摘要目的：观察后巩膜加固手术治疗病理性近视黄斑劈裂(MF)的临床效果。方法前瞻性临床研究。临床确诊为 MF 的36例患者36只眼纳入研究。自愿接受后巩膜加固手术治疗者24例24只眼作为手术组；同意定期随访,但不愿意接受手术治疗者12例12只眼作为对照组。两组患者年龄、性别、眼轴长度、等效球镜度数、最佳矫正视力(BCVA)、黄斑劈裂类型、黄斑中心凹视网膜劈裂高度(CFT)、劈裂最高值(MxFT)比较,差异均无统计学意义(P >0.05)。手术组患眼治疗后3、6、9个月时随访；对照组患眼首诊后每隔3个月随访。均随访9个月。对比观察患眼 BCVA、CFT 和 MxFT 变化以及视网膜复位情况。同时观察手术组患眼并发症发生情况。结果手术组24只眼中,劈裂腔消失、视网膜完全复位6只眼,占25.0%；劈裂腔隙不同程度缩小、视网膜层间积液吸收、视网膜部分复位16只眼,占66.7%；视网膜未复位2只眼,占8.3%。视网膜未复位2只眼分别表现为黄斑裂孔、劈裂腔高度增加。对照组12只眼视网膜均未复位,其中2只眼在随访后第6、8个月时出现黄斑裂孔性视网膜脱离,占16.7%。与治疗前比较,手术组患眼治疗后 BCVA (Z =-3.430)明显提高,CFT(Z =-2.707)明显降低,差异均有统计学意义(P <0.05)；MxFT 无明显变化,差异无统计学意义(Z =-0.670,P >0.05)。与首诊时比较,对照组患眼随访第9个月时 BCVA 无明显变化,差异无统计学意义(Z =-1.840,P >0.05)；CFT、MxFT 均明显提高,差异有统计学意义(Z =-2.803、-2.040,P <0.05)。手术组患眼均未发生眼压增高、眼底出血、黄斑前膜、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。结论后巩膜加固手术治疗 MF,可提高患眼视力,降低 CFT；未见手术相关并发症发生。

abstractsObjective To evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients.Methods A prospective study was conducted,in which 36 pathological myopia patients(36 eyes)with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes ) voluntarily underwent posterior scleral reinforcement (PSR,operation group)and 12 patients (12 eyes)didn′t receive operation (control group). There are no statistical differences (P > 0.05 )in age,gender,length of axis oculi,spherical equivalent between the 2 groups.All patients were examined by best corrected visual acuity (BCVA),macular retinoschisis types,central foveal thickness (CFT),maximum foveal thickness (MxFT).Patients in operation group were scheduled to a follow-up 3rd,6th,and 9th month after surgery respectively.Patients in control group all were followed up once every three months.A contrast observation was made on the changes of BCVA,CFT,MxFT,findings of the foveoschisis and the complications of the surgery between groups.Results Compared with the preoperation after 9 month follow-up:in the operation group,the BCVA was significantly increased postoperatively (Z =-3.43,P =0.01),the mean CFT was significantly decreased postoperatively (Z =-2.71,P =0.007),while the MxFT which was not significantly decreased postoperatively (Z =-0.67,P =0.503).In the control group,there was no significant change in BCVA (Z =-1.840,P >0.05),the CFT and the MxFT were signi? cant increased respectively (Z = - 2.803,-2.04;P <0.05).In the operation group,there were 6 (25.0%)of the 24 eyes get complete resolution of the foveoschisis;1 6 (66.7%)of them is not completely attached however the retinoschisis was significantly decreased;only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased.In the control group no one get complete resolution of the myopic foveoschisis,and 2 eyes developed to retinal detachment in 6 and 8 month respectively.There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis,vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery.Conclusions Posterior scleral reinforcement surgery was found effective in improving the visual acuity,reducing the CFT.No obvious complications were found during and after the surgery.