国际眼科杂志2023，Vol.23Issue(5)：709-716,8.DOI:10.3980/j.issn.1672-5123.2023.5.01
不同类型近视牵引性黄斑病变的发病机制和手术疗效研究
Pathogenesis and surgical outcomes of different types of myopic traction maculopathy
摘要
Abstract
AIM: To explore the pathogenesis and surgical outcomes of different types of myopic traction maculopathy ( MTM) using optical coherence tomography ( OCT) .?METHODS:A total of 193 patients ( 210 eyes) with MTM were retrospectively included, of which 74 eyes ( 35. 2％) underwent vitrectomy combined with internal limiting membrane ( ILM) peeling. The patients were categorized into three groups: foveal detachment (FD), foveoschisis ( FS ) and lamellar macular hole ( LMH ) . Based on the central foveal thickness ( CFT ) at baseline ( M0 ) , eyes with FD were classified into two subgroups: extensive FD and limited FD. Outcomes included best-corrected visual acuity ( BCVA ) , CFT, posterior staphyloma height ( PSH) , the presence of epiretinal membrane ( ERM) and ILM detachment. Risk factors for BCVA at 6mo after vitrectomy ( M6) were analyzed using linear regression.?RESULTS:At M0, ERM was highly present in eyes with LMH ( rs = 0. 28, P<0. 001 ) . Eyes with FD and FS were characterized by higher incidence of ILM detachment ( rs=-0. 25, P < 0. 001 ) . After vitrectomy, CFT and BCVA significantly improved in all eyes ( P<0. 001 ) . Eyes with extensive FD were characterized by a thicker CFT ( rs =0.56, P<0.001) , a lower incidence of ILM detachment ( rs=-0.25, P=0.034) and a thicker nasal PSH (rs=0.27, P=0.024) than eyes with limited FD. Eyes with extensive FD were associated with a worse BCVA at M0 ( P= 0. 013 ) and M6 (P=0.030) than eyes with limited FD. Extensive FD (β=-0.295, P=0.042) and BCVA at M0 (β=0.669, P<0.001) were risk factors for a worse BCVA at M6.? CONCLUSION: There are several pathogenetic mechanisms in MTM. ILM detachment may exert a dominant role in the development of FD and FS, while ERM may have a role in LMH. Vitrectomy combined with ILM peeling improved functional and anatomical outcomes in MTM patients. Eyes with extensive FD may carry a poor prognosis.关键词
近视牵引性黄斑病变/发病机制/手术疗效Key words
myopic traction maculopathy/pathogenesis/surgical outcomes引用本文复制引用
沈迎娇,陶继伟,陈亦棋,张赟,叶昕,华彦婷,张一凡,毛剑波,沈丽君..不同类型近视牵引性黄斑病变的发病机制和手术疗效研究[J].国际眼科杂志,2023,23(5):709-716,8.基金项目
浙江省医药卫生科技计划项目(No.2020KY651) （No.2020KY651）
温州市科学技术局公共服务项目(No.Y2020033) （No.Y2020033）
