玻璃体切割联合内界膜覆盖术治疗高度近视黄斑裂孔视网膜脱离

目的：比较玻璃体切割联合内界膜剥除术或内界膜覆盖术治疗高度近视黄斑裂孔视网膜脱离(MHRD)的疗效。

方法：回顾性临床研究。选取2020-01/2021-06于我院行玻璃体切割联合内界膜剥除术或内界膜覆盖术治疗的高度近视MHRD患者38例38眼,根据手术方式分为对照组(行玻璃体切割联合内界膜剥除术)和观察组(行玻璃体切割联合内界膜覆盖术)。随访至术后3mo,比较两组患者手术时间、最佳矫正视力(BCVA)、黄斑裂孔闭合和视网膜复位情况。

结果：两组患者手术时间无差异(30.71±4.55min vs 35.20±5.44min,P=0.384)。末次随访时,两组患者BCVA均较术前明显改善(均P<0.01),但两组患者BCVA(LogMAR)无差异(1.39±0.24 vs 1.46±0.27,P=0.700); 观察组患者黄斑裂孔闭合率高于对照组(100% vs 71%,P=0.024),但两组患者视网膜再脱离率比较无差异(0 vs 10%,P=0.492)。

结论：两种手术方式均可改善患者视力,但玻璃体切割联合内界膜覆盖术后黄斑裂孔闭合率更高。     

微创玻璃体切割术治疗高度近视性黄斑裂孔视网膜脱离的疗效

目的：观察微创玻璃体切割联合内界膜剥除术治疗高度近视性黄斑裂孔视网膜脱离(macular hole retinal detachment,MHRD)的临床效果。

方法：回顾性非随机临床研究。纳入2011-01/2016-12我院高度近视MHRD患者26例26眼,所有患者均行标准三通道经睫状体平坦部23G微创玻璃体切割联合内界膜剥除术。术后定期进行最佳矫正视力(best corrected visual acuity,BCVA)、眼压、裂隙灯眼前节和眼底检查,并用光学相干断层扫描(optical coherence tomography,OCT)检查黄斑裂孔解剖情况。以发病年龄、裂孔Gass分期、发病天数、裂孔闭合形态(W、V、U型)、初始视力5项作为自变量进行Logistic回归分析,探讨影响术后BCVA的因素。

结果：高度近视MHRD术后黄斑裂孔(macular hole,MH)闭合率为58%。依据OCT图像,将高度近视MHRD术后OCT闭合形态分为3类：U型(3眼),相对正常的中心凹形状; V型(4眼),黄斑中心凹较陡; W型(8眼),黄斑中心凹处神经上皮缺损,但裂孔缘未翘起,无囊腔形成。多因素Logistic回归分析结果表明,术后预后视力提高与裂孔闭合OCT形态和初始视力相关(P<0.05),术后U型裂孔闭合视力提高是W型的6.9倍。

结论：微创玻璃体切割联合内界膜剥除术是治疗高度近视MHRD的有效方式。高度近视MHRD术后视力提高与黄斑裂孔愈合的OCT形态和初始视力相关。     

玻璃体切割联合内界膜翻转覆盖术治疗高度近视黄斑裂孔性视网膜脱离

目的：观察玻璃体切割(pars plana vitrectomy,PPV)联合内界膜(internal limiting membrane,ILM)覆盖术治疗高度近视黄斑裂孔性视网膜脱离(macular hole retinal detachment,MHRD)的疗效。

方法：回顾性病例研究。收集2013-07/2017-11在我院就诊,屈光度数≥-6.00D,眼轴长度≥26mm,经眼底检查确诊为高度近视MHRD的患者27例27眼,其中男9例9眼,女18例18眼,年龄41～70(平均53.69±7.23)岁,最佳矫正视力(best-corrected visual acuity,BCVA)为1.41±0.28(LogMAR)。所有患者均行经睫状体平坦部23G玻璃体切割术,伴有晶状体混浊影响手术者同时行晶状体咬切术。术中彻底切除玻璃体后皮质,亮蓝G染色黄斑区ILM,环形剥除黄斑中心凹周围血管弓内ILM,残留黄斑裂孔(MH)边缘少量ILM,将其反转覆盖于MH上,并行C₃F₈或硅油填充。平均随访时间6mo以上。观察所有患者末次随访时BCVA、MH闭合、视网膜复位和眼部并发症情况。

