| Purpose:To observe and analyze the clinical efficacy of pars plana vitrectomy(PPV)combined with endolaser photocoagulation on the edge of posterior scleral staphyloma,internal limiting membrane(ILM)peeling and silicone oil filling for macular hole retinal detachment(MHRD)with posterior scleral staphyloma in high myopic eyes retrospectively.Methods:49 patients(49 eyes)with high myopic MHRD and posterior scleral staphyloma who were hospitalizedin Tianjin Eye Hospital from January 2018 to June 2019 were collected,they had PPV combined with ILM peeling and silicone oil filling.According to whether PPV combined with endolaser photocoagulation on the edge of posterior scleral staphyloma,25 patients(25 eyes)were in laser group and 24 patients(24eyes)were in non-laser group.All patients received examinations with best corrected visual acuity(BCVA),intraocular pressure,fundus photography,B-ultrasound and optical coherence tomography(OCT)before and after operation.The retinal reattachment rate,macular hole closure rate,visual acuity improvement,and postoperative complications were compared and statistical analysed in the two groups at 1 week,1 month,3 months and 6 months after surgery.All results were analyzed statistically by SPSS26.0.Results:1.The retinal reattachment rate:taking the 6 months after the first operation as the judgment point of efficacy,retinal reattachment was achieved in 24 eyes in the laser group,and the retinal reattachment rate was 96.0%;retinal reattachment was achieved in 17 eyes in the non-laser group,and the retinal reattachment rate was 70.8%.The retinal reattachment rate in the first time of surgery in the laser group was higher than that in the non-laser group,and the difference was statistically significant(χ~2=3.984,P=0.046).2.The macular hole closure rate:taking the 6 months after the first operation as the judgment point of efficacy,macular hole closure was in19 eyes in the laser group,and the macular hole closure rate was 76.0%,macular hole closure in 15 eyes in the non-laser group,and the macular hole closure rate was62.5%.The macular hole closure rate in the first time of surgery in the laser group was higher than that in the non-laser group,and the difference was not statistically significant(χ2=1.051,P=0.305).3.Postoperative vision:the average BCVA(Log MAR)of 25 patients in the laser group were 1.80±0.37,1.38±0.31,1.08±0.39 before surgery,at 3 months and 6 months after surgery,respectively.The average BCVA at 3months after surgery was better than that before the surgery.The average BCVA at 6months after surgery was better than that at 3 months after surgery,and the differences were statistically significant(t=4.398,5.327,P=0.001,0.000).The average BCVA(Log MAR)of 24 patients in the non-laser group were 1.87±0.28,1.45±0.46,and 1.20±0.47 before surgery,at 3 months and 6 months after surgery,respectively.The average BCVA at 3 months after surgery was better than that before the surgery.The average BCVA at 6 months after surgery was better than that at 3 months after surgery,and the differences were statistically significant(t=4.376,2.899,P=0.001,0.014).There was no statistically significant difference in visual acuity between the laser group and the non-laser group at 3 and 6 months after surgery(t=0.409,0.675,P=0.687,0.506).4.Postoperative complications:After the operation,5 patients(2 in the laser group and 3 in the non-laser group)had intraocular pressure higher than21mm Hg before silicone oil extraction,and they were treated with drugs to reduce intraocular pressure.Intraocular pressure returned to normal within one week after treatment.No other serious complications were found at the end of follow-up.Conclusion:1.Endolaser photocoagulation on edge of the posterior scleral staphyloma in the treatment of MHRD with posterior scleral staphyloma in high myopic eyes with PPV has good safety and effectiveness.It can effectively improve the retinal anatomical reattachment rate,has no damage to the restoration of visual function.2.The combination of PPV,ILM peeling,endolaser photocoagulation on the edge of posterior scleral staphyloma and silicone oil filling for the treatment of MHRD in high myopic eyes can achieve a better retinal anatomical reattachment rate,it is conducive to the recovery of visual function. |
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