[1]刘桂阳,田蕊,张璐,等.玻璃体切割联合内界膜剥离术治疗高度近视黄斑裂孔性视网膜脱离[J].眼科新进展,2021,41(7):655-659.[doi:10.13389/j.cnki.rao.2021.0135]
　LIU Guiyang,TIAN Rui,ZHANG Lu,et al.Vitrectomy combined with internal limiting membrane peeling in the treatment of macular hole retinal detachment in high myopic eyes[J].Recent Advances in Ophthalmology,2021,41(7):655-659.[doi:10.13389/j.cnki.rao.2021.0135]
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玻璃体切割联合内界膜剥离术治疗高度近视黄斑裂孔性视网膜脱离/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
41卷
期数:
2021年7期
页码:
655-659
栏目:
应用研究
出版日期:
2021-07-05

文章信息/Info

Title:
Vitrectomy combined with internal limiting membrane peeling in the treatment of macular hole retinal detachment in high myopic eyes
作者:
刘桂阳; 田蕊; 张璐; 田敏
710032　陕西省西安市，中国人民解放军空军军医大学第一附属医院眼科
Author(s):
LIU Guiyang; TIAN Rui; ZHANG Lu; TIAN Min
Department of Ophthalmology,the First Affiliated Hospital of Air Force Military Medical University,Chinese People’s Liberation Army,Xi’an 710032,Shaanxi Province,China
关键词:
高度近视; 黄斑裂孔性视网膜脱离; 玻璃体切割术; 内界膜剥离术; 视功能
Keywords:
high myopia;  macular hole retinal detachment;  vitrectomy;  internal limiting membrane peeling;  visual function
分类号:
R778.1
DOI:
10.13389/j.cnki.rao.2021.0135
文献标志码:
A
摘要:
目的　探讨玻璃体切割联合内界膜剥离术治疗高度近视黄斑裂孔性视网膜脱离（MHRD）的效果。方法　选取2017年2月至2019年2月中国人民解放军空军军医大学第一附属医院眼科收治的180例（180眼）高度近视MHRD患者作为研究对象，采用随机数字表法分为观察组（92例）及对照组（88例），两组患者均常规行三切口玻璃体切割术，观察组患者联合行内界膜剥离术，对照组患者不行内界膜剥离术。观察两组患者治疗后裂孔闭合及视网膜复位情况，进行视力及视功能检查明确视力改变，统计两组患者术后并发症发生情况。结果　观察组及对照组患者裂孔闭合率分别为71.43%、65.91%，差异有统计学意义（P<0.05），视网膜复位率分别为95.65%、90.91%，差异无统计学意义（P>0.05）。观察组及对照组患者术后视力分别为（39.26±3.45）个字母、（38.17±2.96）个字母，均较术前显著提高（均为P<0.05），组间差异无统计学意义（P>0.05）。两组患者术后黄斑区平均光敏感度显著升高，观察组低于对照组（P<0.05）；两组患者固视情况差异无统计学意义（P>0.05）。两组患者多焦视网膜电图（mfERG）一阶函数1环［观察组（110.12±20.63）nV·deg-2、对照组（134.15±25.96）nV·deg-2］及2环P1波反应密度［观察组（70.14±11.96）nV·deg-2、对照组（66.96±12.71）nV·deg-2］较术前［1环P1波反应密度：观察组（55.74±11.41）nV·deg-2、对照组（56.01±10.28）nV·deg-2;2环P1波反应密度：观察组（47.14±10.27）nV·deg-2、对照组（49.22±9.63）nV·deg-2］均明显增加（均为P<0.05），观察组患者术后1环P1波反应密度低于对照组（P<0.05）。两组患者术后并发症发生情况差异无统计学意义（P>0.05）。结论　与单纯玻璃体切割术相比，玻璃体切割联合内界膜剥离术可促进高度近视MHRD患者术后黄斑裂孔的愈合，但也可对微视野及视网膜功能造成一定影响。
Abstract:
Objective　To explore the effects of vitrectomy combined with internal limiting membrane peelingin the treatment of macular hole retinal detachment (MHRD) in high myopic eyes.Methods　Totally 180 patients (180 eyes) with high myopia and MHRD who were admitted to the Department of Ophthalmology at the First Affiliated Hospital of PLA Air Force Military Medical University were selected as the research subjects between February 2017 and February 2019. The patients enrolled were divided into observation group (92 patients) and control group (88 patients) by random number table method. All patients underwent conventional three-incision vitrectomy, and patients in the observation group were additionally treated with internal limiting membrane peeling. The situation of macular hole closure and retinal reattachment was observed, and visual acuity as well as visual function was tested. The incidence of postoperative complications was counted.Results　The macular hole closure rate was 71.43% in the observation group and 65.91% in the control group, respectively, with statistically significance (P<0.05), and retinal reattachment rates were 95.65% and 90.91%, respectively, but no statistically significance (P>0.05). The postoperative visual acuity of the observation group and the control group was (39.26±3.45) letters and (38.17±2.96) letters, respectively, which was significantly higher compared to pre-operation (both P<0.05), but there was no significant difference between the observation group and the control group (P>0.05). The mean light sensitivity in macular area was significantly increased in the two groups, and the observation group had lower mean light sensitivity than the control group (P<0.05). There was no statistically significant difference in fixation between the two groups (P>0.05). After operation, the response density of the first ring of P1 wave in the first order kernel in multifocal electroretinogram (mfERG) was (110.12±20.63) nV·deg-2 for the observation group and (134.15±25.96) nV·deg-2 for the control group, and the response density of the second ring of P1 wave was (70.14±11.96) nV·deg-2 for the observation group and (66.96±12.71) nV·deg-2 for the control group, all of which were significantly higher compared to pre-operation ［the response density of the first ring of P1 wave:(55.74±11.41) nV·deg-2 for the observation group and (56.01±10.28) nV·deg-2 for the control group, the response density of the second ring of P1 wave:(47.14±10.27) nV·deg-2 for the observation group and (49.22±9.63) nV·deg-2 for the control group］ (all P<0.05). It was found that the response density of the first ring of P1 wave was lower in the observation group than in the control group (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups (P>0.05).Conclusion　Compared with simple vitrectomy, vitrectomy combined with internal limiting membrane peeling can promote macular hole healing in patients with high myopia and MHRD, but it has certain influence on micro field and retinal function.

