度近视黄斑劈裂患者视力及改善视物变形。
Objective To observe the clinical effect of vitrectomy combined with internal boundary membrane dissection for high degree of nearsighted macular cleavage.Methods From January 2016 to May 2017,23 patients(30 eyes) diagnosed as high degree of nearsighted macular cleavage in our hospital were selected.All patients underwent 23 G vitrectomy,and the inner boundary membrane 2-3 PD in the yellow spot area was removed after indocyanine green staining.A total of 6 months of follow-up was conducted,and the best preoperative and postoperative visual correction,axial length,maximum foveal thickness(MxFT),b-wave amplitude,minimum and maximum thickness of visual mesh in the macular area were compared,as well as the surgical effects were evaluated.Results All the 23 patients(30 eyes) were successfully operated.At 6 months after surgery,the best orthopaedic power of 30 eyes was significantly higher than that before surgery,with statistically significant difference(P=0.006).Six months after surgery,the axial length of the affected eye was significantly lower than that before surgery,and the difference was statistically significant(P=0.033).Compared with preoperative MxFT,MxFT was significantly decreased 6 months after surgery,with statistically significant difference(P=0.001),and six of them(20.0%) returned to normal.B wave amplitude of the affected eye was higher 6 months after surgery than before surgery,and the difference was statistically significant(P=0.040),and 24 eyes of them(80.0%) were significantly higher than those before operation.The central peak was recovered step by step in the three-dimensional topography.The irregular low reaction area located in the paracentric concave area became less or disappeared.Compared with before the operation,the minimum and maximum thickness of visual mesh in the macular area were all significantly decreased at the 6 months after the operation(both P<0.005).At the end of follow-up,the VFQ-25 score was higher than that before operation,and the difference was statistically significant(P=0.021).Conclusion Vitreous excision combined with internal boundary membrane stripping can significantly improve the visual acuity and improve the shape of vision in patients with high degree of nearsighted macular cleavage.
Objective To observe the clinical effect of vitrectomy combined with internal boundary membrane dissection for high degree of nearsighted macular cleavage.Methods From January 2016 to May 2017,23 patients(30 eyes) diagnosed as high degree of nearsighted macular cleavage in our hospital were selected.All patients underwent 23 G vitrectomy,and the inner boundary membrane 2-3 PD in the yellow spot area was removed after indocyanine green staining.A total of 6 months of follow-up was conducted,and the best preoperative and postoperative visual correction,axial length,maximum foveal thickness(MxFT),b-wave amplitude,minimum and maximum thickness of visual mesh in the macular area were compared,as well as the surgical effects were evaluated.Results All the 23 patients(30 eyes) were successfully operated.At 6 months after surgery,the best orthopaedic power of 30 eyes was significantly higher than that before surgery,with statistically significant difference(P=0.006).Six months after surgery,the axial length of the affected eye was significantly lower than that before surgery,and the difference was statistically significant(P=0.033).Compared with preoperative MxFT,MxFT was significantly decreased 6 months after surgery,with statistically significant difference(P=0.001),and six of them(20.0%) returned to normal.B wave amplitude of the affected eye was higher 6 months after surgery than before surgery,and the difference was statistically significant(P=0.040),and 24 eyes of them(80.0%) were significantly higher than those before operation.The central peak was recovered step by step in the three-dimensional topography.The irregular low reaction area located in the paracentric concave area became less or disappeared.Compared with before the operation,the minimum and maximum thickness of visual mesh in the macular area were all significantly decreased at the 6 months after the operation(both P<0.005).At the end of follow-up,the VFQ-25 score was higher than that before operation,and the difference was statistically significant(P=0.021).Conclusion Vitreous excision combined with internal boundary membrane stripping can significantly improve the visual acuity and improve the shape of vision in patients with high degree of nearsighted macular cleavage.
引文
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[3] GAUCHER D,HAOUCHINE B,TADAYONI R,PASCALE M,ALI E,NATHANAEL B,et al.Long-term follow-up of high myopic foveoschisis:Natural course and surgical outcome[J].Am J Ophthalmol,2007,143(3):4620.
[4] SHIMADA N,OHNO-MATSUI K,BABA T,SOH,F,TAKASHI T,MANABU M,et al.Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment[J].Am J Ophthalmol,2006,142(3):500.
[5] KWOK A K,LAI T Y,YIP W K.Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis[J].Br J Ophthalmol,2005,89(9):1180-1183.
[6] HUANG D,SWANSON E A,LIN C P,SCHUMAN J S,STINSON W G,CHANG W,et al.Optical coherence tomography[J].Science,1991,254(5035):1178-1181.
