From the Wills Eye Hospital (T.W., Y.Y.), Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan; Casey Eye Institute (K.T.), Oregon Health & Science University, Portland, Oregon, USA.
Am J Ophthalmol. 2023 Oct;254:182-192. doi: 10.1016/j.ajo.2023.06.005. Epub 2023 Jun 19.
To evaluate the influence of tamponade on the visual and anatomic outcomes of pars plana vitrectomy for myopic traction maculopathy (MTM).
Multicenter, retrospective clinical cohort study.
Consecutive eyes that underwent vitrectomy for advanced MTM with tamponade of air, sulfur hexafluoride (SF), or perfluoropropane (CF) or without tamponade with a minimum follow-up of 12 months were included. Main outcome measures included postoperative visual acuity (VA) at 12 months in eyes with vs without tamponade.
We included a total of 193 eyes (193 patients) in this study; 136 eyes (70%) treated with tamponade were compared with 57 eyes (30%) treated without tamponade. Baseline characteristics did not differ significantly between the groups. Both groups showed significant visual improvement at 12 months (both P < .001). However, postoperative visual acuity and visual improvement at 12 months were significantly better (P = .003 and P = .028, respectively) in eyes without tamponade, although the MTM in these eyes without tamponade took longer to resolve (P = .039). Retinal thickness and the ellipsoid zone were more preserved in eyes without tamponade (P < .001 and P = .001, respectively). Complications such as macular holes did not differ between the groups. A novel imaging finding of "schisis bending (accordioning)" was identified during MTM resolution.
Vitrectomy either with or without tamponade for MTM was effective in improving vision in this study. However, eyes without tamponade experienced even better visual improvement and preserved retinal anatomy, despite a longer schisis resolution time. Surgery without tamponade may achieve better visual outcomes.
评估眼内填塞对孔源性牵引性黄斑病变（MTM）行睫状体平坦部玻璃体切除术的视力和解剖结果的影响。
多中心回顾性临床队列研究。
纳入了连续行玻璃体切除术治疗晚期 MTM 并接受空气、六氟化硫（SF）或全氟丙烷（CF）眼内填塞或未行眼内填塞治疗且随访时间至少 12 个月的患眼。主要观察指标为有/无眼内填塞治疗的患眼术后 12 个月的视力。
本研究共纳入 193 只眼（193 例患者）；136 只眼（70%）接受了眼内填塞治疗，与 57 只眼（30%）未接受眼内填塞治疗的患眼进行了比较。两组患者的基线特征无显著差异。两组患眼术后 12 个月视力均显著提高（均 P <.001）。然而，无眼内填塞治疗的患眼术后视力和视力改善情况更佳（P =.003 和 P =.028），尽管这些眼内无填塞治疗的 MTM 恢复时间更长（P =.039）。无眼内填塞治疗的患眼视网膜厚度和椭圆体带保留更好（P <.001 和 P =.001）。两组患者黄斑裂孔等并发症无差异。在 MTM 缓解过程中发现了一种新的影像学表现，即“劈裂弯曲（风琴样）”。
本研究中，MTM 行玻璃体切除术联合或不联合眼内填塞均能有效改善视力。然而，与眼内填塞治疗相比，无眼内填塞治疗的患眼视力改善更好，视网膜解剖结构保留更好，尽管劈裂缓解时间更长。无眼内填塞的手术可能会获得更好的视力结果。
