目的: 初步观察高度近视后极部视网膜脱离患者的后极部裂孔(非黄斑裂孔)的形态及相关因素,探讨玻璃体切除手术治疗的临床效果。方法: 回顾性分析高度近视非黄斑裂孔的后极部孔源性视网膜脱离患者19例19眼的病例资料,观察裂孔的形态、位置、玻璃体牵拉和后巩膜葡萄肿的形态。所有病例行玻璃体切除联合裂孔周围视网膜内界膜剥除术,术中眼内激光光凝封闭裂孔,根据患者病情给予不同的辅助处理,如玻璃体腔内填充消毒空气、C3F8、硅油等,术后3～5个月行硅油取出手术。术后随访观察患者最佳矫正视力和视网膜复位情况。结果: 19只眼中后极部裂孔呈裂隙状12只眼(63.2 %),小马蹄形3只眼(15.8 %),小圆形4只眼(21.0 %)。其中＜1/4 PD者10眼(52.6 %),1/2～1/4 PD者7眼(36.9 %),1～1/2 PD者2眼(10.5 %)。裂孔位于下方血管弓旁9只眼(占47.4 %),上方血管弓旁4只眼(占21.1 %),视盘下方1-4个视盘直径距离5只眼(占26.3 %),视盘上方2个视盘直径距离1只眼(占5.2 %)。后巩膜葡萄肿18只眼(占94.7 %),其中Ⅰ型(宽基底黄斑型)11只眼(占61.1 %),Ⅱ型(窄基底黄斑型)5只眼(占27.8 %),Ⅲ型(盘周型)2只眼(占11.1 %)。术后6个月最佳矫正视力LogMAR较术前降低,差异有统计学意义(Z=-3.162,P=0.002)。术后6个月视网膜复位率94.7 %。结论: 导致高度近视视网膜脱离的后极部裂孔的形成可能与后巩膜葡萄肿、血管延伸性、玻璃体皮质牵拉有关,以裂隙状和细小裂孔为主,玻璃体切除手术中仔细寻找裂孔,联合裂孔周围视网膜内界膜剥除,可促进视网膜复位,提高术后视力。

Objective: To evaluate the clinical efficacy of vitrectomy by exploring the morphology and related factors of posterior pole hole (non-macular hole) in high myopia patients with rhegmatogenous retinal detachment. Methods: Clinical data of 19 high myopia patients (19 eyes) with rhegmatogenous retinal detachment at posterior pole were retrospectively analyzed. The shape, location, vitreous traction and posterior scleral staphyloma were assessed. All cases underwent vitrectomy combined with excision of the internal limiting membrane around the hole. During the operation, intraocular laser photocoagulation was used to seal the hole. Depending on the patient's condition, different auxiliary treatments were given, such as filling the vitreous cavity with sterile air, C3F8 or silicone oil. Silicone oil removal was performed 3 to 5 months after vitrectomy. Best corrected visual acuity (BCVA) and retinal reattachment were observed during the following-up. Results: In 19 eyes, of which 12 eyes (63.2 %) had slit-shaped holes at the posterior pole, 3 eyes had small horseshoe-shaped holes (15.8 %), and 4 eyes had small round holes (21.0 %). Among them, the size of hole in 10 eyes (52.6 %) were less than 1/4 papilla diameter (PD), 7 eyes (36.9 %) were 1/2 to 1/4PD, and 2 eyes (10.5 %) were 1 to 1/2PD. The holes of 9 eyes (47.4 %) located next to the lower vascular arch, 4 eyes (21.1 %) next to the upper vascular arch, 5 eyes (26.3 %) 1 to 4 PD below the optic disc, and 1 eye (5.2 %) 2 PD above the optic disc. Posterior scleral staphyloma was found in 18 eyes (94.7 %), including type I (wide, macular staphyloma) in 11 eyes (accounting for 61.1 %), type II (narrow, macular staphyloma) in 5 eyes (accounting for 27.8 %), and type III (peripapillary staphyloma) in 2 eyes (11.1 %). The LogMAR of BCVA at 6 months after vitrectomy was lower than that before vitrectomy, and the difference was statistically significant (Z=-3.162, P=0.002). The retinal reattachment rate was 94.7 % 6 months after vitrectomy. Conclusion: The formation of posterior pole in high myopia patients with rhegmatogenous retinal detachment may be related to posterior scleral staphyloma, vascular extension, and vitreous cortex traction. Mains of them are slit-shaped holes and small holes. Careful probing the hole and peeling inner-limiting membrane around the hole during vitrectomy could promote retina reattachment and improve post-operative visual acuity.