目的：观察微创玻璃体切割联合内界膜剥除术治疗高度近视性黄斑裂孔视网膜脱离(macular hole retinal detachment，MHRD)的临床效果。

方法：回顾性非随机临床研究。纳入2011-01/2016-12我院高度近视MHRD患者26例26眼，所有患者均行标准三通道经睫状体平坦部23G微创玻璃体切割联合内界膜剥除术。术后定期进行最佳矫正视力(best corrected visual acuity，BCVA)、眼压、裂隙灯眼前节和眼底检查，并用光学相干断层扫描(optical coherence tomography，OCT)检查黄斑裂孔解剖情况。以发病年龄、裂孔Gass分期、发病天数、裂孔闭合形态(W、V、U型)、初始视力5项作为自变量进行Logistic回归分析，探讨影响术后BCVA的因素。

结果：高度近视MHRD术后黄斑裂孔(macular hole，MH)闭合率为58%。依据OCT图像，将高度近视MHRD术后OCT闭合形态分为3类：U型(3眼)，相对正常的中心凹形状； V型(4眼)，黄斑中心凹较陡； W型(8眼)，黄斑中心凹处神经上皮缺损，但裂孔缘未翘起，无囊腔形成。多因素Logistic回归分析结果表明，术后预后视力提高与裂孔闭合OCT形态和初始视力相关(P<0.05)，术后U型裂孔闭合视力提高是W型的6.9倍。

结论：微创玻璃体切割联合内界膜剥除术是治疗高度近视MHRD的有效方式。高度近视MHRD术后视力提高与黄斑裂孔愈合的OCT形态和初始视力相关。

METHODS: This was a retrospective non-randomized controlled clinical study. A total of 26 eyes of 26 patients with high myopic MHRD from January 2011 to December 2016 were included. All eyes underwent 23G pars plana microincision vitrectomy combined with ILM peeling. The preoperative and postoperative best corrected visual acuity(BCVA), intraocular pressure, ocular anterior segment and fundus examination were observed, and the anatomical closure of macular hole was checked by optical coherence tomography(OCT). The relationships between final BCVA and these parameters(age, GASS stage, onset time, OCT pattern of MH closure, initial vision)were examined by regression analysis.

RESULTS: The postoperative MH closure rate of high myopia MHRD was 58%. OCT images of the repaired MH in high myopia were categorized into 3 patterns: U-type(3 eyes)with relative normal foveal contour; V-type(4 eyes)with steep foveal contour; W-type(8 eyes)with foveal defect od neruosensory retina, but without warped hem of retinal hole or cystic formation. Multivariate Logistic regression analysis showed that postoperative BCVA was correlated with the OCT patternts of closed MH and initial vision(P<0.05). The postoperative visual acuity of U-type closed MH was 6.9 times higher than that of W-type.

CONCLUSION: Microincision vitrectomy combined with ILM peeling is a safe and effective surgical treatment for high myopia patient with macular hole retinal detachment. The postoperative visual acuity was correlated with the OCT patterns of closed MH and initial vision.