Purtskhvanidze K, Balken L, Hamann T, Wöster L, von der Burchard C, Roider J, Treumer Felix
Department of Ophthalmology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, building 25, 24105, Kiel, Germany.
Graefes Arch Clin Exp Ophthalmol. 2018 Jun;256(6):1067-1078. doi: 10.1007/s00417-018-3972-2. Epub 2018 Apr 6.
To assess morphological and functional changes of lamellar macular holes and pseudoholes with or without vitrectomy and membrane peeling with at least 5 years follow-up.
Retrospective study of 73 eyes with lamellar macular hole (LH, n = 28), macular pseudohole (PH, n = 31), and pseudohole with cleaved edges (cleavedPH, n = 14). Forty-six eyes were merely observed without vitreoretinal intervention (observation group), and 27 eyes underwent vitrectomy with membrane peeling (vitrectomy group). Outcome measures were best corrected visual acuity (BCVA) and morphological retinal parameters evaluated with optical coherence tomography (TD-OCT and SD-OCT).
Mean follow-up was 8.3 years (5-12); mean age was 67 years (46-84). In the observation group, median BCVA (logMAR) at first exam was 0.2 (LH), 0.1 (PH), 0.2 (cleavedPH) and at last exam 0.3 (LH, p = 0.02), 0.2 (PH), 0.15 (cleavedPH). In the vitrectomy group, median BCVA at first exam was 0.4 (LH), 0.3 (PH), 0.25 (cleavedPH); before vitrectomy BCVA was 0.5 (LH), 0.35 (PH), 0.35 (cleavedPH); and at last exam BCVA increased to 0.3 (LH), 0.2 (PH, p < 0.05), 0.1 (cleavedPH, p < 0.05). At last exam, BCVA of LH was significantly worse compared to PH and cleavedPH. In the observation group, 6 of 29 eyes with PH or cleavedPH showed a spontaneous resolution of the epiretinal membrane with improvement of the foveal contour. Nine of 16 eyes with LH and 2/20 eyes with PH presented lamellar hole-associated epiretinal proliferation (LHEP) in SD-OCT.
LH, PH, and cleavedPH are often stable over a very long time. LH tends to worse visual function compared to PH and cleavedPH. A spontaneous separation of epiretinal membranes in the long-term is not uncommon. Vitreoretinal intervention should be considered in cases with significant visual loss or functional and morphological progression.
评估板层黄斑裂孔和假性裂孔在接受或未接受玻璃体切除术及视网膜前膜剥除术情况下的形态和功能变化，并进行至少5年的随访。
对73只眼进行回顾性研究，其中包括板层黄斑裂孔（LH，n = 28）、黄斑假性裂孔（PH，n = 31）和边缘裂开的假性裂孔（裂开的PH，n = 14）。46只眼仅接受观察，未进行玻璃体视网膜干预（观察组），27只眼接受了玻璃体切除术及视网膜前膜剥除术（玻璃体切除术组）。观察指标为最佳矫正视力（BCVA）以及使用光学相干断层扫描（TD - OCT和SD - OCT）评估的视网膜形态学参数。
平均随访时间为8.3年（5 - 12年）；平均年龄为67岁（46 - 84岁）。在观察组中，初次检查时LH的BCVA中位数（logMAR）为0.2，PH为0.1，裂开的PH为0.2；末次检查时LH为0.3（p = 0.02），PH为0.2，裂开的PH为0.15。在玻璃体切除术组中，初次检查时LH的BCVA中位数为0.4，PH为0.3，裂开的PH为0.25；玻璃体切除术前LH为0.5，PH为0.35，裂开的PH为0.35；末次检查时LH的BCVA提高到0.3，PH为0.2（p < 0.05），裂开的PH为0.1（p < 0.05）。末次检查时，LH的BCVA明显差于PH和裂开的PH。在观察组中，29只患有PH或裂开的PH的眼中，有6只视网膜前膜自发消退，黄斑轮廓改善。16只患有LH的眼中有9只，20只患有PH的眼中有2只在SD - OCT上出现了板层裂孔相关的视网膜前增殖（LHEP）。
LH、PH和裂开的PH通常在很长一段时间内保持稳定。与PH和裂开的PH相比，LH往往导致更差的视觉功能。视网膜前膜的长期自发分离并不罕见。对于有明显视力丧失或功能及形态进展的病例，应考虑进行玻璃体视网膜干预。
