关键词: 视网膜脱离/外科学, 玻璃体切除术, 空气, 高度近视

Abstract: Objective To study the efficacy of air tamponade combined with vitrectomy in the treatment of high-myopic eyes with non-macular rhegmatogenous retinal detachment (RRD). Design Retrospective case series. Participants Fifty-six high-myopic patients with non-macular RRD who underwent pars plana vitrectomy（PPV） from May 2017 to February 2021 in Nanjing Aier Hospital. Methods Best corrected visual acuity (BCVA), non-contact intraocular pressure (NCT), slit lamp microscope, indirect funduscopy with slit lamp, wide-angle fundus photography, optical coherence tomography (OCT), ophthalmic AB ultrasound examination and length of optic axis with IOL-Master were performed before surgery and postoperative follow-up. All patients underwent 23-gauge PPV, and then 36 patients (air group) were filled with air and 20 patients (silicone oil group) were filled with silicone oil. The follow-up time was 5 days, 3 weeks and 3 months. Initial retinal attachment rate, BCVA and complications were compared between the two groups. Main Outcome Measures Initial retinal attachment rate, BCVA and NCT. Results All patients got retinal attachment during the 5-day and 3-week follow-up. Local retinal redetachment occured in one patient of the air group at the second month after surgery, and got final reattachment after scleral buckling. Initial reattachment was achieved 97.2%. One patient in silicone oil group experienced localized tetinal redetachment due to proliferative tractions, and got retianl reattachment after the second surgery of silicone oil tamponade. After surgery, all patients gained higher BCVA at 5 days, 3 weeks and 3 months after surgery than before surgery（t=5.663, 3.014, -2.934 in air group, P＜0.05; and t=-4.692, -2.629, -1.872 in silicone oil group, P＜0.05）. BCVA of air group was better than that of silicone oil group at 5 days and 3 weeks after surgery（t=1.547, -1.789, all P＜0.05）, but after 3 months the BCVA between the two groups showed no difference（t=1.285，P=0.051）. Increased NCT were found in one patient on the first day and one patient on the third week postoperatively in air group. In silicone oil group, 1 patient, 3 patients, 3 patients and 4 patients got increased NCT at 1 day, 5 days, 3 weeks and 3 months respectively. Conclusion Air tamponade combined with vitrectomy can treat high-myopic patients with non-macular RRD (under PVR C3) cost-effectively. It is also a selective method for those with choroidal detachment, to effectively reduce the application of silicone oil. (Ophthalmol CHN, 2021, 30: 459-464)

Key words: retinal detachment/surgery, vitrectomy, air, high myopia