高度近视黄斑裂孔视网膜脱离应用黄斑塞治疗的三年疗效观察。

Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three-year results.

机构信息

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Department of Ophthalmology, Mackay Memorial Hospital, Hsinchu, Taiwan.

出版信息

Acta Ophthalmol. 2020 Nov;98(7):e839-e847. doi: 10.1111/aos.14418. Epub 2020 Apr 3.

DOI:10.1111/aos.14418

PMID:32243725

Abstract

PURPOSE

To investigate the long-term surgical outcomes of macular hole retinal detachment (MHRD) following vitrectomy with macular plug in highly myopic eyes.

METHODS

Thirty-five cases of highly myopic eyes with MHRD in 35 patients who underwent an initially successful vitrectomy with macular plug and were followed up for at least 3 years were reviewed. The anatomical outcomes were evaluated by fundus examination, fundus photographs and optical coherence tomography (OCT). Myopic features after the surgery were differentiated according to recommendations of the Meta-analysis of Pathologic Myopia (META-PM) Study Group. The best-corrected visual acuities (BCVAs) before and after surgery were analysed as the functional outcome. Main outcome measures time-course changes in BCVA and complications.

RESULTS

The mean patient age was 61.0 ± 11.4 years. The follow-up was 45.2 ± 8.6 months (ranged from 36 to 71 months). The mean axial length was 29.3 ± 1.2 mm. All eyes demonstrated attached retina, but 2 eyes (5.7%) developed reopened macular holes until the last follow-up. Complications of postoperative rhegmatogenous retinal detachment were detected in 2 eyes (5.7%) within 1 year and retina reattached after the secondary vitrectomy. Three cases (8.6%) of prolonged subretinal fluid lasting more than 1 year were detected but finally absorbed completely. Comparing 1-3 years postoperatively, myopic features showed significant progression of myopic maculopathy category (p = 0.035). Functionally, significantly improved BCVA could be maintained postoperatively between 6 months and 3 years. However, vision of 14 eyes (40.0%) worsened within 1-3 years postoperatively, and visual deterioration was associated with progression of myopic maculopathy (p = 0.004) and pre-existing disease of glaucoma (p = 0.006).

CONCLUSIONS

A vitrectomy combined with macular plug provided favourable outcomes in the long term, over the ≥3-year follow-up period.

摘要

目的

探讨玻璃体切除联合黄斑内界膜填塞治疗高度近视黄斑裂孔视网膜脱离（MHRD）的长期手术效果。

方法

回顾性分析 35 例（35 眼）高度近视黄斑裂孔视网膜脱离患者，初次手术均成功行玻璃体切除联合黄斑内界膜填塞，随访时间至少 3 年。通过眼底检查、眼底照相和光学相干断层扫描（OCT）评估解剖学结果。根据病理性近视 Meta 分析（META-PM）研究组的建议，对术后近视特征进行分类。分析术前和术后最佳矫正视力（BCVA）作为功能结果。主要观察指标为 BCVA 随时间的变化和并发症。

结果

患者平均年龄为 61.0±11.4 岁。随访时间为 45.2±8.6 个月（36-71 个月）。平均眼轴长度为 29.3±1.2mm。所有患眼视网膜均贴附，但在最后一次随访时，2 只眼（5.7%）出现黄斑裂孔再开放。术后 1 年内发现 2 只眼（5.7%）并发孔源性视网膜脱离，经二次玻璃体切除后视网膜复位。3 例（8.6%）发生超过 1 年的持续性视网膜下积液，但最终完全吸收。与术后 1-3 年相比，近视性黄斑病变的近视特征明显加重（p=0.035）。术后 6 个月至 3 年，BCVA 持续显著提高。然而，术后 1-3 年内，14 只眼（40.0%）视力下降，视力恶化与近视性黄斑病变的进展（p=0.004）和青光眼的原有疾病（p=0.006）有关。