Ikuno Yasushi, Sayanagi Kaori, Oshima Tetsuro, Gomi Fumi, Kusaka Shunji, Kamei Motohiro, Ohji Masahito, Fujikado Takashi, Tano Yasuo
Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan.
Am J Ophthalmol. 2003 Sep;136(3):477-81. doi: 10.1016/s0002-9394(03)00269-1.
Macular holes cause retinal detachments in highly myopic eyes. Because degenerative macular changes often coexist, biomicroscopic evaluation of macular hole status after retinal reattachment is sometimes difficult. We studied macular holes with retinal detachment after vitrectomy using optical coherence tomography and evaluated the anatomic status of the hole and factors associated with anatomic success.
Retrospective, nonrandomized, comparative study.
Sixteen eyes that underwent vitrectomy for retinal detachment associated with a macular hole were included. Internal limiting membrane peeling with indocyanine green was performed in 14 eyes; the epiretinal membrane was peeled with a diamond-dusted membrane scraper alone in two eyes. All retinas reattached postoperatively. The follow-up period at the optical coherence tomography examination was at least 6 months.
Optical coherence tomography was performed vertically and horizontally, and the presence of a persistent macular hole was determined. Other information was obtained from patient records.
The macular holes closed in seven of 16 eyes (44%). Age, sex, axial length, preoperative best-corrected visual acuity, duration of symptoms, preoperative refractive error, and the preoperative area of the retinal detachment were not significantly correlated with hole closure. Improved postoperative best-corrected visual acuity (P <.05) was significantly associated with macular hole closure, and more frequent visual improvement (P =.06) was of borderline significance.
The success rate was lower than those obtained in eyes without myopia or in myopic macular holes without retinal detachments. Macular hole closure may predict improved visual outcome for patients with retinal detachment and macular holes. Optical coherence tomography detects persistent macular holes in highly myopic eyes with retinal detachment.
黄斑裂孔可导致高度近视眼发生视网膜脱离。由于退行性黄斑病变常同时存在，视网膜复位术后通过生物显微镜评估黄斑裂孔状态有时会很困难。我们使用光学相干断层扫描技术研究了玻璃体切除术后合并视网膜脱离的黄斑裂孔，并评估了裂孔的解剖学状态及与解剖学成功相关的因素。
回顾性、非随机、对照研究。
纳入16只因黄斑裂孔合并视网膜脱离而接受玻璃体切除术的眼睛。14只眼行吲哚菁绿辅助内界膜剥除术；2只眼仅用带金刚石粉的膜刮刀剥除视网膜前膜。所有视网膜术后均复位。光学相干断层扫描检查的随访期至少为6个月。
进行垂直和水平方向的光学相干断层扫描，确定是否存在持续性黄斑裂孔。其他信息从患者记录中获取。
16只眼中7只（44%）黄斑裂孔闭合。年龄、性别、眼轴长度、术前最佳矫正视力、症状持续时间、术前屈光不正以及术前视网膜脱离面积与裂孔闭合均无显著相关性。术后最佳矫正视力提高（P <.05）与黄斑裂孔闭合显著相关，视力改善更频繁（P =.06）具有临界显著性。
成功率低于无近视的眼睛或无视网膜脱离的近视性黄斑裂孔。黄斑裂孔闭合可能预示着视网膜脱离合并黄斑裂孔患者的视力预后改善。光学相干断层扫描可检测高度近视眼合并视网膜脱离时的持续性黄斑裂孔。
