目的：观察玻璃体切割(PPV)和硅油填充术联合术中应用后巩膜葡萄肿(PS)边缘视网膜光凝治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的临床效果。
方法：这是一项回顾性临床研究。从2017年5月至2020年3月，62例MHRDPS患者（62只眼）被纳入研究。将患者分为23GPPV联合PS边缘视网膜术中光凝组(联合组)和常规手术组(常规组),每个人都有31只眼睛。使用曲安奈德和吲哚菁绿去除视网膜前膜和黄斑后部内界膜（ILM）。在合并组中，在PS的边缘上进行2至3行视网膜光凝。患者平均随访8.34±3.21mo。第一次视网膜复位率，黄斑裂孔闭合率,硅油填塞的持续时间，观察并比较两组的最佳矫正视力（BCVA）和平均手术次数。
结果：联合组和常规组的首次视网膜复位率分别为96.7%（29/31）和67.7%（21/31），χ2=6.613,P=0.010。合并组和常规组黄斑裂孔闭合率分别为74.2%(23/31)和67.7%(21/31),χ2=0.128,P=0.721。联合组患者硅油填塞时间低于常规组(t=-41.962,P≤0.001)。联合组和常规组患者术后logMARBCVA值分别为1.27±0.12和1.26±0.11,与术前logMARBCVA比较,各组均有改善(t=19.947,t=-19.517,P≤0.001,P≤0.001)。两组眼的logMARBCVA差异无统计学意义(t=-0.394,P=0.695)。常规组和联合组的平均眼部手术次数分别为2.39±0.62和2.06±0.25次,合并组平均手术次数较少(t=-2.705,P=0.009).
结论：术中PPV治疗MHRD联合PS边缘眼内光凝能有效提高首次手术后视网膜复位率。减少重复操作的次数，减少术后硅油填塞时间。
OBJECTIVE: To observe the clinical effect of pars plana vitrectomy (PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma (PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment (MHRD) with PS.
METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS (62 eyes) were enrolled in the study. Patients were divided into 23G PPV combined with PS marginal retina intraoperative photocoagulation group (combined group) and conventional surgery group (conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane (ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity (BCVA) and average number of operations were observed and compared between the two groups.
RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7% (29/31) and 67.7% (21/31), respectively (χ2 =6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2% (23/31) and 67.7% (21/31), respectively (χ2 =0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group (t=-41.962, P≤0.001). Postoperative logMAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the logMAR BCVA before surgery, each group was improved (t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the logMAR BCVA between the eyes of the two groups (t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average (t=-2.705, P=0.009).
CONCLUSIONS: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.
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