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
Comparison of therapeutic effects between human amniotic membrane plugging and internal limiting membrane flap insertion for macular hole retinal detachment in high myopia
王楚翘 1周激波 2姚腾腾 1王泽淇 1高慧芹 2汪朝阳1
作者信息
- 1. 上海交通大学医学院附属第九人民医院眼科 上海市眼眶病眼肿瘤重点实验室,上海 200011;同济大学附属第十人民医院眼科,上海 200072
- 2. 上海交通大学医学院附属第九人民医院眼科 上海市眼眶病眼肿瘤重点实验室,上海 200011
- 折叠
摘要
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个组间BCVA总体比较差异无统计学意义(F组别=0.183,P＞0.05).人羊膜填塞组和内界膜填塞组分别有2眼和4眼出现术后一过性高眼压,给予降眼压治疗1周后均恢复正常.结论 PPV联合人羊膜填塞术及内界膜填塞术治疗高度近视MHRD均安全有效,且人羊膜填塞术在伴随复杂的眼底情况时也能保持良好的视网膜解剖学复位及功能恢复.
Abstract
Objective To compare the efficacy of pars plana vitrectomy(PPV)combined with human amniotic membrane(hAM)plugging technique or internal limiting membrane(ILM)flap insertion technique for high myopia macular hole retinal detachment(MHRD).Methods A non-randomized controlled clinical study was performed.Sixteen eyes of 15 patients with high myopia MHRD treated in the Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from July 2020 to August 2021 were included.All patients underwent PPV and were divided into hAM plug group(7 eyes of 7 patients)and the ILM insertion group(9 eyes of 8 patients)based on the different plugging materials.The best corrected visual acuity(BCVA)and intraocular pressure were measured before surgery and at 1 week,1,3,and 6 months postoperative,respectively.Slit-lamp microscopy combined with lenses,scanning laser ophthalmoscope and optical coherence tomography(OCT)were used to examine the fundus,the macular hole closure and retinal reposition.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine(No.SH9H-2021-T322-2).Written informed consent was obtained from each subject.Results The retinal reattachment was achieved in 6 eyes in the hAM plug group and all 9 eyes in the ILM insertion group after initial surgery.The macular hole closure was observed in 5 eyes in the hAM plug group and 8 eyes in the ILM insertion group after initial surgery,and there was no statistical difference in the macular hole closure rate between the two groups(P＞0.05).There were significant differences in the overall comparison of BCVA between the two groups over time(Ftime=4.420,P＜0.05).Postoperative BCVA at different time points was better than preoperative BCVA in each group,but the differences were not significant(all at P＞0.05).There was no significant difference in the overall comparison of BCVA between the two groups(Fgroup=0.183,P＞0.05).Two eyes in the hAM plug group and 4 eyes in the ILM insertion group developed transient ocular hypertension,which returned to normal after 1 week of treatment.Conclusions Both PPV combined with hAM plugging technique and ILM insertion technique are safe and effective for the treatment of MHRD in high myopia.The hAM plugging technique can not only achieve anatomical reduction but also functional recovery of the retina even in complicated fundus conditions.
关键词
视网膜脱离/玻璃体切割术/高度近视/黄斑裂孔/羊膜填塞/内界膜翻转填塞Key words
Retinal detachment/Vitrectomy/High myopia/Macular hole/Amniotic membrane plugging/Inverted internal limiting membrane flap insertion引用本文复制引用
出版年
2024
NETL
NSTL
维普
万方数据