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。
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.
作者
刘桂阳
田蕊
张璐
田敏
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)
出处
《眼科新进展》
CAS
北大核心
2021年第7期655-659,共5页
Recent Advances in Ophthalmology
