Schumann Ricarda G, Wolf Armin, Hoerauf Hans, Lommatzsch Albrecht, Maier Mathias, Wachtlin Joachim, Koss Michael J, Kreutzer Thomas, Bertelmann Thomas, Kazerounian Sara, Mennel Stefan, Priglinger Siegfried G
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Department of Ophthalmology, Georg-August-University, Göttingen, Germany.
Retina. 2017 Dec;37(12):2295-2303. doi: 10.1097/IAE.0000000000001473.
To determine functional and anatomical outcomes of pars plana vitrectomy for persistent full-thickness macular hole (MH) after intravitreal injection of ocriplasmin.
This is a multicenter retrospective interventional study of 37 eyes of 37 patients who underwent pars plana vitrectomy with internal limiting membrane peeling for persistent MH after ocriplasmin treatment between December 2013 and December 2015 and comparison with 35 eyes of 35 patients who were offered ocriplasmin injection but underwent pars plana vitrectomy alone without pharmacologic vitreolysis before surgery. In addition, 24 matched pairs (MH diameter at baseline ±5 µm) were analyzed. Clinical data such as visual acuity, intraoperative characteristics, and spectral domain optical coherence tomography images were reviewed. Main outcome measures were visual acuity and MH closure rate.
After a mean follow-up period of 9 months, postoperative mean visual acuity showed no significant differences between ocriplasmin-treated eyes (logarithm of minimum angle of resolution 0.37 ± 0.26, Snellen 20/47) and eyes without ocriplasmin treatment (logarithm of minimum angle of resolution 0.39 ± 0.25; Snellen 20/49) (P > 0.9). After ocriplasmin injection, mean MH diameter enlarged from 217 ± 102 µm to 384 ± 239 µm (P < 0.001). Matched-pair analysis revealed no difference in gain of visual acuity between the first visit and the last follow-up (P = 0.29). Macular hole closure was observed in similar proportion in ocriplasmin-treated eyes (97%) and vitrectomy-only eyes (94%) (P > 0.5).
Eyes with persistent MH after ocriplasmin injection showed significant visual improvement after pars plana vitrectomy. Matched-pair analysis revealed no statistical differences in functional and anatomical postoperative results comparing with eyes of similar MH diameter that proceeded directly to surgery without ocriplasmin pretreatment.
确定玻璃体内注射奥克纤溶酶后，经扁平部玻璃体切除术治疗持续性全层黄斑裂孔（MH）的功能和解剖学结果。
这是一项多中心回顾性干预研究，对2013年12月至2015年12月期间接受奥克纤溶酶治疗后因持续性MH而接受经扁平部玻璃体切除术联合内界膜剥除术的37例患者的37只眼进行研究，并与35例患者的35只眼进行比较，这些患者接受了奥克纤溶酶注射，但术前仅接受经扁平部玻璃体切除术，未进行药物性玻璃体溶解。此外，分析了24对匹配的病例（基线黄斑裂孔直径±5μm）。回顾了诸如视力、术中特征和频域光学相干断层扫描图像等临床数据。主要观察指标为视力和黄斑裂孔闭合率。
平均随访9个月后，奥克纤溶酶治疗组的术后平均视力（最小分辨角对数0.37±0.26，Snellen视力表20/47）与未接受奥克纤溶酶治疗组的术后平均视力（最小分辨角对数0.39±0.25；Snellen视力表20/49）之间无显著差异（P>0.9）。注射奥克纤溶酶后，黄斑裂孔平均直径从217±102μm扩大至384±239μm（P<0.001）。配对分析显示，首次就诊与最后一次随访之间的视力提高无差异（P=0.29）。奥克纤溶酶治疗组（97%）和单纯玻璃体切除组（94%）的黄斑裂孔闭合比例相似（P>0.5）。
奥克纤溶酶注射后仍存在持续性黄斑裂孔的眼，经扁平部玻璃体切除术后视力有显著改善。配对分析显示，与未接受奥克纤溶酶预处理而直接进行手术的黄斑裂孔直径相似的眼相比，术后功能和解剖学结果无统计学差异。
