Takahashi Kosuke, Morizane Yuki, Kimura Shuhei, Shiode Yusuke, Doi Shinichiro, Okanouchi Toshio, Takasu Ippei, Inoue Yasushi, Shiraga Fumio
Department of Ophthalmology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho Kita-ku,, Okayama City, Okayama, 700-8558, Japan.
Kurashiki Medical Center, Okayama, Japan.
Graefes Arch Clin Exp Ophthalmol. 2019 Oct;257(10):2147-2154. doi: 10.1007/s00417-019-04425-9. Epub 2019 Jul 24.
To investigate the outcomes of embedding lamellar hole-associated epiretinal proliferation (LHEP) into retinal cleavage for the surgical treatment of degenerative lamellar macular hole (LMH).
We retrospectively reviewed the medical records of 34 consecutive eyes of degenerative LMH patients who underwent vitrectomy with LHEP embedding and who were followed up for at least 12 months. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and macular structure preoperatively and at the final follow-up were compared.
The mean (±SD) follow-up period was 30.0 ± 17.7 months. Twelve patients (35.3%) were men, and the mean age was 69.6 ± 10.1 years. Twenty-three eyes (67.6%) underwent simultaneous cataract surgery. BCVA was significantly improved at the final visit, from 0.31 ± 0.25 logarithm of the minimum angle of resolution units to 0.10 ± 0.25 (P < 0.01). This improvement in mean BCVA at the final postoperative visit occurred regardless of whether the eyes underwent simultaneous cataract surgery, from 0.30 ± 0.26 preoperatively to 0.04 ± 0.16 (P < 0.01) in the "with cataract surgery" group and from 0.32 ± 0.26 preoperatively to 0.21 ± 0.35 (P < 0.05) in the "without cataract surgery" group. CRT was also significantly improved at the final visit, from 123.2 ± 42.6 μm preoperatively to 191.2 ± 42.6 μm (P < 0.01). External limiting membrane and ellipsoid zone defects were detected in 17 (50.0%) and 15 (44.1%) eyes, respectively, but these were resolved in 10 (58.8%) and 7 (46.7%) eyes, respectively, at the final visit. No intraoperative or postoperative complications were observed.
Embedding LHEP may be an effective and safe procedure to treat degenerative LMH.
探讨将板层孔相关视网膜前增殖（LHEP）嵌入视网膜劈裂处治疗退行性板层黄斑裂孔（LMH）的手术效果。
我们回顾性分析了34例接受LHEP嵌入玻璃体切除术且随访至少12个月的退行性LMH患者的连续眼部病历。比较术前和末次随访时的最佳矫正视力（BCVA）、视网膜中央厚度（CRT）和黄斑结构。
平均（±标准差）随访时间为30.0±17.7个月。12例患者（35.3%）为男性，平均年龄为69.6±10.1岁。23只眼（67.6%）同时接受了白内障手术。末次随访时BCVA显著改善，从术前最小分辨角对数单位的0.31±0.25提高到0.10±0.25（P<0.01）。无论眼睛是否同时接受白内障手术，术后末次随访时平均BCVA均有改善，“白内障手术组”术前为0.30±0.26，术后为0.04±0.16（P<0.01），“无白内障手术组”术前为0.32±0.26，术后为0.21±0.35（P<0.05）｡末次随访时CRT也显著改善，从术前的123.2±42.6μm提高到191.2±42.6μm（P<0.01）。分别在17只眼（50.0%）和15只眼（44.1%）中检测到外限制膜和椭圆体带缺陷，但在末次随访时分别有10只眼（58.8%）和7只眼（46.7%）的这些缺陷得到解决。未观察到术中或术后并发症。
嵌入LHEP可能是治疗退行性LMH的一种有效且安全的方法。
