Klinika Okulistyczna Jasne Blonia, Lodz, Poland.
Ophthalmology. 2010 Oct;117(10):2018-25. doi: 10.1016/j.ophtha.2010.02.011. Epub 2010 Jun 11.
Large macular holes usually have an increased risk of surgical failure. Up to 44% of large macular holes remain open after 1 surgery. Another 19% to 39% of macular holes are flat-open after surgery. Flat-open macular holes are associated with limited visual acuity. This article presents a modification of the standard macular hole surgery to improve functional and anatomic outcomes in patients with large macular holes.
A prospective, randomized clinical trial.
Patients with macular holes larger than 400 μm were included. In group 1, 51 eyes of 40 patients underwent standard 3-port pars plana vitrectomy with air. In group 2, 50 eyes of 46 patients underwent a modification of the standard technique, called the inverted internal limiting membrane (ILM) flap technique.
In the inverted ILM flap technique, instead of completely removing the ILM after trypan blue staining, a remnant attached to the margins of the macular hole was left in place. This ILM remnant was then inverted upside-down to cover the macular hole. Fluid-air exchange was then performed. Spectral optical coherence tomography and clinical examination were performed before surgery and postoperatively at 1 week and 1, 3, 6, and 12 months.
Visual acuity and postoperative macular hole closure.
Preoperative mean visual acuity was 0.12 in group 1 and 0.078 in group 2. Macular hole closure was observed in 88% of patients in group 1 and in 98% of patients in group 2. A flat-hole roof with bare retinal pigment epithelium (flat-open) was observed in 19% of patients in group 1 and 2% of patients in group 2. Mean (or median) postoperative visual acuity 12 months after surgery was 0.17 (range, 0.1-0.6) in group 1 and 0.28 (range, 0.02-0.8) in group 2 (P = 0.001).
The inverted ILM flap technique prevents the postoperative flat-open appearance of a macular hole and improves both the functional and anatomic outcomes of vitrectomy for macular holes with a diameter greater than 400 μm. Spectral optical coherence tomography after vitrectomy with the inverted ILM flap technique suggests improved foveal anatomy compared with the standard surgery.
大的黄斑裂孔通常有更高的手术失败风险。手术后，仍有 44%的大的黄斑裂孔未闭合。另外 19%至 39%的黄斑裂孔在手术后呈扁平开放状态。扁平开放的黄斑裂孔与视力有限有关。本文提出了一种改良的黄斑裂孔手术，以改善大的黄斑裂孔患者的功能和解剖结果。
前瞻性、随机临床试验。
纳入直径大于 400μm 的黄斑裂孔患者。第 1 组中，40 名患者的 51 只眼接受了标准的 3 端口玻璃体切除术联合空气填充。第 2 组中，46 名患者的 50 只眼接受了一种标准技术的改良，称为倒置内界膜（ILM）瓣技术。
在倒置 ILM 瓣技术中，在经锥蓝染色后，并非完全去除 ILM，而是保留附着在黄斑裂孔边缘的一小部分 ILM。然后将这部分 ILM倒置覆盖在黄斑裂孔上。然后进行液体-空气交换。在手术前、术后 1 周以及术后 1、3、6 和 12 个月进行光谱光学相干断层扫描和临床检查。
视力和术后黄斑裂孔闭合情况。
第 1 组术前平均视力为 0.12，第 2 组为 0.078。第 1 组 88%的患者黄斑裂孔闭合，第 2 组 98%的患者黄斑裂孔闭合。第 1 组 19%的患者出现扁平孔顶伴有裸露的视网膜色素上皮（扁平开放），第 2 组为 2%。术后 12 个月，第 1 组平均（或中位数）术后视力为 0.17（范围，0.1-0.6），第 2 组为 0.28（范围，0.02-0.8）（P=0.001）。
倒置 ILM 瓣技术可防止黄斑裂孔术后扁平开放外观，并改善直径大于 400μm 的黄斑裂孔玻璃体切割术的功能和解剖结果。与标准手术相比，采用倒置 ILM 瓣技术的玻璃体切除术后的光谱光学相干断层扫描显示出更好的中心凹解剖结构。
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