| Objective:To observe and analyze the changes of visual acuity,muhifocal electroretinogram(mfERG) and optical coherence tomogram (OCT) before and after successful vitrectomy for macular retinoschisis and macular hole in high myopia, evaluate the efficiency of the surgery, and approach the surgical indication.Methods:A total of 22 eyes of 19 highly myopic patients with macular retinoschisis and macular hole without retinal detachment who underwent Standard 3-port Pars Plana Vitrectomy(PPV) combind with Internal Limiting Membrane Peeling(ILMP) during April 2008 and May 2011 in our hospital were collected. The cases were assigned to 2 groups, macular retinoschisis(12 eyes) and macular hole(10 eyes). visual acuity, mfERG, and OCT were examined prcoperatively and 2,3,and 6 months postoperatively, respectively. The results were analyzed statistically and com pared between the two groups.Results:1.visual acuity:Postoperative visual acuity was better than the preoperative visual acuity significantly in both two groups (P<0.05). Visual acuity improvement in 91.7% of the macular retinoschisis group and 50% of the macular hole group 6 months postoperatively, was significantly better in macular retinoschisis eyes than in macular hole (P< 0.05).2. mfERG:6 months postoperatively,incubation period of wave PI of ring 1(foveal area) was shorter than preoperatively in macular retinoschisis group(P<0.05), While no significant difference was found in macular hole group(P>0.05). incubation period improvement of wave PI of ring 1 was significantly better in macular retinoschisis eyes than in macular hole (P< 0.05). The response densities of wave P1 of ring 1 got higher and higher 2,3,and 6 months postoperatively,but still lower than preoperatively in both two groups.There is no significant improvement of the response densities of wave P1 of ring 2(parafoveal area).Before the operation, the central peaks of mfERG topographies were absent and low,and many irregular low reaction regions were found in the parafoveal area.Among the healed patients,the central peaks of mfERG topographies reappeared little by little during 6 months after the surgery,also the irregular low reaction regions in the parafoveal area were decreased gradually or disappeared.3.OCT:The retinoschisis completely resolved in 11 (91.7 %) of the 12 eyes and partially resolved in the remaining one eye (8.3%) in high myopic macular retinoschisis group.The macular hole closed in four (40%) of the 11 eyes in the macular hole group, partially closed in three (30%) of the 11 eyes and not closed in the other three (30%) eyes. This expressed that the recovery of macular morphology in macular retinoschisis group was more significant than in macular hole group (P<0.01)4.complications of surgery:no iatrogenic retinal holes formed in the operation and no intraocular hemorrhage or endoophthalmitis happened postoperatively.Conclusions:1.PPV combined with ILMP is a safe and effective surgical treatment for high myopic macular retinoschisis and macular hole.2.Vitrectomy can be performed in time when the macular retinoschisis patient complains of visual disturbances,before macular hole formed.It could be effective for patients'preservation of visual function and improvement of visual acuity. |
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