Wu Z Q, Zhao X J, Chen S D, Lian P, Li J, Ma W, Deng X Y, Tang N N, Lyu J G, Liu B Q, Lyu L
Zhongshan Ophthalmic Centre, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou 510060, China.
Zhonghua Yan Ke Za Zhi. 2021 Jun 11;57(6):433-439. doi: 10.3760/cma.j.cn112142-20200910-00581.
To observe the efficacy of macular buckling in the treatment of highly myopic traction maculopathy. Retrospective case series study. The patients with high myopia who underwent macular buckling at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2014 to June 2019 were enrolled, including 136 males and 212 females. The age was (56.68±11.59) years old. The outcomes measured included retinal reattachment rate, foveoschisis recovery rate, macular hole closure rate, postoperative best corrected visual acuity (BCVA), axial length (AL), and complications. The measurements were recorded preoperatively and at 1 month, 6 months, 1 year, 2 years, and 3 years postoperatively. The data was statistically analyzed using paired test. A total of 378 eyes were included, including 216 eyes with foveoschisis and macular detachment and 162 eyes with macular holes and macular detachment. Among them, 296 eyes underwent macular buckling, and the other 82 eyes underwent macular buckling combined with pars plana vitrectomy. During the follow-up period, 373 eyes (98.68%) achieved retinal reattachment; in patients with foveoschisis, 204 eyes (94.44%) were recovered; in patients with macular holes, 89 eyes (54.09%) achieved closure. All the postoperative results of BCVA were better than the preoperative value (1.459±0.841). BCVA continued to increase from postoperative month 1, remained stable at 1 year, and reached 0.908±0.606 at 3 years (=6.896, <0.01). All the postoperative results of AL were shorter than the preoperative value. The AL shortened by (4.423±1.740)mm at one month (=33.144, <0.01), increased gradually thereafter, remained stable at 1 year, and shortened by (2.101±1.643) mm at three years (=6.392, <0.01). The common complications included transient high intraocular pressure in 98 eyes (25.92%), epiretinal hemorrhage in 67 eyes (17.72%), and vitreous hemorrhage in 9 eyes (2.38%), which all resolved spontaneously within 1 month. In the early postoperative period, all patients had a certain degree of eye movement limitation, and 39 eyes (10.31%) had diplopia which resolved within 6 months without treatment. The strabismus surgery was arranged to treat esotropia in 6 eyes (1.58%). The macular buckle was removed from 1 eye (0.26%) because of the inability to tolerate diplopia. There were 8 eyes (2.11%) requiring a second operation to adjust the position of the buckle. The macular buckle was also removed from 4 eyes (1.05%) due to the implant rejection. Macular buckling can effectively shorten the AL, resolve posterior scleral staphyloma, and improve vision in the treatment of highly myopic traction maculopathy.
观察黄斑扣带术治疗高度近视性牵引性黄斑病变的疗效。回顾性病例系列研究。纳入2014年6月至2019年6月在中山大学中山眼科中心接受黄斑扣带术的高度近视患者，其中男性136例，女性212例。年龄为（56.68±11.59）岁。测量的结果包括视网膜复位率、黄斑劈裂恢复率、黄斑裂孔闭合率、术后最佳矫正视力（BCVA）、眼轴长度（AL）及并发症。术前及术后1个月、6个月、1年、2年和3年进行测量记录。采用配对检验对数据进行统计学分析。共纳入378只眼，其中黄斑劈裂合并黄斑脱离216只眼，黄斑裂孔合并黄斑脱离162只眼。其中296只眼行黄斑扣带术，另82只眼行黄斑扣带联合玻璃体切割术。随访期间，373只眼（98.68%）视网膜复位；黄斑劈裂患者中，204只眼（94.44%）恢复；黄斑裂孔患者中，89只眼（54.09%）闭合。所有患者术后BCVA均优于术前（1.459±0.841）。BCVA术后1个月开始持续提高，1年时稳定，3年时达到0.908±0.606（t=6.896，P<0.01）。所有患者术后AL均短于术前。术后1个月AL缩短（4.423±1.740）mm（t=33.144，P<0.01），此后逐渐增加，1年时稳定，3年时缩短（2.101±1.643）mm（t=6.392，P<0.01）。常见并发症包括98只眼（25.92%）出现短暂高眼压，67只眼（17.72%）出现视网膜前出血，9只眼（2.38%）出现玻璃体积血，均在1个月内自行消退。术后早期，所有患者均有一定程度的眼球运动受限，39只眼（10.31%）出现复视，未经治疗在6个月内消失。6只眼（1.58%）因内斜视接受斜视手术治疗。1只眼（0.26%）因无法耐受复视而取出黄斑扣带。8只眼（2.11%）需要二次手术调整扣带位置。4只眼（1.05%）因植入物排斥反应也取出了黄斑扣带。黄斑扣带术在治疗高度近视性牵引性黄斑病变时可有效缩短眼轴、消除后巩膜葡萄肿并提高视力。
