Vingolo E M, Valente S, Gerace E, Spadea L, Nebbioso M
Department of Ophthalmology, Polo Pontino, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Department of Sense Organs, Ocular Electrophysiology Center, Faculty of Medicine and Odontology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Eye (Lond). 2015 May;29(5):699-702. doi: 10.1038/eye.2014.344. Epub 2015 Feb 20.
To investigate long-term retinal changes after microincision pars plana vitrectomy surgery (MIVS) for macular hole (MH) in retinitis pigmentosa (RP) patients-retrospective and observational study.
Three RP patients suffering from MH were evaluated by means of best corrected visual acuity, anterior and posterior binocular examination, spectralis high-resolution optical coherence tomography, MP-1 microperimetry (MP-1), and full-field electroretinogram (ERG), before MIVS and during the 36-month follow-up. Patients underwent simultaneous MIVS and microincision cataract surgery; IOL was positioned in capsular bag. Patients were hospitalised for 2 days after the surgery. Surgical procedure was performed according the following schedule: surgical removal of crystalline lens, MIVS with 23-gauge sutureless system trocars, core vitreous body removal, peeling of the inner limiting membrane, and balanced sterile saline solution-air-micro-structured polydimethylsiloxane (PDMS) exchange. PDMS tamponade, after 6 months starting from MIVS, was removed.
In all patients visual acuity increased after vitrectomy as a consequence of complete MH closure and restoration of retinal architecture. None of the patients developed ocular hypertension, or re-opening of MH during the 3-year follow-up. MP-1 bivariate contour ellipse area was reduced in its dimensions and improved in all patients demonstrating a better fixation.
MIVS could be an effective treatment in RP patients with MH if medical therapy is not applicable or not sufficient. Finally more studies will be needed to improve knowledge about this genetic disease.
对患有黄斑裂孔（MH）的视网膜色素变性（RP）患者行扁平部微小切口玻璃体切除术（MIVS）后进行长期视网膜变化的调查——回顾性观察研究。
对3例患有MH的RP患者在MIVS术前及36个月随访期间，通过最佳矫正视力、双眼前后节检查、Spectralis高分辨率光学相干断层扫描、MP - 1微视野计（MP - 1）和全视野视网膜电图（ERG）进行评估。患者同时接受MIVS和微小切口白内障手术；人工晶状体植入囊袋内。术后患者住院2天。手术按以下步骤进行：晶状体摘除术、使用23G无缝合系统套管针行MIVS、去除核心玻璃体、剥除内界膜以及平衡盐溶液 - 空气 - 微结构聚二甲基硅氧烷（PDMS）置换。从MIVS开始6个月后取出PDMS填塞物。
所有患者玻璃体切除术后视力均因MH完全闭合和视网膜结构恢复而提高。3年随访期间，所有患者均未发生高眼压或MH再次裂开。所有患者的MP - 1双变量轮廓椭圆面积减小，注视功能改善。
如果药物治疗不适用或不足，MIVS可能是治疗患有MH的RP患者的有效方法。最后，需要更多研究来增进对这种遗传性疾病的了解。
