Analysis Of Clinical Effect Of Vitrectomy For Macular Hole With Retinal Detachment In High Myopia

Objective To analyze the clinical effect of vitrectomy with internal limiting membrane peeling or not for retinal detachment caused by macular hole in highly myopic eyesMethods To retrospectively analyze the therapeutic efficacy morphological changes of macular in the cases of 55 (56 eyes) macular hole retinal detachment in high myopia in our hospital during September,2005 to September,2010. There are 8 eyes of male patients and 48 eyes of female patients aged from 39 to 74 years old(58.17±8.41 years old average) including 31 right eyes and 25 left eyes. Diopter:-7.00--22.00 D(-14.80±4.80 D average). It was caused by macular holes in 49eyes, peripheral retinal hole in 7 eyes, choroidal detachment in 8 eyes. All the patients underwent vitrectomy, C3F8 or silicone oil tamponade, combined with internal limiting membrane peel off (28 eyes), or not(28 eyes) and they were in prone position after surgery at least 2 weeks. All patients were followed up for 6-12months to evaluate and observe eyesight improvement and morphological changes in macular through visual acuity, mfERG examination and OCT examination. Application SPSS 13.0 package for statistical analysis, using chi-square test and Fisher test, to p<0.05 was considered statistically significant.Results The healing rate is 92.86% (26 eyes) in macular hole healed primary surgical combined with internal limiting membrane peel off group, It is 71.43%(20 eyes) in macular hole healed primary surgical without combining with internal limiting membrane peel off group. There is statistically significant difference in the healing rate of macular hole between these two groups(P<0.05). The visual acuity improvement rate is 82.14%(23 eyes) in combined with internal limiting membrane peel off group, and it is 57.14%(15 eyes) in without combining with internal limiting membrane peel off group. There is statistically significant difference in visual acuity improvement rate between these two groups (P<0.05). The postoperative densities of PI wave in mfERG increased significantly than that of preoperative, there is a significant difference of statistical significance(P<0.05).Conclusion Vitrectomy with internal limiting membrane peel off can significantly improve the healing rate, visual acuity improvement rate. There are a lot of factors that impact the postoperative vision acuity and visual function including the size of macular hole, the postoperative complications and pathological changes of fundus.The changs of density mainly concentrated in the PI wave of mfERG after PPV.and which improved more obviously with the extension of time.