结果：患者术后BCVA提高21眼(78%),视力不变4眼(15%),视力下降2眼(7%)。平均BCVA为0.84±0.40(LogMAR),与术前比较差异有统计学意义(t=7.32,P<0.05)。术后MH闭合24眼(89%),视网膜解剖复位25眼(93%),所有患者无严重眼部和全身并发症。

结论：PPV联合ILM覆盖术治疗高度近视MHRD安全有效,可改善视力,裂孔闭合率、视网膜复位率高。     

不同方法治疗特发性黄斑裂孔对黄斑区解剖结构和脉络膜厚度的影响

目的：探讨玻璃体切割分别联合内界膜移植、内界膜翻瓣、自体血填充治疗特发性黄斑裂孔(IMH)的效果及对黄斑区解剖结构和脉络膜厚度的影响。

方法：回顾性分析2017-01/2019-12我院收治的IMH患者79例82眼的临床资料,所有患者均行标准玻璃体切割+内界膜剥除术及气液交换术,其中联合内界膜移植28例29眼(内界膜移植组)、联合内界膜瓣翻转26例28眼(内界膜翻瓣组)、联合自体血填充25例25眼(自体血填充组)。观察三组患者裂孔闭合情况、裂孔闭合形态; 记录最佳矫正视力(BCVA)、椭圆体带(EZ)及外界膜层(ELM)缺损直径、黄斑中心凹无血管区周长(PERIM)、浅层毛细血管层(SCP)血流密度及黄斑中心凹下(SFCT)、颞侧(TCT)、鼻侧(NCT)脉络膜厚度。

结果：三组患者均成功完成手术,术后3mo时内界膜移植组、内界膜翻瓣组BCVA优于自体血填充组,EZ层缺损直径、ELM层缺损直径低于自体血填充组(P<0.05)。三组间黄斑裂孔闭合率、椭圆体区闭合率、PERIM、SCP血流密度、SFCT、TCT、NCT脉络膜厚度比较无差异(P>0.05); 但三组患者黄斑裂孔闭合形态分型有差异(P<0.05),其中内界膜翻瓣组患者U型比例最高。

结论：玻璃体切割联合手术中内界膜移植术、内界膜翻瓣术及自体血填充治疗IMH均可较好地恢复黄斑裂孔闭合,但内界膜移植术、内界膜翻瓣术在恢复黄斑区解剖结构、提高视力方面优于自体血填充。     

内界膜剥除、翻转填塞辅助治疗高度近视黄斑裂孔性视网膜脱离患者的疗效评价

目的 评价内界膜剥除、翻转填塞治疗高度近视黄斑裂孔性视网膜脱离(MHRD)患者的疗效.方法 选取我院2018年1月～2019年3月高度近视MHRD患者28例,均行内界膜剥除、翻转填塞辅助25G微创玻璃体切割手术治疗,对比术前及术后1个月、3个月、6个月BCVA、黄斑区视网膜厚度,并统计黄斑区裂孔闭合率及视网膜复位率.结...     

人羊膜填塞与内界膜翻转填塞对高度近视黄斑裂孔性视网膜脱离疗效比较

目的对比玻璃体切割(PPV)联合人羊膜填塞术或内界膜翻转填塞术治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。方法采用非随机对照临床研究方法, 纳入2020年7月至2021年8月就诊于上海交通大学医学院附属第九人民医院的高度近视MHRD患者15例16眼。所有患者均接受PPV, 根据术中黄斑裂孔填塞材料的不同将患者分为人羊膜填塞组7例7眼和内界膜填塞组8例9眼。分别于术前及术后1周、1个月、3个月和6个月测定术眼最佳矫正视力(BCVA)、眼压;采用裂隙灯显微镜联合前置镜、激光扫描检眼镜及光学相干断层扫描(OCT)检查眼底情况并判定黄斑裂孔闭合及视网膜复位情况。结果人羊膜填塞组6眼初次手术后视网膜即复位, 内界膜填塞组所有术眼均实现一次手术后视网膜复位。初次手术后, 人羊膜填塞组5眼黄斑裂孔闭合, 内界膜填塞组8眼黄斑裂孔闭合, 2个组间黄斑裂孔闭合率比较差异无统计学意义(P>0.05)。2个组患者手术前后不同时间点间BCVA总体比较差异有统计学意义(F时间=4.420, P<0.05);术后不同时间点BCVA均优于术前值, 但差异无统计学意义(均P>0.05)。2个...     

