目的：评价后巩膜加固术(PSR)辅助超长眼轴黄斑裂孔性视网膜脱离患者玻璃体切除手术(PPV)的临床效果。

方法：采用临床随机对照研究。纳入眼轴≥29mm的超长眼轴黄斑裂孔性视网膜脱离患者46例46眼，随机分为两组：A组采用PSR+PPV+硅油填充，B组采用单纯PPV +硅油填充。随访1a，分析各组术后BCVA、黄斑裂孔愈合情况、视网膜脱离复位率、再手术率等指标。

结果：两组治疗后平均BCVA(LogMAR视力)均较术前改善，A组由1.61±0.02提升为0.85±0.22(t=10.36，P<0.01)，B组由1.59±0.04提升为1.08±0.16(t=7.92，P<0.01)，其中A组改善幅度大于B组(t=-2.38，P=0.03)。两组术前术后眼轴均无明显改变(P>0.05)。A组一次手术黄斑裂孔愈合率为91%(21/23)，取油前再手术率4%(1/23)，取油后无再脱离患者，1a随访期内所有术眼完成了硅油取出。B组一次手术黄斑裂孔愈合率为65%(15/23)，取油前再手术率35%(8/23)，取油后再脱离比例26%(6/23)，1a随访期取出硅油比例74%(17/23)。

结论：后巩膜加固术有助于提高病理性近视黄斑裂孔性视网膜脱离的手术成功率，减少复发及再手术的几率。

METHODS:A clinical randomized controlled trial was conducted. Patients of macular hole retinal detachment with over-long axial length ≥29mm were randomly divided into two groups. Group A accepted PSR + PPV + silicone oil injection, group B accepted PPV + silicone oil injection. After followed-up one year, the BCVA, the percentage of macular hole closure, cure rate of retinal detachment and reoperation rate were analyzed.

RESULTS:Totally 46 eyes were included in the study. The average BCVA of the two groups after treatment was improved. The BCVA of group A changed from 1.61±0.02 to 0.85±0.22(t=10.36, P<0.01), and that of group B increased from 1.59±0.04 to 1.08±0.16(t=7.92, P<0.01). The improvement of group A was greater than that of group B(t= -2.38, P=0.03). There was no significant change of the axial length before and after operation in both groups(P>0.05). In group A, the healing rate of macular hole was 91%(21/23), and the reoperation rate was 4%(1/23)before silicone oil removal. After silicone oil removal, no patients recurred to retinal detachment. During the follow-up period, silicone oil removal was completed in all eyes. In group B, the closure rate of macular hole was 65%(15/23), the rate of reoperation before silicone oil removal was 35%(8/23), the redetachment rate after silicone oil removal was 26%(6/23), and the rate of the silicone oil removal throughout the follow-up period was 74%(17/23).

CONCLUSION: PSR can effectively improve the successful rate of pathological myopic macular holes with retinal detachment and reduce the recurrence and reoperation.