Ho Tzyy-Chang, Yang Chung-May, Huang Jen-Shang, Yang Chang-Hao, Yeh Po-Ting, Chen Ta-Ching, Ho Allen, Chen Muh-Shy
*Department of Ophthalmology, National Taiwan University Hospital, College of medicine, National Taiwan University, Taipei, Taiwan; †Department of Medicine, School of Medicine, Chang-Gung University, Tauyuan, Taiwan; and ‡Department of Ophthalmology, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan.
Retina. 2014 Sep;34(9):1833-40. doi: 10.1097/IAE.0000000000000149.
To investigate the long-term results of a novel technique to preserve the foveolar cone without peeling off the foveolar internal limiting membrane (ILM) during myopic traction maculopathy surgery.
Nineteen patients (19 eyes) were retrospectively studied and divided into 2 groups by the extent of ILM peeled and followed for more than 3 years. Group 1: foveolar ILM nonpeeling group (FN) (12 eyes) and Group 2: total peeling of foveal ILM group (TP) (7 eyes). A donut-shaped ILM was peeled off, leaving a 400-μm diameter ILM over foveola with a sharp margin in FN group.
Macular hole was developed in 2 of the 7 eyes (28.6%) in the TP group and none in the FN group. Long-term central fovea thickness thinning and decrease of vision were found in the TP group, but not in the FN group (P < 0.05). Inner segment/outer segment line recovered in 75% of the 12 eyes in the FN group, but in only 14.3% of the 7 eyes in the TP group.
Preservation of the foveolar cone by foveola nonpeeling surgery correlates with better anatomical and visual results than total peel, prevents long-term foveolar retinal thinning, and successfully saves the fovea from macular hole formation.
探讨一种在近视性牵引性黄斑病变手术中不剥除黄斑中心凹内界膜（ILM）而保留黄斑中心凹锥体的新技术的长期效果。
对19例患者（19只眼）进行回顾性研究，根据ILM剥除范围分为2组，并随访3年以上。第1组：黄斑中心凹ILM未剥除组（FN）（12只眼）；第2组：黄斑中心凹ILM完全剥除组（TP）（7只眼）。在FN组中，剥除环形ILM，在黄斑中心凹上方保留直径400μm的ILM，边缘锐利。
TP组7只眼中有2只眼（28.6%）出现黄斑裂孔，FN组无黄斑裂孔发生。TP组出现长期黄斑中心凹厚度变薄和视力下降，而FN组未出现（P<0.05）。FN组12只眼中75%的眼内节/外节线恢复，而TP组7只眼中仅有14.3%的眼内节/外节线恢复。
与完全剥除相比，黄斑中心凹不剥除手术保留黄斑中心凹锥体与更好的解剖和视觉效果相关，可防止黄斑中心凹视网膜长期变薄，并成功避免黄斑裂孔形成。