内界膜剥除对适度高度近视黄斑裂孔性视网膜脱离视网膜复位及裂孔闭合的影响

目的 比较曲安奈德(TA)玻璃体染色辅助玻璃体切割(PPV)联合与不联合内界膜剥除对适度高度近视黄斑裂孔性视网膜脱离(MHRD)视网膜复位及黄斑裂孔闭合的影响.方法 屈光度≥6D,增生型玻璃体视网膜病变分级A、B级,眼轴长度≥26 mm但＜29 mm,视网膜色素上皮及脉络膜萎缩轻或不明显,0～1级且深度≤2 mm巩膜后葡萄肿的适度高度近视MHRD患者43例43只眼纳入观察.将43只眼随机分为内界膜剥除组和内界膜保留组.其中,内界膜剥除组24只眼,内界膜保留组19只眼.TA玻璃体染色辅助PPV后,内界膜剥除组行内界膜剥除,内界膜保留组不行内界膜剥除.手术后1周,l、3、6、12个月时随访,比较两组间矫正视力、视网膜复位及黄斑裂孔闭合率的差异.结果 手术后12个月,内界膜剥除组视网膜复位22只眼,视网膜复位率91.67％;内界膜保留组视网膜复位18只眼,视网膜复位率94.74％;两组患者的视网膜复位率比较,差异无统计学意义(Fisher确切概率法,P=1.000).内界膜剥除组黄斑裂孔闭合14只眼,黄斑裂孔闭合率58.33％;内界膜保留组黄斑裂孔闭合11只眼,黄斑裂孔闭合57.89％;两组患者的黄斑裂孔闭合率比较,差异无统计学意义(x2=0.049,P=0.824).两组患者手术后视力比较,差异无统计学意义(x2=0.001,P=0.977).结论 采用TA辅助PPV治疗适度高度近视MHRD眼,其视网膜复位、裂孔闭合及视力改变与内界膜是否剥除无明显关系.     

内界膜翻转填塞与内界膜剥除治疗高度近视黄斑裂孔视网膜脱离的Meta分析

目的：评价玻璃体切除(PPV)联合内界膜(ILM)翻转填塞或ILM剥除在治疗高度近视黄斑裂孔视网膜脱离(MHRD)中解剖学及视力恢复疗效。

方法：从中国知网(CNKI)、维普(VIP)、万方数据库(Wan Fang Database)、PubMed、EMbase、The Cochrane Library、Europe PMC、Nature数据库中检索文献,检索时间均为建库至2018-09。以术后6mo为随访时间节点,观察黄斑裂孔闭合、原发性视网膜复位及BCVA情况。采用Review 5.3及Stata 15.1软件进行Meta分析。

结果：本研究包括8项研究266眼。ILM翻转填塞在黄斑裂孔闭合率方面优于ILM剥除(RR=2.05,95%CI 1.69～2.49,P<0.00001),在原发性视网膜复位率方面无差异(RR=1.04,95%CI 0.98～1.12,P=0.21),在术后6mo两组BCVA均较术前明显提高(分别为：RR=0.44,95%CI 0.33～0.55,P<0.00001; RR=0.29,95%CI 0.10～0.48,P=0.003),两组间BCVA改善程度的差异结果存在异质性,其结论可能不稳定,尚需更多可靠数据证明。

