Objective: To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied by foveal detachment (FD). Methods: A retrospective case series study was conducted. The medical records of patients diagnosed with unilateral MF accompanied by FD at the Eye & ENT Hospital of Fudan University between May 2018 and December 2021 were collected. All patients underwent 23-gauge PPV with posterior vitreous cortex clearance, and no intraocular tamponade was applied. The cases were divided into groups based on whether the internal limiting membrane was peeled during surgery or retained. Follow-up was conducted for at least 12 months. The main outcome measures included postoperative best-corrected visual acuity (BCVA, converted to logarithm of the minimum angle of resolution), central foveal thickness (CFT), MF resolution, and complications. Statistical analyses were performed using t-tests, chi-square tests, Fisher's exact tests, and univariate and multivariate linear regression. Results: A total of 40 patients (40 eyes) with MF and FD were included in the study, with 30.0% being male and 70.0% female. The mean age was (56.9±11.7) years, and the axial length of the eyes was (29.1±1.9) mm. At 12 months postoperatively, BCVA improved from baseline 1.15±0.58 to 0.73±0.39 (t=6.11, P<0.001), and CFT decreased from baseline (610.1±207.2) μm to (155.9±104.1) μm (t=13.47, P<0.001). Complete resolution of MF with foveal reattachment was observed in 80.0% of eyes, with a median time of 6 (5, 8) months. There was no significant difference in BCVA and CFT between the internal limiting membrane peeled group and retained group [0.68±0.39 vs. 0.79±0.40, t=0.85, P=0.403; (148.3±63.8)vs.(164.3±137.2)um,t=0.48, P=0.634]. One eye experienced macular hole and another eye developed retinal detachment postoperatively. Correlation analysis showed a positive correlation between BCVA at 12 months postoperatively and baseline BCVA (β=0.433, P<0.001). Conclusions: Pars plana vitrectomy without intraocular tamponade is effective in treating MF accompanied by FD. The choice between internal limiting membrane peeling and retention does not significantly affect visual prognosis.
目的： 探讨不联合眼内填充的单纯玻璃体切除术治疗高度近视眼黄斑劈裂（MF）伴黄斑中心凹脱离（FD）的疗效。 方法： 回顾性病例系列研究。收集2018年5月至2021年12月在复旦大学附属眼耳鼻喉科医院诊断为单眼伴有FD的MF患者的病历资料。所有患者均行23G玻璃体切除术，术中清除玻璃体后皮质，所有患者均未进行眼内填充。根据术中是否剥除内界膜分为内界膜剥除组及内界膜保留组。术后至少随访12个月。主要评价指标为术后最佳矫正视力（BCVA，转换为最小分辨角的对数表示）、黄斑中心凹视网膜厚度（CFT）、MF愈合情况及并发症情况。采用t检验、卡方检验、Fisher精确检验、单因素线性及多因素线性回归分析进行统计学处理。 结果： 共40例（40只眼）MF伴FD的患者纳入研究，其中12例（30.0%）为男性，28例（70.0%）为女性；年龄为（56.9±11.7）岁，眼轴长度为（29.1±1.9）mm。术后12个月，BCVA由基线的1.15±0.58提高至0.73±0.39（t=6.11，P<0.001），CFT由基线的（610.1±207.2）μm下降至（155.9±104.1）μm（t=13.47，P<0.001），32只眼（80.0%）的视网膜劈裂完全恢复，劈裂完全好转所需的时间为6（5，8）个月。内界膜剥除组及内界膜保留组的BCVA（分别为0.68±0.39和0.79±0.40）及CFT［分别为（148.3±63.8）和（164.3±137.2）μm］差异无统计学意义（t=0.85，P=0.403；t=0.48，P=0.634）。术后分别有1只眼发生黄斑裂孔及视网膜脱离。相关性分析提示术后12个月BCVA与术前基线BCVA呈正相关（β=0.433，P<0.001）。 结论： 不联合眼内填充的单纯玻璃体切除术可有效治疗伴有FD的MF。内界膜剥除和保留的术式对视力预后影响无明显差别。.