Department of Ophthalmology, Charité, University Medicine Berlin, Berlin, Germany.
Retina. 2013 Jun;33(6):1132-6. doi: 10.1097/IAE.0b013e31827c5384.
The purpose of this study was to investigate and identify predictors for idiopathic macular hole persistence after pars plana vitrectomy with dye-assisted internal limiting membrane peeling.
In a retrospective case series, 160 eyes underwent identical vitreoretinal procedures performed by the same surgeon. Baseline characteristics and preoperative optical coherence tomography were evaluated regarding the postoperative anatomical outcome.
n overall closure rate of 86.3% (138/160) was achieved. According to the Gass classification system, the closure rates were 100.0% (11/11) in Stage 2, 95.0% (57/60) in Stage 3, and 78.7% (70/89) in Stage 4. Thereby, a significant influence of preoperative best-corrected visual acuity and basal hole diameter was observed. Especially, idiopathic macular hole with a basal hole diameter of ≥800 μm and a best-corrected visual acuity of ≤20/100 had a 4 and 6 times higher risk to persist, respectively. On the other hand, age, gender, bilateral occurrence, symptom duration, and lens status did not have an effect on the surgical outcome. Furthermore, perifoveal pseudocysts were associated with a higher closure rate in Stage 4 idiopathic macular hole.
Simple clinical parameters such as best-corrected visual acuity, basal diameter, and perifoveal pseudocysts are efficient predictors and might be used to expand the validity of the Gass classification.
本研究旨在调查并确定经平坝玻璃体切除术联合染料辅助内界膜剥除治疗特发性黄斑裂孔后持续存在的预测因子。
在一项回顾性病例系列研究中，160 只眼由同一位外科医生进行了相同的玻璃体视网膜手术。根据术后解剖学结果评估了基线特征和术前光学相干断层扫描。
总体闭合率为 86.3%（138/160）。根据 Gass 分类系统，2 期的闭合率为 100.0%（11/11），3 期为 95.0%（57/60），4 期为 78.7%（70/89）。因此，术前最佳矫正视力和基底部孔直径有显著影响。特别是基底部孔直径≥800μm且最佳矫正视力≤20/100 的特发性黄斑裂孔，其持续存在的风险分别增加了 4 倍和 6 倍。另一方面，年龄、性别、双侧发生、症状持续时间和晶状体状态对手术结果没有影响。此外，黄斑旁假性囊肿与 4 期特发性黄斑裂孔的更高闭合率相关。
简单的临床参数，如最佳矫正视力、基底部直径和黄斑旁假性囊肿，是有效的预测因子，并可能用于扩大 Gass 分类的有效性。
