高度近视黄斑裂孔性视网膜脱离中内界膜剥除联合和不联合内界膜瓣翻转对视力结果的比较

Comparison of Internal Limiting Membrane Peeling and Flap Removal to Flap Insertion on Visual Outcomes in Highly Myopic Eyes with Macular-Hole Retinal Detachment.

机构信息

Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan.

Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan,

出版信息

Ophthalmologica. 2021;244(2):110-117. doi: 10.1159/000510150. Epub 2020 Jul 15.

DOI:10.1159/000510150

PMID:32668435

Abstract

INTRODUCTION

To compare the morphological and visual outcomes after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and flap removal to that with flap insertion in eyes with myopic macular-hole retinal detachment (MHRD).

METHODS

Forty-six eyes of 45 patients with MHRD were studied. Eighteen eyes were treated by PPV with ILM peeling and flap removal and 28 eyes by flap insertion, respectively. The baseline characteristics and postoperative findings were compared between the 2 groups.

RESULTS

The average age of the cases was 70.0 ± 8.5 years. The best-corrected visual acuity (BCVA) improved, from 1.51 ± 0.14 to 1.31 ± 0.20 logMAR units in the flap removal group, and from 1.20 ± 0.10 to 0.88 ± 0.10 logMAR units in the flap insertion group (p = 0.049). A significantly larger number of MHs were closed in the flap insertion group (96 vs. 50% in the removed group; p < 0.001). Restoration of the ellipsoid zone (EZ) and external limiting membrane (ELM) was also better in the flap insertion group than in the flap removal group (EZ 14 vs. 6%, p = 0.003; ELM 36 vs. 6%, p < 0.001).

DISCUSSION

The technique of ILM peeling with flap insertion is more effective in closing the MH, and results in better BCVA and better restoration of the outer retinal microstructures than flap removal.

摘要

简介

比较经平坦部玻璃体切除术（PPV）联合内界膜（ILM）剥除和瓣层撕除与PPV 联合瓣层插入治疗近视性黄斑裂孔视网膜脱离（MHRD）的形态和视觉结果。

方法

研究了 45 例 46 眼 MHRD 患者。18 眼接受 PPV 联合 ILM 剥除和瓣层撕除治疗，28 眼接受瓣层插入治疗。比较两组患者的基线特征和术后发现。

结果

病例的平均年龄为 70.0±8.5 岁。在瓣层撕除组，最佳矫正视力（BCVA）从 1.51±0.14 提高至 1.31±0.20 logMAR 单位，在瓣层插入组从 1.20±0.10 提高至 0.88±0.10 logMAR 单位（p=0.049）。瓣层插入组有更多的 MH 闭合（96%比去除组的 50%；p<0.001）。在瓣层插入组，外核层（EZ）和外界膜（ELM）的恢复也优于瓣层撕除组（EZ 14%比 6%，p=0.003；ELM 36%比 6%，p<0.001）。