Tang W Y, Chen X, Zhang T, Huang X, Chang Q, Xu G Z
Department of Ophthalmology, Eye & ENT Hospital of Fudan University, NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai 200031, China.
Zhonghua Yan Ke Za Zhi. 2024 Mar 11;60(3):234-241. doi: 10.3760/cma.j.cn112142-20231019-00155.
To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied by foveal detachment (FD). A retrospective case series study was conducted. The medical records of patients diagnosed with unilateral MF accompanied by FD at the Eye & ENT Hospital of Fudan University between May 2018 and December 2021 were collected. All patients underwent 23-gauge PPV with posterior vitreous cortex clearance, and no intraocular tamponade was applied. The cases were divided into groups based on whether the internal limiting membrane was peeled during surgery or retained. Follow-up was conducted for at least 12 months. The main outcome measures included postoperative best-corrected visual acuity (BCVA, converted to logarithm of the minimum angle of resolution), central foveal thickness (CFT), MF resolution, and complications. Statistical analyses were performed using -tests, chi-square tests, Fisher's exact tests, and univariate and multivariate linear regression. A total of 40 patients (40 eyes) with MF and FD were included in the study, with 30.0% being male and 70.0% female. The mean age was (56.9±11.7) years, and the axial length of the eyes was (29.1±1.9) mm. At 12 months postoperatively, BCVA improved from baseline 1.15±0.58 to 0.73±0.39 (=6.11, <0.001), and CFT decreased from baseline (610.1±207.2) μm to (155.9±104.1) μm (=13.47, <0.001). Complete resolution of MF with foveal reattachment was observed in 80.0% of eyes, with a median time of 6 (5, 8) months. There was no significant difference in BCVA and CFT between the internal limiting membrane peeled group and retained group [0.68±0.39 0.79±0.40, =0.85, =0.403; (148.3±63.8)(164.3±137.2)um,=0.48, =0.634]. One eye experienced macular hole and another eye developed retinal detachment postoperatively. Correlation analysis showed a positive correlation between BCVA at 12 months postoperatively and baseline BCVA (=0.433, <0.001). Pars plana vitrectomy without intraocular tamponade is effective in treating MF accompanied by FD. The choice between internal limiting membrane peeling and retention does not significantly affect visual prognosis.
探讨不使用眼内填充的玻璃体切割术（PPV）治疗伴有黄斑裂孔性视网膜脱离（FD）的高度近视性黄斑劈裂（MF）的疗效。进行了一项回顾性病例系列研究。收集了2018年5月至2021年12月在复旦大学附属眼耳鼻喉科医院诊断为单侧MF伴FD的患者的病历。所有患者均接受了23G PPV及玻璃体后皮质清除术，未应用眼内填充。根据手术中是否剥除内界膜将病例分组。随访至少12个月。主要观察指标包括术后最佳矫正视力（BCVA，转换为最小分辨角对数）、中心凹厚度（CFT）、MF的消退情况及并发症。采用t检验、卡方检验、Fisher精确检验以及单因素和多因素线性回归进行统计分析。本研究共纳入40例（40眼）MF伴FD患者，男性占30.0%，女性占70.0%。平均年龄为（56.9±11.7）岁，眼轴长度为（29.1±1.9）mm。术后12个月时，BCVA从基线的1.15±0.58提高至0.73±0.39（t=6.11，P<0.001），CFT从基线的（610.1±207.2）μm降至（155.9±104.1）μm（t=13.47，P<0.001）。80.0%的患眼中MF完全消退且黄斑重新附着，中位时间为6（5，8）个月。内界膜剥除组和保留组的BCVA及CFT差异无统计学意义[0.68±0.39对0.79±0.40，t=0.85，P=0.403；（148.3±63.8）对（164.3±137.2）μm，t=0.48，P=0.634]。1只眼术后发生黄斑裂孔，另1只眼发生视网膜脱离。相关性分析显示术后12个月的BCVA与基线BCVA呈正相关（r=0.433，P<0.001）。不使用眼内填充的玻璃体切割术治疗MF伴FD有效。内界膜剥除与保留的选择对视力预后无显著影响。