结论：PPV联合ILM翻转填塞在治疗高度近视MHRD患者中更有效。     

不同程度高度近视黄斑裂孔性视网膜脱离玻璃体切割手术后疗效比较

目的 比较适度与极端高度近视黄斑裂孔性视网膜脱离(MHRD)曲安奈德(TA)染色辅助玻璃体切割及内界膜剥除联合长效气体眼内填充手术后的疗效.方法 41例高度近视MHRD住院患者41只眼纳入研究.其中,眼轴长度＜ 29 mm,视网膜色素上皮(RPE)及脉络膜萎缩轻,0～1级且深度≤2 mm的巩膜后葡萄肿者24只眼(适度组);眼轴长度≥29 mm,RPE及脉络膜明显萎缩,2～3级且深度＞2 mm的巩膜后葡萄肿者17只眼(极端组).两组患者均行TA染色辅助玻璃体切割手术联合内界膜剥除手术治疗,手术完毕时行C3F8眼内填充.对手术后发生视网膜再脱离者行再次手术.以手术后12个月为疗效判定时间点,比较两组患者视网膜复位率、黄斑裂孔闭合率及视力情况.结果 第1次手术后,适度组、极端组视网膜复位率分别为91.67％、64.71％,黄斑裂孔闭合率分别为58.33％、17.65％.两组第1次手术后视网膜复位率(P=0.049)、黄斑裂孔闭合率(x2=6.787,P=0.009)比较,差异均有统计学意义.第2次手术后,适度组、极端组视网膜复位率分别为95.83％％、88.24％,黄斑裂孔闭合率分别为58.33％、23.53％.两组比较,视网膜复位率间差异无统计学意义(P=0.560),黄斑裂孔闭合率间差异有统计学意义(x2=4.894,P=0.027).手术后12个月,适度组视力提高14只眼,视力不变9只眼,视力下降1只眼;极端组视力提高6只眼,视力不变8只眼,视力下降3只眼.两组视力情况比较,差异无统计学意义(x2 =0.209,P=0.647).结论 TA染色辅助玻璃体切割及内界膜剥除联合长效气体眼内填充手术后,适度高度近视MHRD患者视网膜复位率及黄斑孔闭合率较极端高度近视MHRD患者更高,但视力预后无明显差异.     

两种内界膜剥离方式治疗MHCI<0.7特发性黄斑裂孔的疗效

目的：观察玻璃体切割术中不同内界膜剥离方式治疗黄斑裂孔闭合指数(MHCI)<0.7特发性黄斑裂孔(IMH)的临床效果。

方法：将2014-05/2017-05收治的MHCI<0.7 IMH患者88例88眼随机分为A组(44眼,行扩大内界膜剥离术)和B组(44眼,行标准内界膜剥离术),观察两组患者黄斑裂孔闭合情况、最佳矫正视力(BCVA)、中心暗点及并发症发生情况。

结果：术后6mo,A组患者黄斑裂孔闭合率明显高于B组(91% vs 75%,P<0.05),BCVA优于B组(0.47±0.05 vs 0.74±0.14,P<0.05),中心暗点眼数占比低于B组(4% vs 23%,P<0.05),且两组患者并发症发生率无明显差异(11% vs 9%,P>0.05)。

结论：临床治疗MHCI<0.7的IMH采用扩大内界膜剥离术较标准内界膜剥离术疗效更突出,前者视网膜功能恢复效果更佳。     

Surgical management of retinal detachment resulting from macular hole in a setting of high myopia

 PURPOSE:To evaluate the anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and use of retinal tamponade for retinal detachments resulting from macular hole (MHRD) in highly myopic eyes. METHODS: Twenty-nine highly myopic patients (29 eyes) underwent PPV with ILM peeling and retinal tamponade for MHRD were enrolled. Demographics and best-corrected visual acuity (BCVA) were measured preoperatively and at final follow-up. Anatomical success and macular hole closure were analyzed. RESULTS:Patients' mean age of patients was 58.7 ± 10.6 years, mean follow-up was 11.7 ± 7.4 months. Twenty three eyes (23/26, 88.5%) undergoing primary PPV combined with ILM peeling had successful initial retinal reattachment, including 19 eyes (19/19, 100%) with silicone oil tamponade and in 4 eyes (4/7, 57.1%) with sulfur hexafluoride (C3F8) tamponade. Overall anatomical success was achieved in 27 eyes (27/29, 93.1%). The macular hole closure was observed in 17 eyes (17/26, 65.4%) with final anatomical success. Compared to preoperative BCVA, the mean postoperative BCVA in the eyes with anatomical success was significantly improved (P = 0.007, Wilcoxon signed rank test). CONCLUSION:As a primary or secondary procedure, PPV combined with ILM peeling and usage of retinal tamponade serves as an effective method for MHRD in highly myopic eyes.     

