Sanisoglu Huseyin, Sevim Mehmet Sahin, Aktas Betul, Sevim Semra, Nohutcu Ahmet
Haydarpaşa Numune Education and Research Hospital, Department of Ophthalmology.
Clin Ophthalmol. 2011;5:1177-83. doi: 10.2147/OPTH.S22381. Epub 2011 Aug 19.
The evaluation of anatomic and visual outcomes in macular hole cases treated with internal limiting membrane (ILM) peeling, brilliant blue (BB), and 23-gauge pars plana vitrectomy (PPV).
Fifty eyes of 48 patients who presented between July 2007 and December 2009 with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification who had undergone PPV and ILM peeling were included in this study. Pre- and postoperative macular examinations were assessed with spectral-domain optical coherence tomography. 23 G sutureless PPV and ILM peeling with BB was performed on all patients.
The mean age of patients was 63.34 ± 9.6 years. Stage 2 macular hole was determined in 17 eyes (34%), stage 3 in 24 eyes (48%), and stage 4 in 9 eyes (18%). The mean follow-up time was 13.6 ± 1.09 months. Anatomic closure was detected in 46/50 eyes (92%), whereas, in four cases, macular hole persisted and a second operation was not required due to subretinal fluid drainage. At follow-up after 2 months, persistant macular hole was detected in one case and it was closed with reoperation. At 12 months, an increase in visual acuity in 41 eyes was observed, while it remained at the same level in six eyes. In three eyes visual acuity decreased. There was a postoperative statistically significant increase in visual acuity in stage 2 and 3 cases (P < 0.05), however, no increase in visual acuity in stage 4 cases was observed.
PPV and ILM peeling in stage 2, 3, and 4 macular hole cases provide successful anatomic outcomes, however, in delayed cases, due to photoreceptor loss, it has no effect on functional recovery. BB, used for clarity of ILM, may be beneficial due to its low retinal toxicity.
评估采用内界膜（ILM）剥除术、亮蓝（BB）及23Gauge经平坦部玻璃体切除术（PPV）治疗黄斑裂孔病例的解剖学和视觉效果。
本研究纳入了2007年7月至2009年12月期间就诊，根据Gass分类诊断为2、3或4期黄斑裂孔且接受了PPV和ILM剥除术的48例患者的50只眼。术前和术后黄斑检查采用光谱域光学相干断层扫描进行评估。所有患者均进行了23G无缝合PPV及使用BB的ILM剥除术。
患者的平均年龄为63.34±9.6岁。17只眼（34%）为2期黄斑裂孔，24只眼（48%）为3期，9只眼（18%）为4期。平均随访时间为13.6±1.09个月。50只眼中46只（92%）检测到解剖学上的闭合，而在4例中黄斑裂孔持续存在，但由于视网膜下液引流无需进行二次手术。在2个月后的随访中，1例检测到持续性黄斑裂孔，再次手术将其闭合。在12个月时，41只眼视力提高，6只眼视力保持在同一水平，3只眼视力下降。2期和3期病例术后视力有统计学意义的提高（P<0.05），然而，4期病例未观察到视力提高。
2、3和4期黄斑裂孔病例的PPV和ILM剥除术可提供成功的解剖学结果，然而，在延迟病例中，由于光感受器丧失，对功能恢复无影响。用于提高ILM清晰度的BB因其低视网膜毒性可能有益。
