Instituto de Microcirugía Ocular, , Barcelona, Spain.
Br J Ophthalmol. 2014 Jan;98(1):104-9. doi: 10.1136/bjophthalmol-2013-304016. Epub 2013 Oct 29.
Macular hole (MH) with associated foveoschisis is very specific to highly myopic eyes with a pronounced posterior staphyloma. A high axial length increases the risk of foveoschisis, MH formation and retinal detachment secondary to a macular hole (MHRD). These highly myopic MH show poor surgical outcomes after vitrectomy and internal limiting membrane peeling compared with non-myopic MH. The posterior staphyloma seems to play an important role, and thus macular buckling could prove useful to improve both visual and anatomical results.
Sixteen highly myopic eyes with MH and associated foveoschisis that underwent macular buckling were studied. Vitrectomy combined with macular buckling was performed in all 16 eyes. Optical coherence tomography was performed to confirm MH closure in all cases.
Combined vitrectomy and macular buckling resulted in MH closure in all patients. Best-corrected visual acuity (BCVA) improved in 13 out of 16 eyes (81.25%), remained stable in 2 eyes (12.5%) and worsened in 1 eye (6.25%). Mean preoperative BCVA was 20/125, whereas mean postoperative BCVA was 20/50.
Combined vitrectomy and macular buckling is a safe and effective approach to achieve primary closure of MH in eyes with posterior staphyloma and associated foveoschisis. Eyes with a high axial length show a less favourable prognosis, which can be partially overcome by means of macular buckling.
伴有黄斑劈裂的黄斑裂孔（MH）在高度近视眼伴有明显后葡萄肿时非常特殊。眼轴长度增加会增加黄斑劈裂、MH 形成和孔源性视网膜脱离的风险。与非高度近视 MH 相比，这些高度近视 MH 在玻璃体切除和内界膜剥除后手术效果较差。后葡萄肿似乎起着重要作用，因此黄斑兜带术可能有助于改善视力和解剖结果。
研究了 16 例伴有 MH 和黄斑劈裂的高度近视眼，这些眼均行黄斑兜带术。所有 16 只眼均行玻璃体切除术联合黄斑兜带术。所有病例均行光学相干断层扫描以确认 MH 闭合。
所有患者均行联合玻璃体切除术和黄斑兜带术，MH 闭合。16 只眼中 13 只（81.25%）视力提高，2 只（12.5%）稳定，1 只（6.25%）恶化。术前最佳矫正视力（BCVA）为 20/125，术后平均 BCVA 为 20/50。
对于伴有后葡萄肿和黄斑劈裂的眼，联合玻璃体切除术和黄斑兜带术是实现 MH 初次闭合的安全有效方法。眼轴长度高的眼预后较差，但可以通过黄斑兜带术部分改善。