Comparison of anatomical and functional outcomes of different surgical techniques in myopic macular hole without retinal detachment

AIM: To define the anatomic and functional outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, inverted ILM flap and free ILM patch graft technique for the treatment of myopic macular hole (MH) without retinal detachment. METHODS: Sixty-four eyes of 64 patients who underwent PPV for myopic MH were included. Group 1 consists of patients underwent ILM peeling (n=26), and Groups 2 and 3 consists of patient underwent free ILM patch graft (n=20) and inverted ILM flap procedure (n=18) respectively. Outcomes following surgery were MH closure and best corrected visual acuity (BCVA) in logMAR at 6mo. RESULTS: Closure of MH was obtained in 20 eyes (76.9%) of the Group 1, in 16 eyes (80%) of the Group 2 and in 16 eyes (88.9%) of the Group 3. The mean preoperative and postoperative BCVA was 1.60±0.53 logMAR and 1.27±0.58 logMAR, respectively (P<0.05). There was no significant difference in the postoperative BCVA and anatomical closure rates in the three groups. Although the anatomical closure rate did not differ significantly in the groups, closure of MH tended to be better in the inverted ILM flap technique group at 6mo. CONCLUSION: Different surgical techniques may provide favorable visual and anatomical results for myopic MH surgery. ILM flap techniques offer higher closure rates compared to ILM peeling technique. However, in terms of visual outcomes, the study reveals no difference in three surgical techniques.     

亮蓝辅助视网膜内界膜剥离治疗病理性近视黄斑裂孔视网膜脱离的疗效评估

目的 评估亮蓝(BBG)辅助视网膜内界膜(ILM)剥离治疗病理性近视黄斑裂孔视网膜脱离的安全性和有效性.方法 前瞻性非对照研究.27例病理性近视黄斑裂孔视网膜脱离患者27只眼纳入研究.常规行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜+90 D前置镜眼底检查,A和(或)B型超声、光相干断层扫描(OCT)及视野检查.所有患者行玻璃体切割手术(PPV),手术中采用BBG辅助ILM剥离,手术后采用C3F8气体填充.观察患者有无视网膜或角膜水肿、前房炎症反应、眼压增高等BBG毒性反应.手术后1、7 d,1、3、6个月进行随访,采用手术前相同的仪器设备行相关检查,对比分析手术前后BCVA、眼压、眼底表现、视野变化、黄斑裂孔闭合、视网膜复位等情况.结果 BBG辅助下,所有患者均完整地剥离ILM.无手术后角膜水肿、前房反应、眼压升高、视野缺损等不良反应发生.手术后1个月,27只眼中26只眼黄斑裂孔闭合、视网膜完全复位,占96.3%;1只眼黄斑裂孔未闭合、视网膜再脱离,占3.7%.手术后6个月,27只眼中25只眼视力提高,占92.6%;2只眼视力不变,占7.4%.手术前后BCVA比较,差异有统计学意义(t=6.08,P＜0.05).结论 BBG可充分染色ILM,且无不良反应发生;其辅助ILM剥离治疗病理性近视黄斑裂孔视网膜脱离安全有效.     

Técnica modificada del flap invertido superior con vitrectomía versus vitrectomía con pelado de membrana limitante interna para el desprendimiento de retina con agujero macular miópico

PurposeTo evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling.MethodsRetrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups.ResultsThere were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (P = .9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (P = .62).ConclusionsILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.     

Inverted internal limiting membrane flap technique for myopic macular hole: A meta-analysis

A macular hole (MH) may be a significant complication in patients with high myopia. The recently reported inverted internal limiting membrane (ILM) flap technique is a promising alternative to treat myopic MHs. We performed a meta-analysis of the published anatomical and functional results of the “inverted ILM flap” technique for the treatment of myopic MH with or without retinal detachment (RD). Our results showed that the inverted ILM flap technique, either covering or insertion, is an effective method for treating myopic MH with or without RD and provides high MH closure, ranging from 91.8% to 97.1%. Despite the high MH closure rate, the pooled visual acuity improvement rate was 77.3% and 66.2% in patients with myopic MH without RD, while it was 95% and 80.3% in patients with myopic MHRD, using “covering” and “insertion” ILM flap technique, respectively. Potential complications included reopening or persistence of MH, development of RD, choroidal detachment, ocular hypertension, and chorioretinal atrophy.     

