在3期特发性黄斑裂孔手术中，是否总是需要去除内界膜？

Is removal of internal limiting membrane always necessary during stage 3 idiopathic macular hole surgery?

作者信息

Kimura Tetsushi, Takahashi Masayo, Takagi Hitoshi, Kiryu Junichi, Nishiwaki Hirokazu, Tanabe Teruyo, Suzuma Kiyoshi, Oh Hideyasu, Honda Yoshihito

机构信息

Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University,Kyoto, Japan.

出版信息

Retina. 2005 Jan;25(1):54-8. doi: 10.1097/00006982-200501000-00007.

DOI:10.1097/00006982-200501000-00007

PMID:15655441

Abstract

PURPOSE

To determine the indications for internal limiting membrane (ILM) removal in stage 3 idiopathic macular holes (MHs).

METHODS

Focal posterior vitreous detachments (PVDs) at MH rims were examined preoperatively by optical coherence tomography and binocular slit-lamp fundus examination in 19 patients retrospectively. All eyes underwent pars plana vitrectomy and creation of a PVD, and some eyes underwent a second surgery to remove the ILM. Indications of ILM removal for MH closure were discussed.

RESULTS

Preoperatively, 9 eyes did not (non-PVD group) and 10 eyes did (PVD group) have complete focal PVDs. In all nine eyes in the non-PVD group, MHs were closed after the creation of a PVD without ILM peeling (P <0.05, chi test). In the PVD group, 5 eyes (50%) had MHs closed by making PVD complete without ILM removal, and 5 eyes (50%) required ILM removal in a second surgery. In the end, closure of MHs was achieved in all eyes.

CONCLUSION

Anatomic closure of stage 3 idiopathic MHs without a PVD at the rim of the hole may be achieved only by creating a PVD without ILM removal.

摘要

目的

确定3期特发性黄斑裂孔（MH）内界膜（ILM）剥除的指征。

方法

回顾性分析19例患者术前通过光学相干断层扫描和双眼裂隙灯眼底检查对MH边缘的局灶性玻璃体后脱离（PVD）情况。所有患眼均接受了玻璃体切割术并形成PVD，部分患眼接受了第二次手术以剥除ILM。讨论了剥除ILM促进MH闭合的指征。

结果

术前，9只眼未出现完全局灶性PVD（非PVD组），10只眼出现了完全局灶性PVD（PVD组）。在非PVD组的所有9只眼中，在未剥除ILM的情况下形成PVD后MH闭合（P<0.05，卡方检验）。在PVD组中，5只眼（50%）通过使PVD完全形成而未剥除ILM使MH闭合，5只眼（50%）在第二次手术中需要剥除ILM。最终，所有患眼的MH均实现了闭合。