Department of Ophthalmology, Peking Union Medical College Hospital, No.1 Shuai fu yuan, Dongcheng District, 100730, Beijing, China.
Eye (Lond). 2019 Jan;33(1):136-143. doi: 10.1038/s41433-018-0098-z. Epub 2018 Sep 5.
To evaluate the efficacy of intravitreal injection (IVI) of expansile gas to treat primary full-thickness macular hole (FTMH).
Prospective interventional case series. Twenty-six eyes of 26 patients in Peking Union Medical College Hospital with primary FTMH underwent IVI of perfluoropropane (CF) 0.2 ml, followed by 7-14 days' face-down positioning. The macular hole closure rate, post-operative visual acuity, and the incidence of surgical complications were observed. The correlation between the patients' age, macular hole diameter, pre-operative best-corrected visual acuity (BCVA), status of the vitreous, and the macular hole closure rates were analyzed.
A total of 17 cases (65.4%) had hole closure after IVI of CF alone. The closure rate of small, medium, and large FTMH was 85.7, 80, and 33.3%, respectively. Pre-operative OCT examination showed that 10 cases (37%) had vitreomacular traction (VMT), and all of them achieved vitreous-macula separation after IVI of the gas. The diameters of the hole (P = 0.024) and the status of the vitreous (P = 0.038) had a significance difference for hole closure. The mean pre-operative and post-operative BCVA was 0.84 ± 0.29 and 0.49 ± 0.36 (logMAR), respectively (P < 0.01). One myope with persistent hole developed rhegmatogenous retinal detachment (RRD) 2 months after the surgery. Another myope with hole closure developed RRD 10 months after the surgery. They achieved hole closure and retinal reattachment after vitrectomy and scleral buckling, respectively.
Intravitreal injection of CF gas alone was an effective treatment for small-sized and medium-sized primary FTMH, but further large prospective studies are needed.
评估膨胀性气体玻璃体腔内注射（IVI）治疗原发性全层黄斑裂孔（FTMH）的疗效。
前瞻性干预性病例系列研究。北京协和医院 26 例（26 只眼）原发性 FTMH 患者行 0.2ml 全氟丙烷（CF）IVI，随后行 7-14 天面朝下体位。观察黄斑裂孔闭合率、术后视力和手术并发症的发生率。分析患者年龄、黄斑裂孔直径、术前最佳矫正视力（BCVA）、玻璃体状态与黄斑裂孔闭合率的相关性。
单纯 CF IVI 后共有 17 例（65.4%）裂孔闭合。小、中、大 FTMH 的闭合率分别为 85.7%、80%和 33.3%。术前 OCT 检查发现 10 例（37%）存在玻璃体黄斑牵拉（VMT），所有患者在接受气体注射后均发生玻璃体-黄斑分离。裂孔直径（P=0.024）和玻璃体状态（P=0.038）对裂孔闭合有显著影响。平均术前和术后 BCVA 分别为 0.84±0.29 和 0.49±0.36（logMAR）（P<0.01）。1 例近视患者术后 2 个月出现孔源性视网膜脱离（RRD），1 例孔闭合患者术后 10 个月出现 RRD，均经玻璃体切割联合巩膜扣带术成功闭合裂孔并复位视网膜。
单纯 CF 气体玻璃体腔内注射是治疗小、中型原发性 FTMH 的有效方法，但需要进一步开展大型前瞻性研究。