[7] LIANG H,CREWTHER D P,CREWTHER S G,BARILA A M.A role for photoreceptor outer segments in the induction of deprivation myopia[J].Vis Res,1995,35(9):1225.
[8] CHENG X,XU L,LI L Q,CHEN C X.The morphological changes in form-deprived chickens’retinas[J].Ophthalmol CHN,2000,9(2):108-110.程序,徐亮,李辽青,陈长喜.鸡形觉剥夺性近视眼视网膜光镜下形态改变[J].眼科,2000,9(2):108-110.
[9] WEI Y T,LING Y L,HUANG X G,ZHANG Z T,MA H Z,ZHANG T,et al.Microinvasive vitrectomy combined with internal limiting membrane stripping for macular structure and function after high myopia macular splitting[J].Chin J Ocul Fundus Dis,2013,29(2):193-195.魏雁涛,凌运兰,黄雄高,张钊填,马海智,张婷,等.微创玻璃体切割联合内界膜剥除治疗高度近视黄斑劈裂手术后黄斑结构与功能研究[J].中华眼底病杂志,2013,29(2):193-195.
[10] IKUNO Y,SAYANAGI K,SOGA K,YUSUKE O,MASAHITO O,YASUO T Y,et al.Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis[J].Jpn J Ophthalmol,2008,52(4):269-276..
[11] IKUNO Y,GOMI F,TANO Y.Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J].Am J Ophthalmol,2005,139(3):462-467.
[12] HIDEO K,KISHI S.Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis[J].Ophthalmology,2003,110(9):1702-1707.
[13] BROOKS H L.Macular hole surgery with and without internal limiting membrane peeling[J].Ophthalmology,2000,107(10):1939-1948.
[14] ZHU Z,JI X,ZHANG J.Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients[J].Clin Exp Ophthalmol,2010,37(7):660-663.
[2] TAKAAO M,KISHI S,TAKANO M,KISHI S.Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J].Am J Ophthalmol,1999,128(4):472-476.
[3] GAUCHER D,HAOUCHINE B,TADAYONI R,PASCALE M,ALI E,NATHANAEL B,et al.Long-term follow-up of high myopic foveoschisis:Natural course and surgical outcome[J].Am J Ophthalmol,2007,143(3):4620.
[4] SHIMADA N,OHNO-MATSUI K,BABA T,SOH,F,TAKASHI T,MANABU M,et al.Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment[J].Am J Ophthalmol,2006,142(3):500.
[5] KWOK A K,LAI T Y,YIP W K.Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis[J].Br J Ophthalmol,2005,89(9):1180-1183.
[6] HUANG D,SWANSON E A,LIN C P,SCHUMAN J S,STINSON W G,CHANG W,et al.Optical coherence tomography[J].Science,1991,254(5035):1178-1181.
[7] LIANG H,CREWTHER D P,CREWTHER S G,BARILA A M.A role for photoreceptor outer segments in the induction of deprivation myopia[J].Vis Res,1995,35(9):1225.
[8] CHENG X,XU L,LI L Q,CHEN C X.The morphological changes in form-deprived chickens’retinas[J].Ophthalmol CHN,2000,9(2):108-110.程序,徐亮,李辽青,陈长喜.鸡形觉剥夺性近视眼视网膜光镜下形态改变[J].眼科,2000,9(2):108-110.
[9] WEI Y T,LING Y L,HUANG X G,ZHANG Z T,MA H Z,ZHANG T,et al.Microinvasive vitrectomy combined with internal limiting membrane stripping for macular structure and function after high myopia macular splitting[J].Chin J Ocul Fundus Dis,2013,29(2):193-195.魏雁涛,凌运兰,黄雄高,张钊填,马海智,张婷,等.微创玻璃体切割联合内界膜剥除治疗高度近视黄斑劈裂手术后黄斑结构与功能研究[J].中华眼底病杂志,2013,29(2):193-195.
[10] IKUNO Y,SAYANAGI K,SOGA K,YUSUKE O,MASAHITO O,YASUO T Y,et al.Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis[J].Jpn J Ophthalmol,2008,52(4):269-276..
[11] IKUNO Y,GOMI F,TANO Y.Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J].Am J Ophthalmol,2005,139(3):462-467.
[12] HIDEO K,KISHI S.Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis[J].Ophthalmology,2003,110(9):1702-1707.
[13] BROOKS H L.Macular hole surgery with and without internal limiting membrane peeling[J].Ophthalmology,2000,107(10):1939-1948.
[14] ZHU Z,JI X,ZHANG J.Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients[J].Clin Exp Ophthalmol,2010,37(7):660-663.