目的:描述一种新的手术技术,涉及使用人羊膜(hAM)视网膜上补片治疗高度近视患者的原发性黄斑孔视网膜脱离(MHRD)。
方法:一名60岁的高度近视男子被转诊到我们的诊所,诊断为右眼MHRD。病人是假晶状体,在基线评估时计数手指的视敏度。进行了平坦部玻璃体切除术,在葡萄肿的内缘形成了一个小的视网膜切开术,和膜蓝色双用于获得内界膜的充分剥离。然后,获得1.5mm直径的圆形hAM贴片,并定位在黄斑孔上,其中绒毛膜层沉积在视网膜上。完成流体-空气交换后,使用20%的六氟化硫气体作为内填充剂,病人被要求脸朝下三天。
结果:手术后四周,光学相干断层扫描(OCT)扫描显示hAM斑块,可视化为与视网膜很好地结合的独特的超反射层。手术后九个月,黄斑裂孔被关闭,视网膜重新连接,HAM贴片粘附在视网膜上,患者的最佳矫正视力提高到0.7logMar。随访期间未发现术后不良事件。
结论:上视网膜hAM植入物可以代表一种新的手术技术,与目前用于治疗高度近视患者MHRD的其他技术相比,这是可行且更容易的。
OBJECTIVE: To describe a new surgical technique involving the use of a human amniotic membrane (hAM) epiretinal patch to treat a primary macular hole retinal detachment (MHRD) in a highly myopic patient.
METHODS: A 60 years old highly myopic man was referred to our clinic with a diagnosis of MHRD in his right eye. The patient was pseudophakic, with a visual acuity of counting fingers at the baseline evaluation. Pars plana vitrectomy was performed, a small retinotomy was created at the inner margin of the staphyloma, and membrane blue dual was used to obtain an adequate peeling of the inner limiting membrane. Then, a 1.5 mm diameter circular hAM patch was obtained and positioned over the macular hole with the chorion layer settled over the retina. After a complete fluid-air exchange, 20% sulfur hexafluoride gas was used as endotamponade, and the patient was asked to remain face down for three days.
RESULTS: Four weeks after surgery, optical coherence tomography (OCT) scan showed the hAM patch, visualized as a distinct hyperreflective layer well integrated with the retina. Nine months after surgery, the macular hole was closed, the retina reattached, the hAM patch was adherent to the retina, and the patient presented a best-corrected visual acuity improved to 0.7 logMar. No postoperative adverse events were registered during the follow-up.
CONCLUSIONS: Epiretinal hAM implant could represent a novel surgical technique, feasible and easier compared to other current techniques used to treat MHRD in highly myopic patients.