朱双倩 王勤美等 中华眼视光学与视觉科学
【摘要】 目的 评价后巩膜加固术治疗病理性近视黄斑劈裂的效果，观察手术前后黄斑劈裂腔与ERG的变化。方法 回顾性病例研究，对25例（32眼）病理性近视黄斑劈裂（其中6眼伴视网膜局限性浅脱离）患者行后巩膜加固术，观察手术前与手术后6个月最佳矫正视力、等效球镜度、眼轴、OCT、ERG的变化。最佳矫正视力、等效球镜度、眼轴的比较采用配对样本t检验，黄斑劈裂腔的大小与ERG各参数的比较采用符号秩和检验。结果 手术前后等效球镜度与眼轴差异有统计学意义（t=-11.23、13.23，P<0.01）。术后OCT示，14眼黄斑劈裂愈合，劈裂腔消失，此14眼术前劈裂腔高度为277（190～428）μm；17眼（53%）好转，劈裂腔减小，此17眼术前、术后劈裂腔高度分别为447（344～617）μm和194（106～259）μm，差异有统计学意义（Z=-3.724，P<0.01）；1眼未愈。ERG示，黄斑劈裂愈合组ERG最大反应中的a波波幅术前和术后分别为114（63.45～143.00）μV和119（93.75～169.50）μV，差异有统计学意义（Z=-2.232，P<0.05）。黄斑劈裂好转者术前和术后ERG最大反应中的a波波幅分别为104（76.65～130.00）μV和107（83～151）μV，差异有统计学意义（Z=-2.056，P<0.05）。其他检测的各参数指标差异均无统计学意义。无严重并发症发生。结论 后巩膜加固术治疗病理性近视黄斑劈裂具有一定的疗效，不仅有助于黄斑劈裂腔的减小，也有助于视网膜光感受器传导功能的改善。
【关键词】 近视，退行性； 后巩膜加固术； 视网膜劈裂症； 体层摄影术，光学相干； 视网膜电描记术
DOI：10.3760/cma.j.issn.1674-845X.2014.03.012
基金项目：温州市科技计划项目（Y20110148）
作者单位：325027
通信作者：薛安全，Email：safesnow88@yahoo.com.cn
Effect of posterior scleral reinforcement in the treatment of pathological myopic macular retinoschisis
Zhu Shuangqian， Wang Qinmei， Zheng Linyan， Su Yanfeng， Zheng Weiwei， LI Tao， Xue Anquan. Eye Hospital of Wenzhou Medical University， Wenzhou 325027， China
Corresponding author：Xue Anquan，Email：safesnow88@yahoo.com.cn
【Abstract】 Objective To investigate the effect of posterior scleral reinforcement in eyes with pathological myopic macular retinoschisis. To observe macular retinoschisis and ERG changing. Methods Retrospective study. Thirty-two eyes of 25 patients with pathological myopic macular retinoschisis （6 eyes of foveal detachment） who underwent surgery with the posterior scleral reinforcement were studied. The best corrected visual acuity， spherical equivalent， axial length， OCT and ERG outcomes were observed before and 6 months after surgery. Paired t test was used to evaluate best corrected visual acuity， spherical equivalent and axial length between preoperation and postoperation. Wilcoxon test was used to compare the value of macular splitting cavity and the parameters of ERG. Results There were significant differences in mean spherical equivalent and mean axial length between pre- and postoperation （t=-11.23， 13.23， P<0.05）. OCT showed： healing of macular retinoschisis in 14 eyes， max value of macular splitting cavity preoperation was 277（190-428）μm； improved macular retinoschisis in 17 eyes， max value of macular splitting cavity changed significantly（Z=-3.724， P<0.01） from a preoperative value of 447（344-617）μm to 194（106-259）μm at 6 months postoperation； no change in 1 eye. ERG： healing group（14 eyes）， the max-a wave showed a significant change between preoperative and postoperative from 114（63.45-143.00）μV to 119（93.75-169.50）μV， respectively （Z=-2.232， P<0.05）； improved group （17 eyes）， the max-a wave showed a significant change between preoperative and postoperative from 104（76.65-130.00）μV to 107（83-151）μV， respectively （Z=-2.056， P<0.05）. There were no significant changes between other parameters. No serious complications were observed. Conclusion Posterior scleral reinforcement is an approach to treat pathological myopic macular retinoschisis， not only help to reduce macular splitting cavity， but also improve retina photoreceptor conduction function.
【Key words】 Myopia，degenerative； Posterior scleral reinforcement； Retinoschisis； Tomography，optical coherence； Electroretinography； Surgery