Horiguchi Masayuki, Tanikawa Atsuhiro, Mizuguchi Tadashi, Tanaka Hidenori, Sugimoto Mitsuo, Shimada Yoshiaki
Department of Ophthalmology, Fujita Health University School of Medicine, Toyoake, Japan.
Department of Ophthalmology, Fujita Health University School of Medicine, Toyoake, Japan.
Ophthalmol Retina. 2017 Sep-Oct;1(5):421-427. doi: 10.1016/j.oret.2017.01.010. Epub 2017 Mar 14.
To study the effect of an inverted internal limiting membrane (ILM) flap on the retina.
Prospective case series.
Twenty-nine patients with large (>400 μm) unilateral macular holes underwent surgery using a modified inverted ILM flap technique.
The macular ILM was peeled, and a large (2-3 disc diameter) ILM flap was made on the superior side of the hole, and then the flap was inverted on the inferior side.
In all patients, multifocal electroretinograms (mfERGs) were recorded from operated eyes and normal fellow eyes. The peak time and amplitude of N1, P1, and N2 in the focal ERG from the upper retina without the ILM flap and those from the lower retina with the ILM flap were evaluated. In 14 patients, microperimetry was also performed in both eyes, and the averaged sensitivity was measured from the upper and lower areas.
The peak times of P1 and N2 from the upper and lower retina were significantly longer in operated eyes than in the fellow eyes (P1 upper and lower: P < 0.04, N2 upper: P < 0.01, and N2 lower: P < 0.04), although we could not identify a significant difference in peak time and amplitude of N1, P1, and N2 between the upper retina and lower retina in both eyes (fellow eye-N1 amplitude: P > 0.2, N1 peak time: P > 0.5, P1 amplitude: P > 0.9, P1 peak time: P > 0.4, N2 amplitude: P > 0.9, N2 peak time: P > 0.9; operated eye-N1 amplitude: P > 0.8, N1 peak time: P > 0.4, P1 amplitude: P > 0.6, P1 peak time: P > 0.4, N2 amplitude: P > 0.9, N2 peak time: P > 0.9). We could not observe a significant difference in sensitivity between the upper and lower retinas in both eyes (fellow eye: P = 0.28, operated eye: P = 0.66).
The results of this study revealed no significant difference between the upper retina without the ILM flap and the lower retina with the ILM flap, suggesting that an inverted ILM flap has little effect on retinal function.
研究倒置的内界膜（ILM）瓣对视网膜的影响。
前瞻性病例系列研究。
29例单侧黄斑裂孔较大（>400μm）的患者接受了改良的倒置ILM瓣技术手术。
剥除黄斑区ILM，在裂孔上方制作一个大的（2 - 3视盘直径）ILM瓣，然后将瓣翻转至下方。
对所有患者，记录手术眼和正常对侧眼的多焦视网膜电图（mfERGs）。评估无ILM瓣的上方视网膜和有ILM瓣的下方视网膜的局部视网膜电图中N1、P1和N2的峰时及波幅。对14例患者，还对双眼进行了微视野检查，并测量上下区域的平均敏感度。
手术眼上方和下方视网膜P1和N2的峰时均显著长于对侧眼（P1上方和下方：P < 0.04，N2上方：P < 0.01，N2下方：P < 0.04），尽管我们未发现双眼上方视网膜和下方视网膜之间N1、P1和N2的峰时及波幅有显著差异（对侧眼 - N1波幅：P > 0.2，N1峰时：P > 0.5，P1波幅：P > 0.9，P1峰时：P > 0.4，N2波幅：P > 0.9，N2峰时：P > 0.9；手术眼 - N1波幅：P > 0.8，N1峰时：P > 0.4，P1波幅：P > 0.6，P1峰时：P > 0.4，N2波幅：P > 0.9，N2峰时：P > 0.9）。我们未观察到双眼上下视网膜之间敏感度有显著差异（对侧眼：P = 0.28，手术眼：P = 0.66）。
本研究结果显示无ILM瓣的上方视网膜和有ILM瓣的下方视网膜之间无显著差异，提示倒置的ILM瓣对视网膜功能影响较小。