参考文献/References:

［1］　CHEN Y C,YANG C M,CHEN S N .Lens capsular flap in the management of posterior retinal hole associated retinal detachment in high myopic eyes with previous internal limiting membrane peeling:3 case reports［J］.Medicine,2019,98(29):e16422.
［2］　LIU B Q,CHEN S D,LI Y H,LIAN P,ZHAO X J,YU X L,et al.Comparison of macular buckling and vitrectomy for the treatment of macular schisis and associated macular detachment in high myopia:a randomized clinical trial［J］.Acta Ophthalmol,2020,98(3):e266-e272.
［3］　LAVIERS H,LI J P O,GRABOWSKA A,CHARLES S J,CHARTERIS D,HAYNES R J,et al.The management of macular hole retinal detachment and macular retinoschisis in pathological myopia:a UK collaborative study［J］.Eye,2018,32(11):1743-1751.
［4］　CHEN S N,YANG C M .Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia［J］.Am J Ophthalmol,2016,16(2):99-106.
［5］　YE J,WU Y,ZHU S Q,DONG L,QU J,LU F,et al.Evaluation of the efficacy of posterior scleral contraction in the treatment of macular hole with retinal detachment in high myopia macular surgery on sclera［J］.Retina,2021,［Online ahead of print］.
［6］　陈璇,吴昌龙.高度近视黄斑裂孔患眼脉络膜厚度观察［J］.中华眼底病杂志,2019,35(5):494-495.
CHEN X,WU C L.Observation of choroidal thickness in eyes with macular hole in high myopia［J］.Chin J Ocul Fundus Dis,2019,35(5):494-495.
［7］　PENG K L,KUNG Y H,HSU C M,CHANG S P,TSENG P L,WU T T.Surgical outcomes of centripetal non-fovea-sparing internal limiting membrane peeling for myopic foveoschisis with and without foveal detachment:a follow-up of at least 3 years［J］.Br J Ophthalmol,2020,104(9):1266-1270.
［8］　CHEN S N,HSIEH Y T,YANG C M .Multiple free internal limiting membrane flap insertion in the treatment of macular hole-associated retinal detachment in high myopia［J］.Ophthalmologica,2018,240(3):143-149.
［9］　OKONKWO O N,GYASI M E,HASSAN A O,ODERINLO O.Inverted internal limiting membrane technique maintains macular hole closure in retinal detachment following macular hole repair［J］.Middle East Afr J Ophthalmol,2018,25(3-4):167-169.
［10］　徐武平,徐学东,孙驰平.玻璃体切割联合内界膜填塞术治疗高度近视黄斑裂孔性视网膜脱离［J］.眼科新进展,2019,39(5):477-478.
XU W P,XU X D,SUN C P.Vitrectomy combined with internal limiting membrane tamponade for the treatment of high myopia macular hole retinal detachment［J］.Rec Adv Ophthalmol,2019,39(5):477-478.
［11］　MATSUMAE H,MORIZANE Y,YAMANE S,YANAGISAWA S,SAKURAI T,KOBORI A,et al.Inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia［J］.Ophthalmol Retina,2020,4(9):919-926.
［12］　张国明,高汝龙.关于增生性玻璃体视网膜病变命名和分类的看法［J］.临床眼科杂志,2004,12(4):378.
ZHANG G M,GAO R L.Views on the naming and classification of proliferative vitreoretinopathy［J］.J Clin Ophthalmol,2004,12(4):378.
［13］　CAPOROSSI T,DE ANGELIS L,PACINI B,TARTARO R,FINOCCHIO L,BARCA F,et al.A human amniotic membrane plug to manage high myopic macular hole associated with retinal detachment［J］.Acta Ophthalmol,2019,98(2):e252-e256.
