Hu Zhixiang, Lin Haishuang, Liang Qihua, Wu Ronghan
Eye Hospital of Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang Province, China.
Int Ophthalmol. 2020 Jan;40(1):141-149. doi: 10.1007/s10792-019-01162-0. Epub 2019 Aug 28.
To compare the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique and the autologous blood clot (ABC) to ILM insertion technique for the repair of refractory macular hole (RMH).
Fifty-two consecutive patients (52 eyes) diagnosed with RMH with a minimum diameter more than 700 µm were enrolled. All patients underwent vitrectomy and gas tamponade. Of these, 25 patients undergo inverted ILM flap combination with ABC (Group A). The remaining 27 patients underwent ILM insertion (Group B). The main outcome measures were macular hole (MH) closure, foveal configuration, logarithm of the minimum angle of resolution (logMAR), best-corrected visual acuity (BCVA), superficial foveal avascular zone (FAZ) and superficial parafoveal vessel density.
Three months post-operation, MH was successfully anatomic closed in 24 of 25 eyes (96%) in Group A and 25 of 27 eyes (92.5%) in Group B (P = 0.599). A concave foveal configuration of MH closure was observed in 23 of 25 eyes (92%) in Group A and 2 of 27 eyes (7.4%) in Group B (P < 0.001). Mean BCVA (logMAR) had improved from 1.31 ± 0.61 to 0.68 ± 0.40 in Group A (P < 0.001) and from 1.34 ± 0.39 to 1.29 ± 0.62 in Group B (P = 0.584) at 3 months. Average superficial FAZ area and superficial parafoveal vessel density were 0.29 ± 0.08 mm and 51.41 ± 2.79% in Group A and 0.73 ± 0.15 mm and 43.77 ± 2.71% in Group B, respectively. There was a significant difference in both the average superficial FAZ area and parafoveal vessel density between Groups A and B (P < 0.001 for both).
Anatomical foveal configuration, mean BCVA (logMAR), mean superficial FAZ and parafoveal vessel density outcomes for the inverted ILM flap combined with ABC approach were better than the outcomes obtained with ILM insertion in the treatment of RMH. This approach may promote better long-term, vision function outcomes for patients diagnosed with RMH.
比较内界膜（ILM）翻转瓣技术和自体血凝块（ABC）注入ILM技术修复难治性黄斑裂孔（RMH）的解剖学和功能学结果。
纳入52例连续诊断为RMH且最小直径超过700 µm的患者（52只眼）。所有患者均接受玻璃体切除术和气体填塞。其中，25例患者采用ILM翻转瓣联合ABC治疗（A组）。其余27例患者接受ILM植入术（B组）。主要观察指标包括黄斑裂孔（MH）闭合情况、黄斑中心凹形态、最小分辨角对数（logMAR）、最佳矫正视力（BCVA）、黄斑中心凹无血管区（FAZ）表面及黄斑中心凹旁浅层血管密度。
术后3个月，A组25只眼中24只（96%）MH成功实现解剖学闭合，B组27只眼中25只（92.5%）实现解剖学闭合（P = 0.599）。A组25只眼中23只（92%）MH闭合呈现凹形黄斑中心凹形态，B组27只眼中2只（7.4%）呈现该形态（P < 0.001）。3个月时，A组平均BCVA（logMAR）从1.31 ± 0.61改善至0.68 ± 0.40（P < 0.001），B组从1.34 ± 0.39改善至1.29 ± 0.62（P = 0.584）。A组平均FAZ表面面积和黄斑中心凹旁浅层血管密度分别为0.29 ± 0.08 mm和51.41 ± 2.79%，B组分别为0.73 ± 0.15 mm和43.77 ± 2.71%。A组和B组在平均FAZ表面面积和黄斑中心凹旁血管密度方面均存在显著差异（两者P均< 0.001）。
在RMH治疗中，ILM翻转瓣联合ABC方法的黄斑中心凹解剖形态、平均BCVA（logMAR）、平均FAZ表面及黄斑中心凹旁血管密度结果均优于ILM植入术。该方法可能为诊断为RMH的患者带来更好的长期视觉功能预后。
