Schüler A, Lucke K, Bopp S
Augenklinik Universitätsallee, Parkallee 301, Bremen.
Klin Monbl Augenheilkd. 2009 Nov;226(11):927-32. doi: 10.1055/s-0028-1109643. Epub 2009 Oct 1.
Postoperative persistent macular holes after vitrectomy are a rare, but typical phenomenon. Without further surgical intervention the visual acuity remains unchanged. There are no generally accepted treatment recommendations for these cases. We report on 23 cases with postoperative persistent macular holes with and without further surgical treatment and analyzed the clinical outcome.
A retrospective case control study was performed and visual acuity and anatomic status of the macular holes were analysed in 23 cases with a persistent macular hole after previous vitrectomy. Seven patients refused further surgical treatment (group 1) and were used as a control group. Three patients received a second intravitreal gas tamponade without further surgical manipulation (group 2). A vitrectomy revision with endotamponade was performed in 13 eyes (group 3). Additional autologous blood on the macular hole was used in 4 cases and adjuvant ICG-assisted peeling of the inner limiting membrane around the macular hole was performed in another 9 cases.
The eyes of group 1 showed a statistically not significant (p = 0.56) change of the median LogMAR visual acuity from 1.3 (range 0.7 - 1.4) to 1.2 (range 0.3 - 2.0) over a median follow-up of 11.8 months. No eye in group 2 developed a closure of the macular hole. After a median follow-up of 3.6 months the LogMAR visual acuity dropped statistically not significantly from 0.7 (range 0.7 - 1.9 to 1.0 (range 0.8 - 1.0; p = 0.5). 61 % of eyes showed a closure of the macular hole after a second vitrectomy (group 3). Eight out of 16 retreated eyes had finally a persistent macular hole. In these cases median LogMAR visual acuity decreased insignificantly from 1.0 (range 0.7 - 1.4) to 1.1 (range 0.7 - 1.4; p = 0.27) during a median follow-up of 13.7 months. In 8 eyes with a finally closed macular hole median LogMAR visual acuity increased statistically significantly from 0.8 (rage 0.4 - 1.3) to 0.35 (range 0.04 - 0.9; p = 0.016) after a median follow-up of 8.1 months.
Surgical revision of postoperative persistent macular holes using vitrectomy and endotamponade showed a success rate of 61 %. Eyes that had unsuccessful subsequent surgery had a slight decay of the visual acuity during the follow-up that was similar to that of eyes without further surgical treatment. In contrast, the final closure of the macular hole after a second surgery was associated with a significantly increased visual acuity.
玻璃体切除术后持续性黄斑裂孔是一种罕见但典型的现象。若不进行进一步手术干预，视力将保持不变。对于这些病例，尚无普遍接受的治疗建议。我们报告23例术后持续性黄斑裂孔病例，包括接受和未接受进一步手术治疗的情况，并分析其临床结果。
进行一项回顾性病例对照研究，分析23例既往玻璃体切除术后持续性黄斑裂孔患者的视力和黄斑裂孔的解剖状态。7例患者拒绝进一步手术治疗（第1组），作为对照组。3例患者接受了第二次玻璃体腔内气体填塞，未进行进一步手术操作（第2组）。13只眼进行了玻璃体切除翻修术并联合眼内填塞（第3组）。4例在黄斑裂孔处使用了自体血，另外9例在黄斑裂孔周围进行了吲哚菁绿辅助的内界膜剥除术。
第1组患者在中位随访11.8个月期间，LogMAR视力中位数从1.3（范围0.7 - 1.4）降至1.2（范围0.3 - 2.0），差异无统计学意义（p = 0.56）。第2组中没有一只眼的黄斑裂孔闭合。在中位随访3.6个月后，LogMAR视力从0.7（范围0.7 - 1.9）降至1.0（范围0.8 - 1.0），差异无统计学意义（p = 0.5）。第二次玻璃体切除术后（第3组），61%的眼黄斑裂孔闭合。16只再次手术的眼中有8只最终仍有持续性黄斑裂孔。在这些病例中，中位随访13.7个月期间，LogMAR视力中位数从1.0（范围0.7 - 1.4）降至1.1（范围0.7 - 1.4），差异无统计学意义（p = 0.27）。在8只最终黄斑裂孔闭合的眼中，中位随访8.1个月后，LogMAR视力中位数从0.8（范围0.4 - 1.3）显著提高至0.35（范围0.04 - 0.9）（p = 0.016）。
采用玻璃体切除和眼内填塞对术后持续性黄斑裂孔进行手术翻修的成功率为61%。后续手术失败的眼在随访期间视力略有下降，与未进行进一步手术治疗的眼相似。相比之下，第二次手术后黄斑裂孔最终闭合与视力显著提高相关。
