Background The recurrent rate of retinal detachment is much higher after silicone oil removal in high myopia with macular hole.How reduce the recurrence is a hot topic.Whether optical coherence tomography (OCT)-assisted examination is helpful for the improvement of surgery successful rate is in clinical observation Objective This study was to observe macular retinal status before silicone oil removal in eyes with macular holerelated retinal detachment in highly myopic eyes by OCT and evaluate the factors that influence successful silicone oil removal. Methods Fifty-five eyes of 49 consecutive patients who received vitreoretinal surgery for highly myopic retinal detachment caused by macular hole from January 2005 to December 2008 were involved,and 45 eyes of 40 patients who underwent silicone oil tamponade were retrospectively analyzed.Three to six months after vitreoretinal surgery combined with silicone oil tamponade,removal of silicone oil was performed based on the macular appearance on the OCT and the patients were followed up for over 1 year.The OCT manifestation of macular hole and the best corrected visual acuity (BCVA) were compared between before vitrectomy combined with silicone oil tamponade surgery,and after removal of silicone oil.The healing of the macular hole was classified into type Ⅰ and Ⅱ healing according to the OCT results. Results The retina at the macular area completely reattached in 40 eyes(88.89％ )before removal of silicone,and the margin of the macular hole had disappeared in 2 of the 40 eyes,showing type Ⅰ heal.Thirty-eight eyes were determined to exhibit type Ⅱ healing,presenting with a visible hole margin and local defection of nervous fiber layer.Two years after the removal of silicone,retinal detachment reappeared in 1 eye with type Ⅱ heal.The BCVAs were 1.93±0.06 and 1.16±0.07 before and 1 year after removal of silicone,respectively,showing a significant difference between them(P =0.00). Conclusions OCT is a useful tool for the prediction of anatomic outcomes in macular hole-related retinal detachment eyes with high myopia.Silicone oil removal can be performed in macular hole closure eye or attached-well hole edge eye based on OCT examination.However,attachedwell hole edge eye should receive longer follow-up time.%背景 黄斑裂孔性视网膜脱离行硅油取出后视网膜脱离复发率高,如何降低术后复发率是研究的热点.光学相干断层扫描(OCT)检查可确认适宜的取油时机,是否有助于提高手术成功率有待进一步临床观察. 目的 OCT观察高度近视黄斑裂孔性视网膜脱离行硅油取出术前黄斑区视网膜的解剖形态,分析影响硅油成功取出的因素. 方法 收集2005年1月至2008年12月经玻璃体切割术治疗的高度近视黄斑裂孔性视网膜脱离患者49例55眼的临床资料,其中联合硅油填充术者40例45眼,术后3～6个月,OCT检查黄斑区形态,行硅油取出术,随访时间均为硅油取出术后1年以上.比较玻璃体切割联合硅油填充术前、硅油取出术前和硅油取出术后1年患眼黄斑区的OCT表现以及最佳矫正视力(BCVA).OCT检查黄斑裂孔愈合标准分为一类愈合及二类愈合.结果 硅油取出前OCT示40眼视网膜成功复位,占88.89％,其中2眼裂孔愈合,裂孔边缘消失,属于一类愈合；38眼裂孔边缘平贴于视网膜色素上皮( RPE)层,但中心凹处神经纤维层存在缺损及RPE层暴露,属于二类愈合.硅油取出术后,二类愈合眼中l眼于术后2年发现视网膜脱离复发；联合硅油填充术者40例45眼术前BCVA为1.93±0.06,硅油取出后1年BCVA为1.16±0.07,术后视力较术前明显提高,差异有统计学意义(P=0.00). 结论 OCT检查可以作为硅油取出的术前评估.OCT证实黄斑裂孔闭合或黄斑裂孔的贴附眼可行硅油取出术；OCT检查示黄斑裂孔未闭合的贴附眼行硅油取出后预后较差,是视网膜再脱离的危险因素之一,需长期进行随访.
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