探讨周边部视网膜裂孔合并黄斑裂孔(MH)性视网膜脱离的临床特征、诊疗方法及预后。

收集2020年11月至2023年10月于首都医科大学附属北京同仁医院眼科中心诊断为周边部视网膜裂孔合并MH性视网膜脱离的患者20例(20只眼)进行研究。其中，男性11例(11只眼)，女性9例(9只眼)；年龄30~67岁，平均年龄(51.8±10.5)岁。询问并记录患者病史，常规检查手术前和术后1个月、3个月及1年随访时患眼最佳矫正视力、眼前节及眼底情况，病例资料采用例数(眼数)和百分比进行描述。

全部周边部视网膜裂孔患者20例(20只眼)中，术前发现MH和术中发现MH的患者分别为13例(13只眼)和7例(7只眼)，分别占65%(13/20)和35%(7/20)；行25G/23G微创玻璃体切除术和初次行巩膜扣带手术术后发现遗漏MH再行25G微创玻璃体切除术者分别为18例(18只眼)和2例(2只眼)，分别占90%(18/20)和10%(2/20)；术中填充硅油或全氟丙烷者分别为17例(17只眼)和3例(3只眼)，分别占85%(17/20)和15%(3/20)；1次手术和2次手术视网膜脱离复位的患者分别为19例(19只眼)和1例(1只眼)，分别占95%(19/20)和5%(1/20)；术后MH闭合和MH未闭合者分别为18例(18只眼)和2例(2只眼)，分别占90%(18/20)和10%(2/20)；术后视力提高、视力不变及视力下降者分别为18例(18只眼)、1例(1只眼)及1例(1只眼)，分别占90%(18/20)、5%(1/20)及5%(1/20)。

周边部视网膜裂孔视网膜脱离患者病情发展过程中可并发MH，并发MH的时机可发生在初诊时、待入院时、待手术时及手术中。因此，不可仅凭初诊为准还应关注待入院时、待手术时及手术中是否发生MH，避免漏诊漏治。玻璃体切除联合惰性气体或硅油填充，是治疗周边裂孔视网膜脱离合并MH的有效治疗手段。

To explore the clinical characteristics, diagnosis and treatment methods, and prognosis of retinal detachment caused by peripheral retinal holes combined with macular holes (MH).

A total of 20 patients (20 eyes) diagnosed with peripheral retinal tears combined with MH retinal detachment were collected at the Ophthalmic Center of Beijing Tongren Hospital affiliated to Capital Medical University from November 2020 to October 2023. Among them, there were 11 males (11 eyes) and 9 females (9 eyes) with an average age (51.8±10.5) years old (ranging from 30 to 67 years old). The patient′s medical history, conduct routine examinations before surgery and at 1 month, 3 months, and 1 year follow-up after surgery were recorded to determine the best corrected visual acuity, anterior segment, and fundus condition of the affected eye. The case data was described using the number of cases (eyes) and percentage.

Among the 20 patients (20 eyes) with peripheral retinal holes, 13 (13 eyes) were diagnosed with MH before surgery and 7 (7 eyes) were diagnosed with MH during surgery, accounting for 65% (13/20) and 35% (7/20), respectively. After undergoing 25G/23G minimally invasive vitrectomy and initial scleral buckle surgery, 18 cases (18 eyes) and 2 cases (2 eyes) were found to have missed MH and underwent 25G minimally invasive vitrectomy again, accounting for 90% (18/20) and 10% (2/20), respectively; 17 cases (17 eyes) and 3 cases (3 eyes) were filled with silicone oil or perfluoropropane during surgery, accounting for 85% (17/20) and 15% (3/20), respectively; 19 cases (19 eyes) and 1 case (1 eye) of retinal detachment were treated with one surgery and two surgeries, respectively, accounting for 95% (19/20) and 5% (1/20), respectively. There were 18 cases (18 eyes) and 2 cases (2 eyes) of postoperative MH closure and MH non closure, accounting for 90% (18/20) and 10% (2/20), respectively; The postoperative visual acuity improved, remained unchanged, and decreased in 18 cases (18 eyes), 1 case (1 eye), and 1 case (1 eye), respectively, accounting for 90% (18/20), 5% (1/20), and 5% (1/20), respectively.

Patients with peripheral retinal tears and retinal detachment may develop MH during the course of their condition, which can occur at the time of initial diagnosis, admission, surgery, and during the operation. Therefore, it is not enough to rely solely on initial diagnosis. Attention should also be paid to whether MH occurs during hospitalization, surgery, and surgery to avoid missed diagnosis and treatment. Vitrectomy combined with inert gas or silicone oil filling is an effective treatment for peripheral retinal detachment with MH.