Department of Ophthalmology, Nancy University Hospital, Nancy, France.
Department of Ophthalmology, Nancy University Hospital, Nancy, France.
Ophthalmology. 2014 Jun;121(6):1263-8. doi: 10.1016/j.ophtha.2013.12.005. Epub 2014 Jan 27.
To evaluate the outcomes of macular hole (MH) surgery with 3-day prone positioning in highly myopic eyes and to compare them with those from non-highly myopic eyes.
Retrospective nested case-control study from a cohort of 496 consecutive patients (496 eyes) who underwent surgery for MH.
Forty-seven highly myopic eyes (with axial length >26 mm) were included in the study group and were matched for MH size and duration of symptoms with 47 non-highly myopic control eyes selected from the same cohort.
All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and 17% hexafluoroethane gas filling. Patients then were advised to maintain strict face-down positioning for 3 days only and to avoid the supine position during the night for a minimum of 1 week.
The MH closure rate, the relationship between axial length and closure rate, the best-corrected visual acuity (BCVA), and the surgical complications were analyzed.
The mean axial length was 28.5±2.2 mm in highly myopic eyes and 23.3±1.1 mm in controls (P < 0.001). Closure of the MH was achieved in 39 of 47 eyes (83%) in the study group and in 45 of 47 eyes (95.7%) in the control group (P = 0.045). Anatomic outcomes tended to decrease when axial length increased (P = 0.066). Mean BCVA improved in both groups (0.41±0.39 logarithm of the minimal angle of resolution [logMAR] vs. 0.68±0.34 logMAR) but was significantly lower in highly myopic eyes (P < 0.001). Retinal detachment occurred in 8.5% of highly myopic patients versus 2.1% of controls, but the difference was not significant.
Macular hole surgery with 3-day postoperative positioning in highly myopic eyes resulted in satisfactory anatomic and functional outcomes. However, the MH closure rate and mean improvement of visual acuity were less favorable than those in control eyes. Longer axial length may increase the risk of anatomic failure.
评估 3 天俯卧位在高度近视眼中行黄斑裂孔（MH）手术的结果，并与非高度近视眼中的结果进行比较。
从 496 例连续患者（496 只眼）队列中进行的回顾性巢式病例对照研究。
研究组纳入 47 只高度近视眼（眼轴长度>26mm），并与同一队列中选择的 47 只非高度近视对照眼按 MH 大小和症状持续时间匹配。
所有患者均行标准经睫状体平坦部玻璃体切除术、内界膜剥除术和 17%六氟代乙烷气体填充。术后仅建议患者严格保持 3 天俯面朝下体位，并至少在 1 周内避免仰卧位。
分析 MH 闭合率、眼轴长度与闭合率的关系、最佳矫正视力（BCVA）和手术并发症。
高度近视眼中平均眼轴长度为 28.5±2.2mm，对照组为 23.3±1.1mm（P<0.001）。研究组 47 只眼中有 39 只（83%）、对照组 47 只眼中有 45 只（95.7%）的 MH 闭合（P=0.045）。当眼轴长度增加时，解剖学结果趋于下降（P=0.066）。两组 BCVA 均有所改善（0.41±0.39 最小角分辨率对数[logMAR] 与 0.68±0.34 logMAR），但高度近视眼明显较低（P<0.001）。高度近视患者视网膜脱离发生率为 8.5%，对照组为 2.1%，但差异无统计学意义。
3 天术后俯卧位治疗高度近视眼中的 MH 手术可获得满意的解剖学和功能结果。然而，MH 闭合率和平均视力改善均不如对照组。较长的眼轴可能增加解剖学失败的风险。
