高度近视性黄斑裂孔视网膜脱离与玻璃体后皮质.DOC

Posterior vitreous cortex contribute to macular hole in highly myopic eyes with retinal detachment Keywords: posterior vitreous detachment; macular hole; high myopia; retinal detachment Abstract Purpose: To investigate the effect of posterior vitreous cortex(PVC) to macular hole (MH) associated with retinal detachment (RD) formation in highly myopic eyes. Methods: Sixteen consecutive highly myopic eyes with RD due to MH were included in a retrospective analysis of prospective clinical trial from January to April in 2009. The peroperative examinations for detecting posterior vitreous detachment(PVD) and vitreoretinal traction included B-mode ultrasonography and optical coherence tomography(OCT). The residual PVC and PVD were confirmed intraoperatively during triamcinolone acetonide(TA) assisted vitrectomy. Results: Under ultrasonography, the preoperative PVD patterns were stratified as: complete PVD in 3(18.75%) eyes, partial PVD in 8(50%) eyes, and no PVD in 5(31.25%) eyes. OCT confirmed vitreoretinal traction and no complete PVD in 10(62.5%) eyes, including anteroposterior traction in 4 eyes and tangential traction in 6 eyes. During TA-assisted vitrectomy, it was confirmed that no complete PVD exist in 16 eyes, including 6/16 eyes (37.5%) finally diagnosed partial PVD, and 5/16(31.25%) eyes with vitreoschisis. Anteroposterior vitreoretinal traction around MH is always in conjunction with partial PVD(66.7%), and high proportion(80%) of vitreoschisis is associated with tangential vitreoretinal traction. For PVD diagnosis the coincidence rate of ultrasonography was 68.7%(P=0.02), and that of OCT was 62.5%(P0.01). Conclusion: The residual PVC due to partial PVD or vitreoschisis may cause the anteroposterior or tangential traction of macular area, which contributes to the formation of MH and subsequent RD in highly myopic eyes. And it is necessary to realize vitreoretinal relationship and assess the status of PVC synthetically for surgery by combined ultrasonography a