［14］　XIN W,CAI X,XIAO Y,JI L B,GU Y X,LV W J,et al.Surgical treatment for type II macular hole retinal detachment in pathologic myopia［J］.Medicine,2020,99(17):e19531.
［15］　STEEL D H,DONACHIE P,AYLWARD G W,LAIDLAW D A,WILLIAMSON T H,YORSTON D,et al.Factors affecting anatomical and visual outcome after macular hole surgery:findings from a large prospective UK cohort［J］.Eye,2020,35(1):316-325.
［16］　刘玉燕,王莹,楚艳华.不同手术方式治疗特发性黄斑裂孔一年临床观察结果［J］.中华眼底病杂志,2019,35(6):571-575.
LIU Y Y,WANG Y,CHU Y H.One-year clinical observation results of different surgical methods for treatment of idiopathic macular hole［J］.Chin J Ocul Fundus Dis,2019,35(6):571-575.
［17］　CHEN L,MESSINGER J D,SLOAN K R,THOMAS A S,YOSHIMI S,LAWRENCE A Y,et al.Nonexudative macular neovascularization supporting outer retina in age-related macular degeneration:a clinic opathologic correlation［J］.Ophthalmology,2020,127(7):931-947.
［18］　TSUCHIYA S,HIGASHIDE T,UDAGAWA S,SUGIYAMA K .Glaucoma-related central visual field deterioration after vitrectomy for epiretinal membrane:topographic characteristics and risk factors［J］.Eye,2020,35(3):919-928.
［19］　TEPELUS T C,SONG S,NITTALA M G,NASSISI M,SADDA S R,CHOPRA V.Comparison and correlation of retinal sensitivity between microperimetry and standard automated perimetry in low-tension glaucoma［J］.J Glaucoma,2020,29(10):975-980.
［20］　SANTOS A R,RAIMUNDO M,ALVES D,LOPES M,PESTANA S,FIGUEIRA J,et al.Microperimetry and mfERG as functional measurements in diabetic macular oedema undergoing intravitreal ranibizumab treatment［J］.Eye,2021,35(5):1384-1392.
［21］　夏阳,蔺云霞,徐玲.无黄斑病变近视患者黄斑区视网膜结构与视功能改变的相关性［J］.眼科新进展,2020,40(5):457-460.
XIA Y,LIN Y X,XU L.The correlation between retinal structure and visual function changes in macular area in patients with myopia without macular degeneration［J］.Rec Adv Ophthalmol,2020,40(5):457-460.
［22］　QI Y,YAN P Y,FAN W Y,WANG N L,DUAN A L.Comparison of fovea-sparing and non-internal limiting membrane peeling for retinoschisis with foveal detachment in highly myopic eyes［J］.Eye,2021,35(5):1467-1472.
［23］　PARIENTE A,PELEZ R,PREZ-SALA A,LARRYOZ L M.Inflammatory and cell death mechanisms induced by 7-ketocholesterol in the retina.Implications for age-related macular degeneration［J］.Exp Eye Res,2019,187:107746.
［24］　KHANAL S,TURNBULL P R K,LEE N,PHILLIPS J R.The effect of atropine on human global flash mferg responses to retinal defocus［J］.Invest Ophthalmol Vis Sci,2019,60(1):218-225.
［25］　IMAMURA Y,ISHIDA M .Retinal thinning after internal limiting membrane peeling for idiopathic macular hole［J］.Jan J Ophthalmol,2018,62(2):158-162.

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更新日期/Last Update: 2021-07-05