非内界膜剥离的玻璃体切除术联合长效气体填充治疗病理性近视继发黄斑劈裂

目的 探讨非内界膜剥离的玻璃体切除术联合长效气体填充治疗病理性近视继发黄斑劈裂的临床疗效.方法 前瞻性临床研究.对49例(52只眼)病理性近视继发黄斑劈裂患者采用随机数字表法分组,非注气组(接受非内界膜剥离的玻璃体切除术)22例(24只眼);注气组(接受非内界膜剥离的玻璃体切除联合玻璃体腔内长效气体填充)15例(16只眼);对照组(非手术组,接受定期随访观察治疗)12例(12只眼).分别比较各组患者首次诊疗及术后第3、6、9个月的最佳矫正视力及光相干断层扫描(OCT)显示的视网膜劈裂高度变化.3组间不同随访时段的最佳矫正视力、黄斑中心凹厚度、黄斑区视网膜劈裂高度的比较采用Wilcoxon秩和检验,组内手术前后上述3个指标的比较采用配对符号秩和检验.结果 患者术后随访9个月,最佳矫正logMAR视力(四分位数间距)中位数(Q1,Q3):非注气组为0.5(0.3,0.8),较术前的0.7(0.4,1.1)有明显改善(t=2.57,P<0.05);注气组为0.5(0.3,0.7),较术前的0.8(0.5,1.0)有显著改善(t=3.58,P＜0.05);对照组为0.5(0.3,1.3),与术前的0.4(0.1,0.6)比较,差异无统计学意义(t=1.84,P>0.05);术后3组间最佳矫正视力比较,差异无统计学意义(χ2 =0.24,P>0.05).术后9个月OCT检测:非注气组和注气组患者平均视网膜劈裂高度均较术前显著下降.术后9个月视网膜完全复位率:对照组0.0%(0/12)、非注气组66.7%(16/24)、注气组81.3%(13/16),组间差异有统计学意义(χ2=20.50,P＜0.05),表明非内界膜剥离的玻璃体切除术可显著促进病理性近视继发黄斑劈裂的视网膜复位.并发症:对照组中有2只眼分别在随访的6个月和8个月出现黄斑裂孔性视网膜脱离,另10只眼随观察时间延长视网膜劈裂高度逐渐增加;非注气组术后未见明显并发症;注气组3只眼出现一过性眼压增高,经药物治疗后2周眼压控制平稳,1只眼术后2个月出现黄斑裂孔性视网膜脱离,经再次手术和玻璃体腔注油后视网膜复位.结论 非内界膜剥离的玻璃体切除术是治疗病理性近视继发黄斑劈裂的安全有效术式,术中联合玻璃体腔内长效气体填充可提高手术的成功率.(中华眼科杂志,2011,47:497-503)

Abstract：

Objective To evaluate the efficacy of vitrectomy without internal limiting membrane (ILM) peeling associated with gas tamponade in eyes with myopic foveoschisis. Methods A prospective study was conducted, in which 49 pathological myopia patients (52 eyes) with myopic foveoschisis were enrolled and divided into three groups according to the different therapeutic procedures: 22 patients (24 eyes) underwent vitrectomy without internal limiting membrane (non-gas tamponade group), 15 patients (16 eyes) received vitrectomy without internal limiting membrane peeling but combined with gas tamponade (gas tamponade group) and 12 patients (12 eyes) did not receive surgical treatments (control group) . SAS 9.13 was used for the statistic analysis.Best-corrected visual acuity (BCVA) and optical coherence tomographic (OCT) findings of the foveal thickness before and after the operation (the 3rd, 6th, and 9th month postoperatively) were obtained and compared by the Wilcoxon Rank-Sum test. Non-parameters Wilcoxon symbols test was used to compare the BCVA,the central foveal thickness (CFT) and maximum foveal thickness (MxFT) of each group before and after the surgery.Results Postoperative visual acuity was significantly increased in the two operation groups (t=2.57,P<0.05;t=3.58,P<0.05) but not increased in the control group (t=1.84;P>0.05). The difference of BCVA between these three groups was not significant (χ2 =0.24,P>0.05). OCT showed the mean foveal thickness was significantly decreased postoperatively. Vitrectomy without peeling of the ILM significantly promoted the retinal reattachment in eyes with myopic foveoschisis. No retinal reattachments was found in the control group while 16 and 13 retinal reattachments were found in the non-gas tamponade (66.7%) and gas tamponade group (81.3%), the difference between these two operation groups and the control was statistically significant (χ2=20.50, P<0.05). During the follow-up, two eyes in the control group developed a macular hole and both developed retinal detachment (RD) in the 6 and 8 month, respectively . The remaining 10 eyes did not develop any complications, although the thickness of the macula increased significantly. A transient increase of intraocular pressure occurred in three eyes and had been cured by medications within 2 weeks after gas tamponaded. A macular hole was recognized in one eye 2 months after surgery and the retina was reattached at the fovea 1 month after reoperation. Conclusions Vitrectomy without ILM peeling could be a safe and effective surgical approach for the treatment of foveoschisis in pathologic myopia. In addition, gas tamponade can improve the success rate of the operation.     

