Ho Tzyy-Chang, Yang Chung-May, Huang Jen-Shang, Yang Chang-Hao, Chen Muh-Shy
Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 10002, Taiwan, Republic of China.
Graefes Arch Clin Exp Ophthalmol. 2014 Oct;252(10):1553-60. doi: 10.1007/s00417-014-2613-7. Epub 2014 Mar 23.
The purpose of this study was to investigate and present the results of a new vitrectomy technique to preserve the foveolar internal limiting membrane (ILM) during ILM peeling in early stage 2 macular holes (MH).
The medical records of 28 consecutive patients (28 eyes) with early stage 2 MH were retrospectively reviewed and randomly divided into two groups by the extent of ILM peeing. Group 1: foveolar ILM nonpeeling group (14 eyes), and group 2: total peeling of foveal ILM group (14 eyes). A donut-shaped ILM was peeled off, leaving a 400-μm-diameter ILM over foveola in group 1.
Smooth and symmetric umbo foveolar contour was restored without inner retinal dimpling in all eyes in group 1, but not in group 2. The final vision was better in group 1 (P = 0.011). All eyes in group 1 (100 %) and seven of 14 eyes in group 2 (50 %)regained the inner segment/outer segment (IS/OS) line. Restoration of the umbo light reflex was found in 12 of 14 eyes in group 1 (86 %) but none in group 2 (0 %).
Nonpeeling of the foveolar ILM in early stage 2 idiopathic MH surgery prevented inner retinal damages, restored umbo light reflex, achieved better foveolar microstructures, and led to better final visual acuity.
本研究旨在探讨并呈现一种新的玻璃体切割技术在二期黄斑裂孔（MH）早期内界膜（ILM）剥除术中保留黄斑中心凹ILM的效果。
回顾性分析28例（28眼）二期早期MH患者的病历，并根据ILM剥除范围随机分为两组。第1组：黄斑中心凹ILM未剥除组（14眼）；第2组：黄斑中心凹ILM完全剥除组（14眼）。在第1组中，剥除环形ILM，在黄斑中心凹保留直径400μm的ILM。
第1组所有患眼黄斑中心凹轮廓均恢复光滑对称，无视网膜内层凹陷，而第2组则无此现象。第1组最终视力更佳（P = 0.011）。第1组所有患眼（100%）以及第2组14眼中的7眼（50%）恢复了内节/外节（IS/OS）线。第1组14眼中的12眼（86%）恢复了中心凹光反射，而第2组无一恢复（0%）。
二期早期特发性MH手术中不剥除黄斑中心凹ILM可防止视网膜内层损伤，恢复中心凹光反射，获得更好的黄斑中心凹微观结构，并带来更好的最终视力。
