Vitreous Retina Macula Consultants of New York, and the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York.
Vitreo Retinal Surgery, Minneapolis, Minnesota.
Ophthalmology. 2014 Sep;121(9):1727-33. doi: 10.1016/j.ophtha.2014.04.006. Epub 2014 May 13.
To evaluate the clinical outcomes after vitrectomy with inner retinal fenestration-making a partial thickness retinal hole radial to the pit-for the treatment of optic disc pit maculopathy.
Retrospective, interventional case series.
Eighteen eyes with optic disc pit maculopathy.
Pars plana vitrectomy with creation of an inner retinal fenestration was performed in all eyes. A bent 25-gauge needle was used to make a partial thickness inner retinotomy just temporal to the optic disc pit.
Anatomic outcomes determined by optical coherence tomography and postoperative best-corrected visual acuity (BCVA).
Before surgery, gross thickening of the inner and outer retinal layers with accumulation of fluid in the central macula was present in all eyes. Macular detachment was observed in 14 eyes, and outer layer hole was identified in 9 eyes. Patients were followed up for a mean of 34.6±26.6 months after surgery. After surgery, complete resolution of fluid in and under the fovea was achieved in 17 eyes (94%) without additional treatment. In these eyes, reduction of the inner retinal fluid was followed by a slow decrease in the outer retinal fluid and macular detachment. The macular detachment resolved in a mean of 6.1±3.9 months after surgery. Postoperative BCVA (mean, 0.378±0.487 logarithm of the minimum angle of resolution [logMAR]; Snellen equivalent, 20/48) improved significantly compared with preoperative BCVA (mean, 0.725±0.510 logMAR; Snellen equivalent, 20/106; P = 0.006). Ten eyes (56%) had a postoperative BCVA of 20/30 or better. There was neither the recurrence of macular detachment nor an accumulation of outer retinal fluid in the central macula in any eyes.
The introduction of a partial thickness fenestration radial to the optic disc pit was associated with retinal anatomic and functional improvement without additional treatments. These results are consistent with the hypothesis that redirection of flow to allow egress of fluid into the vitreous cavity instead of into the retina can achieve long-lasting amelioration of the pathologic findings of optic pit maculopathy.
评估玻璃体切割术中内视网膜开窗术（在视盘小凹旁作放射状部分厚度视网膜裂孔）治疗视盘小凹黄斑病变的临床疗效。
回顾性、干预性病例系列研究。
18 只眼患有视盘小凹黄斑病变。
所有眼均行标准经睫状体平坦部玻璃体切割术，并作内视网膜开窗术。用弯曲的 25G 针头在视盘小凹旁作部分厚度内视网膜切开。
光学相干断层扫描（OCT）和术后最佳矫正视力（BCVA）确定的解剖学结果。
术前所有眼均可见内层和外层视网膜增厚，黄斑中心区积液积聚。14 眼存在黄斑脱离，9 眼发现外层裂孔。患者术后平均随访 34.6±26.6 个月。术后，17 眼（94%）未经额外治疗即完全消退黄斑中心区和下方积液，无积液复发。这些眼内视网膜液减少后，外层视网膜液和黄斑脱离也逐渐减少。黄斑脱离平均在术后 6.1±3.9 个月消退。术后 BCVA（平均，0.378±0.487 最小分辨角对数 [logMAR]；Snellen 视力，20/48）较术前 BCVA（平均，0.725±0.510 logMAR；Snellen 视力，20/106；P = 0.006）显著提高。术后 10 眼（56%）BCVA 达到 20/30 或更好。术后无黄斑脱离复发或黄斑中心区外层视网膜液积聚。
在视盘小凹旁作部分厚度裂孔与无需额外治疗的视网膜解剖和功能改善相关。这些结果与以下假说一致，即重新引导液体流出到玻璃体腔而不是视网膜内可实现对视盘小凹黄斑病变病理改变的长期改善。
