高度近视眼黄斑裂孔性视网膜脱离合并完全性视网膜前膜分离

Complete epiretinal membrane separation in highly myopic eyes with retinal detachment resulting from a macular hole.

作者信息

Oshima Y, Ikuno Y, Motokura M, Nakae K, Tano Y

机构信息

Department of Ophthalmology, Osaka Rosai Hospital, Sakai-City, Japan.

出版信息

Am J Ophthalmol. 1998 Nov;126(5):669-76. doi: 10.1016/s0002-9394(98)00180-9.

DOI:10.1016/s0002-9394(98)00180-9

PMID:9822230

Abstract

PURPOSE

Epiretinal membranes (ERMs) in highly myopic eyes may result in macular holes and subsequent retinal detachment. However, removing friable, thin ERMs from detached retinas is often difficult. We report the efficacy of a diamond-dusted silicone cannula in the removal of ERMs from detached retinas.

METHODS

Seventeen consecutive highly myopic eyes (16 patients) with retinal detachment underwent pars plana vitrectomy with gas tamponade. Peeling of the ERM adjacent to the macular hole was performed using either conventional tools (n = 11) or a diamond-dusted silicone cannula (n = 6). The rate of complete membrane peeling and the effect of membrane removal on the anatomic success rate were compared between groups.

RESULTS

Retinal reattachment occurred in 13 (92.9%) of the 14 eyes in which the ERM was removed completely; redetachment occurred in the other three eyes, with further surgical interventions in two eyes. The reattachment rate was significantly higher (P = .005) when ERM removal was complete than when there was residual ERM. In the initial surgery, the ERM was successfully removed in all 6 eyes (100%) in the diamond-dusted silicone cannula group and in 5 of 11 eyes (45.5%) in the conventional group (P = .041); the reattachment rate was 100% in the diamond-dusted silicone cannula group and 45.5% in the conventional group (P = .005). When a second surgery was performed, the use of the diamond-dusted silicone cannula was also better than conventional tools for removing the residual ERMs, resulting in retinal reattachment.

CONCLUSION

In highly myopic eyes with a macular hole and subsequent retinal detachment, complete ERM removal is closely related to successful retinal reattachment. The diamond-dusted silicone cannula appears to be more effective than conventional tools for removing ERM and may increase the anatomic success rate. Because of the limitations of a small series, a prospective, randomized trial is required to confirm the current beneficial results of using a diamond-dusted silicone cannula.

摘要

目的

高度近视眼的视网膜前膜（ERM）可能导致黄斑裂孔及随后的视网膜脱离。然而，从脱离的视网膜上移除脆弱、薄的ERM往往很困难。我们报告了一种带金刚石粉末的硅胶套管在从脱离的视网膜上移除ERM方面的疗效。

方法

17例连续的高度近视眼（16例患者）合并视网膜脱离，接受了玻璃体切除联合气体填充的手术。使用传统工具（n = 11）或带金刚石粉末的硅胶套管（n = 6）对黄斑裂孔附近的ERM进行剥离。比较两组之间完全膜剥离的发生率以及膜移除对解剖复位成功率的影响。

结果

在14只完全移除ERM的眼中，有13只（92.9%）实现了视网膜复位；另外三只眼发生了再次脱离，其中两只眼进行了进一步的手术干预。当ERM完全移除时，复位率显著高于有ERM残留时（P = 0.005）。在初次手术中，带金刚石粉末的硅胶套管组的所有6只眼（100%）成功移除了ERM，而传统组的11只眼中有5只（45.5%）成功移除（P = 0.041）；带金刚石粉末的硅胶套管组的复位率为100%，传统组为45.5%（P = 0.005）。当进行二次手术时，使用带金刚石粉末的硅胶套管在移除残留ERM方面也优于传统工具，从而实现了视网膜复位。