Department of Ophthalmology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, 200031, Shanghai, China.
Key NHC Key Laboratory of Mopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, 200031, Shanghai, China.
Eye (Lond). 2019 Sep;33(9):1423-1432. doi: 10.1038/s41433-019-0416-0. Epub 2019 Apr 5.
To evaluate the long-term effect of cataract surgery on highly myopic patients with myopic traction maculopathy (MTM) and the risk factors associated with MTM progression.
Highly myopic patients with cataract and MTM were included. Phacoemulsification surgery was performed on patients who had vision loss below 20/63 and were willing to operation. Exclusion criteria included full thickness macular hole, foveal/retinal detachment, history of vitreoretinal surgery, myopic choroidal neovascularization, macular chorioretinal atrophy, peripheral lattice degeneration, incomplete follow up, or intraoperative complications. All patients underwent a complete ophthalmological examination. Optical coherence tomography examinations and microperimetry examinations were performed.
A total of 229 patients (mean age: 57 ± 6 years) were recruited, including 179 operated patients and 50 unoperated patients. Both the best corrected visual acuity (BCVA) and macular sensitivity (MS) were significantly improved after cataract surgeries throughout the follow-up period (p = 0.000). No difference was found in the proportion of MTM staging and in the rate of resolving/stable or progressive MTM (p = 0.757) between the operated and the unoperated groups. Of all patients, those with S2 to S4 MTM at baseline had significantly higher risk of progressive MTM (p < 0.001). Patients with absence of posterior vitreous detachment or with longer axial length at baseline had higher risks of progressive MTM.
Cataract surgery generally improves the BCVA and MS of highly myopic patients with MTM. Preoperative vitreoretinal adhesion, longer axial length, and S2 to S4 MTM are risk factors for progressive MTM. A long-term follow-up on the development of MTM is recommended.
评估白内障手术对伴有近视牵引性黄斑病变（MTM）的高度近视患者的长期效果，以及与 MTM 进展相关的危险因素。
纳入白内障合并 MTM 的高度近视患者。对视力低于 20/63 且愿意手术的患者行超声乳化白内障吸除术。排除标准包括全层黄斑裂孔、黄斑/视网膜脱离、玻璃体视网膜手术史、近视脉络膜新生血管、黄斑脉络膜萎缩、周边格子样变性、随访不完整或术中并发症。所有患者均接受全面眼科检查，行光学相干断层扫描和微视野检查。
共纳入 229 例患者（平均年龄 57±6 岁），其中 179 例行手术治疗，50 例未手术。在整个随访期间，白内障手术后最佳矫正视力（BCVA）和黄斑敏感性（MS）均显著提高（p=0.000）。手术组和未手术组之间，MTM 分期比例和 MTM 缓解/稳定或进展率无差异（p=0.757）。所有患者中，基线 S2 至 S4 MTM 的患者发生进展性 MTM 的风险显著增加（p<0.001）。基线时无后玻璃体脱离或眼轴较长的患者发生进展性 MTM 的风险较高。
白内障手术通常可改善伴有 MTM 的高度近视患者的 BCVA 和 MS。术前玻璃体视网膜粘连、较长的眼轴和 S2 至 S4 MTM 是 MTM 进展的危险因素。建议对 MTM 的进展进行长期随访。
