目的：比较玻璃体切除(PPV)联合内界膜(ILM)撕除后，分别行单纯的自体血覆盖和ILM翻转填塞联合自体血覆盖治疗中度长眼轴高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。

方法：回顾性研究。选取2020年1月1日至2024年1月1日于我院收治的眼轴在26-29 mm的高度近视MHRD患者45例45眼。根据手术方式不同分为两组：A组24眼行PPV+ILM撕除+ILM翻转填塞+自体血覆盖+硅油填充术； B组21眼行PPV+ILM撕除+自体血覆盖+硅油填充术。比较术前，术后1 wk，1、3、6 mo，两组患者眼压、最佳矫正视力(BCVA)、视网膜复位及黄斑裂孔闭合情况。术后6 mo取出眼内硅油，取油术后定期随访2 mo。

结果：随访至术后8 mo，两组患者视网膜均复位，两组患者黄斑裂孔闭合率比较无差异(88% vs 86%，P=0.860)。术后8 mo两组患者BCVA均较术前显著改善，且B组BCVA优于A组(P<0.001)。A组术后2眼旁黄斑区域存留少量视网膜下液(分别于PPV术后5、8 mo吸收)，B组术后1眼旁黄斑区域存留少量视网膜下液(于PPV术后4 mo吸收)，随访过程中两组患者OCT检查均未发现新的黄斑裂孔的重新开放，且在末次随访时均完全吸收。

结论：中度长眼轴高度近视MHRD患者行PPV及ILM撕除后，单纯的自体血覆盖和ILM翻转填塞联合自体血覆盖两种手术方式均可促进黄斑裂孔闭合及视网膜复位，但单纯自体血覆盖组术后BCVA优于自体血联合ILM填塞组。

METHODS: This retrospective study enrolled 45 patients(45 eyes)with high myopia and MHRD, and axial lengths of 26-29 mm treated at our institution between January 1, 2020 and January 1, 2024. Patients were divided into two groups based on surgical technique: group A(24 eyes)underwent PPV with ILM peeling, ILM flap tamponade, autologous blood coverage, and silicone oil injection; group B(21 eyes)received PPV with ILM peeling followed by autologous blood coverage and silicone oil injection. Intraocular pressure, best-corrected visual acuity(BCVA), retinal reattachment and macular hole closure status were compared at 1 wk, 1, 3, and 6 mo postoperatively. Silicone oil removal was performed at 6 mo postoperatively, with additional 2-month follow-up.

RESULTS:At 8-month postoperative follow-up, both groups achieved complete retinal reattachment. Macular hole closure rates showed no significant intergroup difference(88% vs 86%, P=0.860). Significant improvement in BCVA was observed in both groups compared to preoperative values, with the group B demonstrating better visual outcomes than the group A(P<0.001). Transient parafoveal subretinal fluid persistence was noted in 2 eyes of the group A(resolved spontaneously at 5 and 8 mo post-PPV, respectively), and 1 eye of the group B(resolved by 4 mo post-PPV). Serial optical coherence tomography(OCT)monitoring revealed no macular hole reopening, with complete subretinal fluid resolution confirmed in all cases at final follow-up.

CONCLUSION:For high myopic MHRD patients with moderately long axial length, both surgical approaches effectively promote macular hole closure and retinal reattachment. However, the autologous blood coverage technique demonstrates better BCVA than the combined ILM tamponade.