Cullinane A B, Cleary P E
Department of Ophthalmology, Cork University Hospital, National University of Ireland Cork, Wilton, Cork, Republic of Ireland.
Br J Ophthalmol. 2000 Apr;84(4):372-7. doi: 10.1136/bjo.84.4.372.
BACKGROUND/AIM: The pathogenesis of visual field loss associated with macular hole surgery is uncertain but a number of explanations have been proposed, the most convincing of which is the effect of peeling of the posterior hyaloid, causing either direct damage to the nerve fibre layer or to its blood supply at the optic nerve head. The purpose of this preliminary prospective study was to determine the incidence of visual field defects following macular hole surgery in cases in which peeling of the posterior hyaloid was confined only to the area of the macula.
102 consecutive eyes that had macular hole surgery had preoperative and postoperative visual field examination using a Humphrey's perimeter. A comparison was made between two groups: I, those treated with vitrectomy with complete posterior cortical vitreous peeling; and II, those treated with a vitrectomy with peeling of the posterior hyaloid in the area of the macula but without attempting a complete posterior vitreous detachment. Specifically, no attempt was made to separate the posterior hyaloid from the optic nerve head. Eyes with stage II or III macular holes were operated. Autologous platelet concentrate and non-expansile gas tamponade was used. Patients were postured prone for 1 week.
In group I, 22% of patients were found to have visual field defects. In group II, it was possible to separate the posterior hyaloid from the macula without stripping it from the optic nerve head and in these eyes no pattern of postoperative visual field loss emerged. There were no significant vision threatening complications in this group. The difference in the incidence of visual field loss between group I and group II was significant (p=0.02). The anatomical and visual success rates were comparable between both groups.
The results from this preliminary study suggest that the complication of visual field loss after macular surgery may be reduced if peeling of the posterior hyaloid is confined to the area of the macula so that the hyaloid remains attached at the optic nerve head. The postoperative clinical course does not appear to differ from eyes in which a complete posterior vitreous detachment has been effected during surgery.
背景/目的：黄斑裂孔手术相关视野缺损的发病机制尚不确定，但已提出多种解释，其中最有说服力的是后玻璃体膜剥离的影响，这会对视神经纤维层或其在视神经乳头处的血液供应造成直接损害。这项初步前瞻性研究的目的是确定后玻璃体膜剥离仅限于黄斑区域的黄斑裂孔手术后视野缺损的发生率。
102只连续接受黄斑裂孔手术的眼睛在术前和术后使用汉弗莱视野计进行视野检查。将两组进行比较：第一组，接受玻璃体切除术并完全剥离后皮质玻璃体的患者；第二组，接受玻璃体切除术并仅在黄斑区域剥离后玻璃体膜，但未尝试完全玻璃体后脱离的患者。具体而言，未尝试将后玻璃体膜与视神经乳头分离。对II期或III期黄斑裂孔的眼睛进行手术。使用自体血小板浓缩物和非膨胀性气体填塞。患者俯卧位1周。
在第一组中，发现22%的患者有视野缺损。在第二组中，可以将后玻璃体膜从黄斑分离而不将其从视神经乳头剥离，在这些眼睛中没有出现术后视野缺损的模式。该组没有严重的视力威胁性并发症。第一组和第二组之间视野缺损发生率的差异具有统计学意义（p = 0.02）。两组之间的解剖学成功率和视力成功率相当。
这项初步研究的结果表明，如果后玻璃体膜剥离仅限于黄斑区域，使玻璃体膜在视神经乳头处保持附着，则黄斑手术后视野缺损的并发症可能会减少。术后临床过程似乎与手术中实现完全玻璃体后脱离的眼睛没有差异。
