Hejsek Libor, Dusova Jaroslava, Stepanov Alexandr, Rozsival Pavel
Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014 Dec;158(4):596-9. doi: 10.5507/bp.2013.088. Epub 2013 Nov 29.
Persistent idiopathic macular hole (IMH) after initial pars plana vitrectomy (PPV) appears in approx. 12% of cases. It is, therefore, one of the most common complications. IMH re-operation results tend to be better in eyes where IMH had been closed, while IMH re-operations in cases when the initial surgery had failed tend to be less successful: IMH often becomes even larger and visual acuity decreases, anatomical success rate of closure is about 60% and the resulting postoperative visual acuity is about 20/100.
To establish anatomical and functional success rate of repeated operations of recurrent idiopathic macular hole.
We evaluated the retrospective results of re-operations of persisting IMH that is cases in which the initial surgery did not result in closure: 6 eyes in 6 patients out of the overall 55 operated on IMH (primary PPV failed in almost 11% of cases). The follow-up period was 18 months (since the first surgery).
After the second PPV, the IMH was closed in 100% of operated eyes. It was not necessary to perform a third PPV during the follow-up period. In all cases the visual acuity improved. Anatomical and functional results of IMH treatment can be considered satisfactory. We consider the following combination of factors significant for the anatomical success rate of PPV: IMH size and stage, technical precision of the ILM peeling and the suction of the IMH contents, strict adherence to the recommended head positioning in early postoperative period, and IMH duration.
初次玻璃体切割术后持续性特发性黄斑裂孔（IMH）在约12%的病例中出现。因此，它是最常见的并发症之一。在IMH已闭合的眼中，IMH再次手术的结果往往较好，而在初次手术失败的病例中进行IMH再次手术往往不太成功：IMH常常变得更大，视力下降，闭合的解剖成功率约为60%，术后视力约为20/100。
确定复发性特发性黄斑裂孔再次手术的解剖和功能成功率。
我们评估了持续性IMH再次手术的回顾性结果，即初次手术未导致闭合的病例：在总共55例接受IMH手术的患者中，有6例患者的6只眼（初次玻璃体切割术在近11%的病例中失败）。随访期为18个月（自首次手术起）。
第二次玻璃体切割术后，100%的手术眼IMH闭合。随访期间无需进行第三次玻璃体切割术。所有病例视力均有提高。IMH治疗的解剖和功能结果可认为是令人满意的。我们认为以下因素组合对玻璃体切割术的解剖成功率有重要意义：IMH大小和分期、内界膜剥除和IMH内容物抽吸的技术精度、术后早期严格遵循推荐的头部定位以及IMH持续时间。
