Department of Ophthalmology, University of Padova, Padova, Italy,
Department of Ophthalmology, University of Padova, Padova, Italy.
Ophthalmologica. 2019;242(1):49-58. doi: 10.1159/000496297. Epub 2019 Feb 8.
To propose a new technique of a double inverted epiretinal membrane (ERM) and internal limiting membrane (ILM) flap (double flap group) for the treatment of idiopathic lamellar macular hole (LMH) with atypical ERM (AERM) and to compare surgical outcomes to those of the standard technique of ERM and ILM peeling of the fovea including LMH (control group).
AERM was tomographically defined as a medium reflective thickened membrane above the retinal fiber layers without retinal traction signs. A series of patients affected by LMH with AERM were recruited. Preoperative parameters were: intraretinal cysts (IRC), intraretinal splitting diameter, residual foveal thickness, and ellipsoid zone integrity. Postoperative findings were: full-thickness macular hole (FTMH) development, and persistence or new appearance of IRC. Best-corrected visual acuity (BCVA) at baseline, first, third, and sixth postoperative month was evaluated.
A total of 48 eyes of 48 patients were included in this study. In the double flap group (30 eyes), a clear improvement of BCVA was noted (p = 0.004), and there were no complications. In the control group (18 eyes), BCVA did not improve and 3 patients developed postoperative FTMH.
The double inverted flap technique is associated with better functional recovery compared to the standard technique and reduces the risk of postoperative FTMH development.
提出一种新的双反转内界膜（ILM）和视网膜内界膜（ERM）瓣技术（双瓣组），用于治疗具有非典型 ERM（AERM）的特发性板层黄斑裂孔（LMH），并将手术结果与标准的 ERM 和黄斑裂孔（包括 fovea 的 LMH）的 ILM 剥除技术（对照组）进行比较。
AERM 在视网膜纤维层上方的中等反射增厚的膜被断层成像定义为具有无视网膜牵引迹象的病理性 ERM。招募了一系列患有 AERM 的 LMH 患者。术前参数包括：视网膜内囊泡（IRC）、视网膜内分离直径、残余黄斑中心凹厚度和椭圆体带完整性。术后发现：全层黄斑裂孔（FTMH）的发展，以及 IRC 的持续或新出现。在基线、第一、第三和第六术后月评估最佳矫正视力（BCVA）。
本研究共纳入 48 例 48 只眼。在双瓣组（30 只眼）中，BCVA 明显改善（p = 0.004），且无并发症。在对照组（18 只眼）中，BCVA 没有改善，3 例患者术后发生 FTMH。
与标准技术相比，双反转瓣技术与更好的功能恢复相关，并降低了术后 FTMH 发展的风险。