Prognostic factor analysis in pars plana vitrectomy for retinal detachment attributable to macular hole in high myopia: a multicenter study

PURPOSE: To detect the prognostic factors associated with initial reattachment after primary pars plana vitrectomy (PPV) with gas tamponade for retinal detachment attributable to macular hole (MHRD). DESIGN: Retrospective, multicenter, interventional case series. METHODS: This study included 49 eyes of 48 patients with MHRD in high myopia (axial length more than 28.0 mm). All eyes underwent PPV with gas tamponade. We retrospectively reviewed the medical records and performed univariate analysis to detect the presence of any difference between eyes with a successful initial reattachment and those that failed. We performed multivariate logistic regression analysis to assess the influence of each preoperative factor on initial success. RESULTS: Success rate of initial reattachment was 69%. Postoperative best-corrected visual acuity (BCVA) of 34 eyes with initial success was significantly better than those of 15 eyes with initial failure (P < .05); preoperative BCVA was not significantly different (P = .43). The axial length of eyes with initial success (29.26 +/- 0.94 mm) was shorter than that of eyes with initial failure (30.04 +/- 1.49 mm) with borderline significance (P = .049). There were no significant differences noted for other factors such as use of ILM peeling (P = .43) or type of tamponade gas (P = .99). Multiple logistic regression analysis using preoperative factors indicated that only axial length was significantly associated with initial success (odds ratio, 0.49; 95% confidence interval, 0.26 to 0.93; P < .05). CONCLUSIONS: Initial reattachment is important for visual prognosis, and axial length is a prognostic factor for initial reattachment after PPV with gas tamponade for MHRD in high myopia.     

Vitrectomy with internal limiting membrane peeling versus its flap insertion for macular hole in high myopia: a Meta-analysis

AIM: To compare the anatomic and functional outcomes between vitrectomy with internal limiting membrane(ILM) peeling and internal ILM flap insertion technique for high myopia macular hole(MH).METHODS: Pub Med, Cochrane Library, EMBASE, and CNKI were systematically searched, and all studies involved MH were included. The closure rate of MH and the postoperative best-corrected visual acuity(BCVA) at 6 mo after the initial surgery were the primary measures. All statistical tests were performed in Review Manager 5.3.RESULTS: Five studies that included 151 eyes of 151 patients were finally included, all of which were retrospectively comparative studies. Between the pars plana vitrectomy(PPV) with ILM peeling surgery and the ILM insertion technique, the latter had significantly better efficacy with respect to the closure rate of MH(OR=21.32, 95%CI=7.25-62.67, P<0.001);However, regarding BCVA at 6 mo after the initial surgery in MH, there was no statistical significance between the groups(OR=-0.04, 95%CI=-0.22-0.14, P=0.66). In addition, regarding the rate of retinal reattachment after the initial surgery, the two different methods were not significantly different(OR=2.22, 95%CI=0.34-14.32, P=0.4).CONCLUSION: Both ILM peeling and ILM insertion technique could significantly improve anatomic outcomes of MH in high myopia with or without retinal detachment(RD), and anatomic outcomes are more effective. However, there is no statistical significance in BCVA at 6 mo after the initial surgery in MH, or in the rate of retinal reattachment after the first surgery, between the two methods.