Essex Rohan W, Hunyor Alex P, Moreno-Betancur Margarita, Yek John T O, Kingston Zabrina S, Campbell William G, Connell Paul P, McAllister Ian L
Academic Unit of Ophthalmology, Australian National University, Canberra, Australia.
Save Sight Institute, University of Sydney, Australia.
Ophthalmol Retina. 2018 Nov;2(11):1143-1151. doi: 10.1016/j.oret.2018.04.022. Epub 2018 Jun 28.
To present the visual and safety outcomes of surgery for primary idiopathic macular holes including predictors of visual acuity and the impact of combined phacovitrectomy surgery.
Registry-style, prospective, nonrandomized, observational cohort study.
Patients with idiopathic macular holes undergoing primary surgery.
Surgeons were invited to submit clinical details of all macular hole cases receiving surgery. Baseline demographic and clinical information, and details of surgical intervention were collected. Primary follow-up data were collected at 3 months postoperatively or before revision surgery, and surgeons were also asked to submit data at 12 and 24 months postoperatively.
Visual acuity improvement ≥15 letters and ≥0 letters, change in mean visual acuity, visual acuity ≥70 letters (20/40), retinal detachment, and endophthalmitis.
A total of 2455 eyes of 2366 patients were included in the study, and hole closure was achieved in 95.6% of eyes with a single procedure. Mean baseline vision was 48.3 letters. The proportion of successful eyes improving ≥15 letters at 3, 12, and 24 months was 59.1%, 69.4%, and 68.2%, respectively. The mean improvement in acuity at 3, 12, and 24 months was 16.0, 19.2, and 23.6 letters, and 92.4%, 93.4%, and 95.8% improved ≥0 letters at 3, 12, and 24 months, respectively. Eyes receiving SF6 gas had better visual acuities at all time points postoperatively (adjusted effect 3.4, 3.1, and 4.6 letters better at 3, 12, and 24 months vs. longer-acting gas, respectively). Combined phacovitrectomy in phakic eyes was associated with better corrected visual acuity postoperatively (vs. vitrectomy surgery alone), a difference that vanished when eyes went on to have subsequent cataract surgery. The rate of retinal detachment postoperatively was 1.3%, and the odds of detachment were greater in eyes receiving longer-acting gases versus SF6 gas (adjusted odds ratio, 2.2; 95% confidence interval, 1.04-4.77; P = 0.039). There were no reported cases of endophthalmitis.
Macular hole surgery substantially improved acuity in approximately two thirds of patients and was seldom associated with loss of vision. SF6 gas was associated with better visual outcomes, an effect that warrants further study.
介绍原发性特发性黄斑裂孔手术的视力和安全性结果，包括视力的预测因素以及晶状体玻璃体切除术联合手术的影响。
登记式、前瞻性、非随机、观察性队列研究。
接受原发性手术的特发性黄斑裂孔患者。
邀请外科医生提交所有接受手术的黄斑裂孔病例的临床细节。收集基线人口统计学和临床信息以及手术干预细节。术后3个月或翻修手术前收集主要随访数据，同时要求外科医生在术后12个月和24个月提交数据。
视力提高≥15行和≥0行、平均视力变化、视力≥70行（20/40）、视网膜脱离和眼内炎。
该研究共纳入2366例患者的2455只眼，单次手术使95.6%的患眼裂孔闭合。平均基线视力为48.3行。术后3个月、12个月和24个月视力提高≥15行的成功患眼比例分别为59.1%、69.4%和68.2%。术后3个月、12个月和24个月的平均视力提高分别为16.0行、19.2行和23.6行，术后3个月、12个月和24个月视力提高≥0行的患眼比例分别为92.4%、93.4%和95.8%。接受SF6气体的患眼在术后所有时间点的视力均更好（与长效气体相比，术后3个月、12个月和24个月的调整效应分别好3.4行、3.1行和4.6行）。有晶状体眼的晶状体玻璃体切除术联合手术与术后更好的矫正视力相关（与单纯玻璃体切除术相比），但当患眼随后进行白内障手术时，这种差异消失。术后视网膜脱离发生率为1.3%，接受长效气体的患眼发生视网膜脱离的几率高于接受SF6气体的患眼（调整后的优势比为2.2；95%置信区间为1.04 - 4.77；P = 0.039）。未报告眼内炎病例。
黄斑裂孔手术使约三分之二的患者视力显著提高，且很少导致视力丧失。SF6气体与更好的视力结果相关，这一效应值得进一步研究。
