Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Department of Ophthalmology, Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
Br J Ophthalmol. 2019 Feb;103(2):245-250. doi: 10.1136/bjophthalmol-2017-311770. Epub 2018 Apr 2.
To determine whether the internal limiting membrane (ILM) insertion technique is as effective as the inverted ILM flap technique for the initial surgical treatment of eyes with large idiopathic macular holes (MHs).
This retrospective, non-randomised, comparative clinical study included 41 eyes with large MHs (minimum diameter >500 µm) that were treated using the ILM insertion technique or the inverted ILM flap technique. The hole closure rate, postoperative best corrected visual acuity (BCVA) and swept source optical coherence tomography findings were analysed at 6 months after surgery.
There were 15 and 26 eyes in the insertion and inverted flap groups, respectively. Hole closure was achieved in all eyes. The mean final BCVA was better in the inverted flap group than in the insertion group (0.527 vs 0.773, p=0.006), although significant postoperative improvements were observed in both groups (p<0.001). Postoperative foveal discolouration was more common in the insertion group than in the inverted flap group (86.7% vs 7.7%, p<0.001). Complete resolution of ellipsoid zone and external limiting membrane defects was observed in 7 and 18 eyes, respectively, in the inverted flap group; in contrast, complete resolution was not observed in any of the eyes in the insertion group (p=0.035 and p<0.001, respectively).
The ILM insertion technique may be as effective as the inverted ILM flap technique for the closure of large MHs. However, the latter technique results in better recovery of photoreceptor layers and, consequently, better postoperative visual acuity.
为了确定内界膜（ILM）插入技术是否与翻转 ILM 瓣技术一样有效，作为治疗特发性大孔性黄斑水肿（MH）的初始手术方法。
本回顾性、非随机、对照临床研究纳入了 41 只患有大 MH（最小直径>500μm）的眼睛，这些眼睛分别接受 ILM 插入技术或翻转 ILM 瓣技术治疗。术后 6 个月分析孔闭合率、术后最佳矫正视力（BCVA）和扫频源光学相干断层扫描（OCT）结果。
插入组和翻转瓣组分别有 15 只和 26 只眼睛。所有眼睛均达到孔闭合。翻转瓣组的平均最终 BCVA 优于插入组（0.527 比 0.773，p=0.006），尽管两组术后视力均有显著改善（p<0.001）。插入组术后黄斑区变色比翻转瓣组更常见（86.7%比 7.7%，p<0.001）。翻转瓣组中有 7 只眼的椭圆体带和外界膜缺陷完全恢复，18 只眼完全恢复；而插入组中没有一只眼完全恢复（p=0.035 和 p<0.001）。
ILM 插入技术可能与翻转 ILM 瓣技术一样有效，用于闭合大 MH。然而，后者技术可更好地恢复光感受器层，从而提高术后视力。
