摘要目的:观察玻璃体切割手术（PPV）联合内界膜（ILM）剥除、玻璃体腔注射鼠神经生长因子（mNGF）治疗高度近视黄斑裂孔（HMMH）的疗效。方法:前瞻性研究。2020年8月至2021年2月于南昌大学附属眼科医院检查确诊的HMMH患者31例33只眼纳入研究。所有患者均行最佳矫正视力（BCVA）、光相干断层扫描（OCT）、黄斑区微视野检查以及眼轴长度测量。BCVA检查采用国际标准视力表进行，统计时换算为最小分辨角对数（logMAR）视力。患者随机分为PPV联合ILM剥除和玻璃体腔注射mNGF组（联合组）、PPV联合ILM剥除组（单纯组），分别为15例16只眼、16例17只眼。两组患者logMAR BCVA （ t=0.836 ）、黄斑裂孔（MH）直径（ t=0.657 ）、视敏度（VA）（ t=0.176 ）、外界膜（ELM）及椭圆体带（EZ）缺失长度（ t=1.255、0.966）比较，差异均无统计学意义（ P>0.05）。手术后随访时间≥6个月。对比观察两组患眼手术后BCVA、MH闭合率、ELM和EZ完整性、黄斑区VA恢复情况。两组患眼间手术后不同时间点logMAR BCVA、VA、BCVA变化值、ELM及EZ的缺失长度比较行独立样本 t检验，重复测量数据行方差分析；计数资料比较行Fisher精确性检验。 结果:手术后6个月，单纯组、联合组患眼MH闭合率分别为88.24% （15/17）、93.75% （15/16 ），差异无统计学意义（ P=0.523 ）。手术后3、6个月，联合组患眼ELM完整性恢复较单纯组更好，差异有统计学意义（ t=2.282、3.101， P<0.05）；手术后1、3、6个月，联合组患眼EZ缺失长度较单纯组低，差异有统计学意义（ t=1.815、2.302、2.784， P<0.05）。与手术后1周相比，手术后1、3、6个月联合组患眼黄斑区VA提高，差异有统计学意义（ P=0.007、<0.001、<0.001）。手术后3、6个月，联合组患眼黄斑区VA较单纯组提高，差异有统计学意义（ t=1.897、2.250， P<0.05）。手术方式与随访时间之间存在交互效应，随手术后时间延长，单纯组患眼黄斑区VA降低，联合组患眼黄斑区VA提高，差异有统计学意义（ F=12.963， P<0.001 ）。两组患眼BCVA及BCVA变化值随手术后时间延长而提高，手术后不同时间点联合组患眼BCVA提高及BCVA变化差值均较单纯组明显，差异有统计学意义（ F=12.374、21.807、5.695、4.095， P<0.05）。 结论:与PPV联合ILM剥除手术比较，PPV联合ILM剥除和玻璃体腔注射mNGF治疗HMMH疗效更佳，不仅能改善HMMH患者手术后黄斑区解剖结构，而且可以提高视功能。

abstractsObjective:To observe the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and vitreous injection of mouse never growth factor (mNGF) in the high myopia macular hole (HMMH).Methods:A prospective study. Thirty-one patients (33 eyes) with HMMH diagnosed in Affiliated Eye Hospital of Nanchang University from August 2020 and February 2021 were selected. Before surgery, all included patients were subjected to a complete ophthalmologic evaluation including best corrected visual acuity (BCVA), optical coherence tomography (OCT), macular microperimetry and axial length measurement. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of minimum resolution angle (logMAR) visual acuity during statistics. The included subjects were accepted the treatment of PPV combined with ILM peeling and vitreous injection of mNGF (combined group) or PPV united with ILM peeling (simple group), 15 cases with 16 eyes, 16 cases with 17 eyes, respectively. There were no significant differences in logMAR BCVA ( t=0.836), macular hole (MH) diameter (t=0.657), visual acuity (VA) ( t=0.176), the missing length of external limting membrane (ELM) and ellipsoid zone (EZ) ( t=1.255, 0.966) between two groups ( P>0.05). The follow-up time was at least 6 months. The BCVA, closure rate of MH, integrity of ELM and EZ and recovery of VA in macular area were compared and observed between the two groups after surgery. The logMAR BCVA, VA, the deficient lengths of ELM and EZ at different time points were compared by independent-samples t-test between two groups and analysis of variance was used to compare the repeated measurement data of each group. Fisher test was performed for comparison of count data. Results:Six months after surgery, MH closure rates in the simple group and the combined group were 88.24% (15/17) and 93.75% (15/16), respectively, with no significant difference ( P=0.523). At 3 and 6 months after surgery, the integrity recovery of ELM in the combined group was better than that in the simple group, and the difference was statistically significant ( t=2.282, 3.101; P<0.05). At 1, 3 and 6 months after surgery, EZ deletion length in the combined group was lower than that in the simple group, and the difference was statistically significant ( t=1.815, 2.302, 2.784; P<0.05). Compared with 1 week after surgery, VA in macular area of the combined group increased at 1, 3 and 6 months, and the difference was statistically significant ( P=0.007, <0.001, <0.001). At 3 and 6 months after surgery, VA in macular area of affected eyes in the combined group was higher than that in the simple group, and the difference was statistically significant ( t=1.897, 2.250; P<0.05). There was an interaction effect between the surgical method and the follow-up time. The postoperative time was prolonged, and the VA in macular area was decreased in the simple group and increased in the combined group, with statistical significance ( F=12.963, P<0.001). The BCVA and BCVA changes in the two groups increased with the extension of postoperative time. The improvement of BCVA and the difference of BCVA changes in the combined group were significantly higher than those in the simple group at different time points after surgery, with statistically significant differences ( F=12.374, 21.807, 5.695, 4.095; P<0.05). Conclusion:PPV combined with ILM peeling and vitreous injection of mNGF is more effective than PPV with ILM peeling for HMMH, improving both anatomical and functional outcomes.