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微切口玻璃体切割术治疗近视性黄斑劈裂。

Microincision vitrectomy surgery for myopic foveoschisis.

机构信息

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

Br J Ophthalmol. 2013 Jul;97(7):879-84. doi: 10.1136/bjophthalmol-2012-302906. Epub 2013 Apr 20.

Abstract

OBJECTIVE

To evaluate the technical feasibility and surgical outcome of microincision vitrectomy surgery (MIVS) in patients with myopic foveoschisis (MF).

METHODS

In total, 33 eyes of 29 patients who underwent surgical intervention due to MF were included. The patients were diagnosed with MF by spectral-domain optical coherence tomography (SD-OCT) and followed up for 6 months after MIVS that included internal limiting membrane (ILM) peeling with or without intraocular gas tamponade. To identify factors affecting visual outcome, the best-corrected visual acuity, axial length, and SD-OCT findings were analysed.

RESULTS

After surgery, the mean BCVA improved from 1.01 ± 0.46 logMAR to 0.76 ± 0.64 logMAR (p=0.004). Central subfield thickness in SD-OCT decreased from 431 ± 256 μm to 231 ± 72 μm after surgery (p<0.001). SD-OCT showed complete resolution of MF with complete foveal reattachment in 96% of patients (27/28). The accompanying macular hole was successfully closed in all four cases. Hypotony <6 mm Hg was seen in one eye only. At the end of surgery, eight of 24 eyes (33.3%) undergoing 25-gauge MIVS and four of nine eyes (44.4%) undergoing 23-gauge MIVS required sutures to close at least one sclerotomy site. Postoperative development of a macular hole was seen in one patient. It was successfully treated by reoperation using silicone oil tamponade.

CONCLUSIONS

MIVS with ILM peeling appeared to yield favourable visual and anatomical outcomes for MF in highly myopic eyes.

摘要

目的

评估微创玻璃体切割术(MIVS)治疗近视性黄斑劈裂(MF)的技术可行性和手术效果。

方法

共纳入 29 例 33 只眼因 MF 接受手术干预的患者。所有患者均通过频域光学相干断层扫描(SD-OCT)确诊为 MF,并在 MIVS 术后进行 6 个月的随访,包括内界膜(ILM)剥除,或不联合眼内气体填充。为了明确影响视力预后的因素,对最佳矫正视力、眼轴长度和 SD-OCT 检查结果进行了分析。

结果

术后,平均 BCVA 从 1.01 ± 0.46 logMAR 提高到 0.76 ± 0.64 logMAR(p=0.004)。SD-OCT 显示中央视网膜神经纤维层厚度从术前的 431 ± 256 μm 降至术后的 231 ± 72 μm(p<0.001)。96%(27/28)的患者 SD-OCT 显示 MF 完全缓解,且中心凹完全复位。所有 4 例合并的黄斑裂孔均成功闭合。仅有 1 只眼出现眼压<6mmHg。24 只眼行 25G MIVS 中有 8 只(33.3%)、9 只眼行 23G MIVS 中有 4 只(44.4%)至少有 1 个巩膜切口需要缝线关闭。术后 1 例发生黄斑孔,再次行硅油填充手术成功治疗。

结论

对于高度近视眼的 MF,MIVS 联合 ILM 剥除术可获得良好的视力和解剖学效果。

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