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目的:观察玻璃体切割联合内界膜填塞手术治疗高度近视合并黄斑裂孔性视网膜脱离的效果。方法:对2013年1月—2014年12月在南京医科大学附属眼科医院接受治疗的45例(47眼)高度近视黄斑裂孔性视网膜脱离的患者进行回顾性分析。所有患者采用23G微创玻璃体切割手术,其中24眼行自体内界膜剥除并填塞手术(填塞组);23眼单纯内界膜剥除术(未填塞组)。术后随访6~12个月,观察手术前后视力、眼压、眼底照相、FFA、黄斑光学相干断层成像、网膜复位及黄斑裂孔闭合情况。结果:填塞组与未填塞组术前视力分别为(1.63±0.48)LogMAR和(1.65±0.48)LogMAR,术后6~12个月时患者的视力分别为(1.00±0.12)LogMAR和(1.04±0.07)LogMAR,两组间差异无统计学意义(P>0.05),两组术前术后差异有统计学意义(P<0.001);填塞组黄斑裂孔闭合率为91.6%(22/24),未填塞组黄斑裂孔闭合率为65.2%(15/23),两组间差异有统计学意义(P<0.05);填塞组网膜均复位,无视网膜脱落复发,未填塞组视网膜脱落复发率为8.6%(2/23)。结论:玻璃体切割联合内界膜填塞手术,从解剖上封闭黄斑裂孔,是一种安全有效的治疗高度近视合并黄斑裂孔性视网膜脱离的方法。
Objective: To observe the effect of vitrectomy combined with internal limiting membrane sealing in the treatment of retinal detachment with high myopia and macular hole. Methods: A retrospective analysis was performed on 45 patients (47 eyes) with high myopic macular hole retinal detachment admitted to Affiliated Eye Hospital of Nanjing Medical University from January 2013 to December 2014. All patients underwent 23G minimally invasive vitrectomy. Twenty-four eyes underwent autologous endarterectomy and tamponade. Twenty-three eyes underwent simple endarterectomy (un-tamponade). The patients were followed up for 6 to 12 months. Visual acuity, intraocular pressure, fundus photography, FFA, macular coherence tomography, retinal reattachment and macular hole closure were observed before and after operation. Results: The preoperative visual acuity was (1.63 ± 0.48) LogMAR and (1.65 ± 0.48) LogMAR, respectively. The visual acuity of the patients at 6-12 months after operation was (1.00 ± 0.12) LogMAR and (1.04 ± 0.07) LogMAR, there was no significant difference between the two groups (P> 0.05). There was significant difference between preoperative and postoperative groups (P <0.001). The occlusion rate of macular hole was 91.6% (22/24) The occlusion rate of unaffected macular hole was 65.2% (15/23), there was significant difference between the two groups (P <0.05). The occluder membrane was reset without retinal detachment recurrence, and the recurrence rate of retinal detachment was 8.6% (2/23). CONCLUSION: Vitrectomy combined with internal limiting membrane sealing surgery is an effective and safe method for the treatment of macular hole and retinal detachment due to its close anatomy of the macular hole.