Objective: To compare the outcome of pars plana vitrectomy (PPV) with a single-layered inverted internal limiting membrane (ILM) flap versus PPV with ILM peeling for the treatment of macular hole associated retinal detachment (MHRD) in high myopia. Methods: In a retrospective cohort study, PPV with 2 kinds of adjuvant surgical procedures were used in 35 moderately high myopia eyes with MHRD. These eyes were divided into 2 groups: group 1 (17 eyes) receiving PPV and ILM peeling and group 2 (18 eyes) receiving PPV with a single-layered inverted ILM flap. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity (BCVA) were measured at 6 months after surgery. Results: The retina was successfully reattached in all cases. The difference of the retinal reattachment rate between the two groups was not statistically significant (Fisher's exact test, P=1.000). The rate of macular hole closure was 47.1% in group 1 (8 eyes) and 88.9% in group 2 (16 eyes). The difference of the macular hole closure rate between the two groups was statistically significant (Fisher's exact test, P= 0.012). Significant improvement in logarithm of minimal angle of resolution (logMAR) BCVA was achieved in both groups. There was no difference in the initial, final, or improved logMAR BCVA in the 2 groups. Conclusion: Single-layered inverted ILM flap technique effectively helps close the macular hole in moderately high myopia with MHRD. This may prevent the possible redetachment from the macular hole. (Chin J Ophthalmol, 2017, 53: 338-343).
目的： 比较单层内界膜翻转与内界膜剥除对高度近视眼黄斑裂孔视网膜脱离视网膜复位率、黄斑裂孔闭合率及视力的影响。 方法： 回顾性队列研究。2014年2月至2016年3月于武汉爱尔眼科医院接受玻璃体切除联合内界膜剥除或单层内界膜翻转治疗的适度高度眼近视患者的临床资料，共35例（35只眼）纳入本研究。其中男性7例（7只眼），女性28例（28只眼）；年龄43~76岁，平均年龄（59.83±8.59）岁。其中内界膜剥除组17只眼，内界膜翻转组18只眼。所有患者于手术前及手术后行最佳矫正视力（logMAR视力）、OCT检查。术后均保持头低位休息3~4周，随访6个月以上，观察患眼手术后视网膜复位率、黄斑裂孔闭合率及最佳矫正视力情况。术后两组间视力比较采用独立样本t检验，黄斑裂孔闭合率及视网膜复位率比较用Fisher精确概率法。 结果： 内界膜剥除组与内界膜翻转组所有患者的视网膜均成功复位。内界膜剥除组17只眼中8只眼黄斑裂孔闭合（8/17），内界膜翻转组18只眼中16只眼黄斑裂孔闭合（16/18），两组黄斑裂孔率比较，差异有统计学意义（P=0.012）。术后末次随访时，内界膜剥除组最佳矫正视力为1.57±0.24，内界膜翻转组为1.52±0.19，两组比较差异无统计学意义（t=0.753，P=0.457）。术后内界膜剥除组患者视力提高的幅度为0.20±0.34，内界膜翻转组为0.34±0.41，两组间比较，差异无统计学意义（t=1.134，P=0.265）。 结论： 单层内界膜翻转术是治疗适度高度近视眼黄斑裂孔视网膜脱离的有效方法，能提高黄斑裂孔的闭合率，有利于黄斑中心凹结构的恢复。（中华眼科杂志，2017，53：338-343）.
Keywords: Epiretinal membrane; Myopia; Retinal detachment; Retinal perforations; Vitrectomy.