摘要目的 观察不同类型近视牵引性黄斑病变(MTM)患者玻璃体切割手术后黄斑区结构和视功能的变化.方法 回顾性病例研究.2010年1月至2014年5月连续收治的不伴孔源性视网膜脱离的MTM患者47例47只眼纳入研究.患者中,男性9例9只眼,女性38例38只眼.平均年龄(65.13±6.98)岁,平均眼轴长度(29.23±1.77) mm.根据光相干断层扫描(OCT)检查显示的黄斑病变形态将患眼分为单纯黄斑劈裂(MRS)组、无裂孔性视网膜脱离(FD)组、全层黄斑裂孔(MH)组,分别为18、13、16只眼.均行最佳矫正视力(BCVA)、眼压、眼轴、A/B型超声、眼底彩色照相、OCT、微视野检查.BCVA记录时转换为最小分辨角对数(logMAR)视力.患眼平均logMAR BCVA 1.43±0.52.MRS组、FD组患眼平均黄斑中心视网膜厚度(CRT)为(528.45±167.61) μm.所有患眼均接受标准经睫状体平坦部三通道23G微创玻璃体切割联合内界膜剥除手术.手术后平均随访时间23.4个月.观察手术后患眼视力、微视野及黄斑区解剖结构变化.结果 末次随访时,47只眼平均logMAR BCVA为0.86±0.42;与手术前平均logMAR BCVA比较,差异有统计学意义(t=7.36,P＜0.001).MRS组、FD组患眼平均CRT为(250.90±91.81) μm;与手术前平均CRT比较,差异有统计学意义(t=8.17,P＜0.001).MRS组18只眼视网膜结构均复位或改善.FD组13只眼中,黄斑区视网膜结构复位11只眼;MH形成2只眼.MH组16只眼中,MH性视网膜脱离复发1只眼.MRS组、FD组、MH组患眼之间logMAR BCVA(x2=6.38)、黄斑区视敏度(x2=11.08)比较,差异有统计学意义(P=0.030、0.004).结论 近视性MRS手术后黄斑区结构与视功能恢复优于近视性MH、无裂孔性视网膜脱离.

abstractsObjective To observe the anatomical and functional changes in patients with different degrees of myopic traction maculopathy (MTM) after vitrectomy.Methods It was a retrospective case series study.Forty-seven consecutive patients (47 eyes) diagnosed with MTM were studied between January 2010 and May 2014.There were 38 females (38 eyes) and 9 male (9 eyes),mean age was (65.13±6.98) years,mean axial length was (29.23±1.77) mm.The eyes was divided into 3 groups according to the macular morphologies on optical coherence tomography (OCT),including macular retinoschisis only group (MRS group,18 eyes),foveal retinal detachment group (FD group,13 eyes) and full-thickness macular hole group (MH group,16 eyes).All the eyes underwent minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA),intraocular pressure,axial length,A or B-ultrasonography,fundus photography,OCT and microperimetry examinations.The average logMAR BCVA of 47 eyes was 1.43±0.52.The center retinal thickness (CRT) of eyes in MRS and FD group was (528.45± 167.61) μm.All the patients underwent pars plana vitrectomy combined with internal limiting membrane peeling.The mean follow-up period was 23.4 months.The changes of logMAR BCVA,microperimetry and macular microstructural were observed.Results At the final follow-up,the logMAR BCVA of 47 eyes was 0.86 ± 0.42,which improved compared with the preoperative vision (t=7.36,P＜ 0.001).The mean CRT of eyes in MRS and FD group was (250.90 ± 91.81) μm,which improved compared with the preoperative CRT (t=8.17,P＜0.001).In MRS group,the retina was attached in 18 eyes.In FD group,the retina was attached in 11 eyes,MH was observed in 2 eyes.In MH group,recurrent retinal detachment was observed in 1 eye.The differences of logMAR BCVA and retinal sensitivity among MRS,FD and MH groups were significant (x2 =6.38,11.08;P=0.030,0.004).Conclusion The macular structural and visual function in MTM eyes with macular retinoschisis only after vitrectomy are better than those in MTM eyes with MH and foveal retinal detachment.