Affiliated Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China.
Retina. 2011 Apr;31(4):692-701. doi: 10.1097/IAE.0b013e3181f84fc1.
The purpose of the study was to evaluate visual and anatomical outcomes in patients with myopic foveoschisis who underwent vitrectomy and internal limiting membrane (ILM) peeling with perfluoropropane (C3F8) tamponade or balanced saline solution in the vitreous cavity.
Retrospective comparison of a consecutive surgical series. Eighteen eyes of 17 patients scheduled for myopic foveoschisis surgery were recruited at the affiliated Eye Hospital of Wenzhou Medical College, Zhejiang, China. Pars plana vitrectomy and ILM peeling with indocyanine green staining were performed in all patients. Refractive lens exchange was simultaneously performed in 12 phakic eyes. Finally, the vitreous cavity was filled with balanced saline solution in seven eyes of seven patients (Group A). Fluid-air exchange was performed in another 11 eyes of 11 patients (Group B), followed by injection of 18% C3F8. Patients were evaluated using best-corrected visual acuity (BCVA) testing and optical coherence tomography scans.
All patients completed more than 6 months of follow-up. In two groups, preoperative factors were not significantly different. In Group B, the postoperative BCVA was significantly greater than the preoperative BCVA (t = 4.401, P = 0.001) but not significantly different in Group A (t = 1.970, P = 0.096). The BCVA change in Group B was significantly greater than Group A at the last visit (Z = 2.23, P = 0.025). In both groups, the BCVA change was significantly correlated with the preoperative BCVA, respectively. The BCVA was improved by 0.2 logarithm of the minimum angle of resolution or more in 10 eyes (91%) in Group B and 4 eyes (56%) in Group A. All eyes in both groups did not have decreases in the postoperative BCVA. In 3 months after vitrectomy, 6 eyes in Group A did not have anatomical resolutions. However, it was interesting to see that the height of retinoschisis at the central macular region gradually decreased until anatomical resolution was achieved. In Group B, all eyes had anatomical resolutions in 3 months after vitrectomy. None of the eyes developed macular hole during the surgery and the period of routine follow-up period.
Vitrectomy with ILM peeling does not increase the risk of iatrogenic macular hole formation. The poor elasticity of the ILM and the traction of membranous structure on the surface of the ILM play important roles in the development of myopic foveoschisis. In eyes undergoing vitrectomy and ILM peeling for myopic foveoschisis, C3F8 tamponade results in more rapid anatomical resolution and greater improvement in BCVA than balanced saline solution.
本研究旨在评估接受玻璃体切割术和内界膜（ILM）剥离术联合全氟丙烷（C3F8）或平衡盐溶液（BSS）眼内填充治疗的近视性黄斑劈裂患者的视力和解剖学结果。
回顾性连续手术系列比较。在中国浙江温州医科大学附属眼视光医院，招募了 17 名患者的 18 只眼进行近视性黄斑劈裂手术。所有患者均行玻璃体切割术和 ILM 剥离术，并使用吲哚菁绿染色。12 只眼同时行屈光晶状体置换术。最终，7 只眼（A 组）的玻璃体腔填充 BSS，7 只眼（B 组）行液-气交换，随后注射 18% C3F8。使用最佳矫正视力（BCVA）检查和光学相干断层扫描（OCT）评估患者。
所有患者均完成了 6 个月以上的随访。两组患者术前各项因素无显著差异。B 组术后 BCVA 显著高于术前（t = 4.401，P = 0.001），但 A 组无显著差异（t = 1.970，P = 0.096）。B 组末次随访时 BCVA 变化明显大于 A 组（Z = 2.23，P = 0.025）。两组患者的 BCVA 变化均与术前 BCVA 显著相关。B 组 10 只眼（91%）和 A 组 4 只眼（56%）的 BCVA 提高了 0.2 个最小分辨角对数或更多。两组患者术后 BCVA 均未下降。玻璃体切割术后 3 个月，A 组 6 只眼未达到解剖学复位。但有趣的是，中央黄斑区视网膜劈裂的高度逐渐降低，直至达到解剖学复位。B 组所有患者在玻璃体切割术后 3 个月均达到解剖学复位。手术和常规随访期间，无眼发生黄斑裂孔。
玻璃体切割术联合 ILM 剥离术不会增加医源性黄斑裂孔形成的风险。ILM 的弹性差和 ILM 表面膜结构的牵引在近视性黄斑劈裂的发生发展中起重要作用。对于接受玻璃体切割术和 ILM 剥离术治疗的近视性黄斑劈裂患者，C3F8 眼内填充导致更快的解剖学复位和更好的 BCVA 改善，优于 BSS。
