Shakya Kiran, Pokharel Ram Prasad, Malla Om Krishna
Department of Ophthalmology Kathmandu Medical College Teaching Hospital Kathmandu.
Nepal J Ophthalmol. 2019 Jan;11(21):29-32. doi: 10.3126/nepjoph.v11i1.25414.
Large macular holes are not uncommon among Nepalese women population causing severe visual problem.
To evaluate the technique of inverted internal limiting membrane (ILM) flaps for the repairment of large macular holes.
All 10 macular holes (diameter > 400 μm) were treated with pars planavitrectomy with inverted ILM flap technique. The procedure for macular hole surgerywas pars plana vitrectomy, posterior vitreous removal, internal limiting membrane(ILM) peeling with brilliant blue assisted, inverting ILM flap into macular hole, filling of the vitreous cavity with a gas bubble(C3 F8) and post-operative face-down positioning for 1 week. SD OCT images were taken preoperative and postoperative 1 month and 3 months follow up to assess the anatomical outcome of surgery and best corrected visual acuity (BCVA) was used to evaluate the functional outcome during each visit. The BCVA was recorded using the Snellen chart and was converted to the logarithm of the minimum angle of resolution (LogMAR) equivalents.
All 10 eyes had complete anatomical closure. The mean age of patients was 64.3 ± 7.53 years. The mean macular hole base diameter was 1039.4 μm (663-1526μm). Mean BVCA pre-operatively was 1.29 log MAR ±SD 0.25. Post-operatively, mean BCVA was 0.925 log MAR ±SD 0.143 (p= 0.002). There were no intra operative or post-operative complications. All the patients were followed up for a period of 3months.
Inverted ILM flaps is effective for closure of the large macular hole and restoration of functional vision.
大的黄斑裂孔在尼泊尔女性人群中并不罕见，会导致严重的视力问题。
评估倒置内界膜（ILM）瓣修复大黄斑裂孔的技术。
所有10个黄斑裂孔（直径>400μm）均采用经平坦部玻璃体切除术联合倒置ILM瓣技术进行治疗。黄斑裂孔手术步骤为经平坦部玻璃体切除术、切除玻璃体后皮质、在亮蓝辅助下剥除内界膜、将ILM瓣倒置入黄斑裂孔、用气泡（C3F8）填充玻璃体腔并术后面朝下体位保持1周。术前、术后1个月和3个月随访时拍摄SD OCT图像以评估手术的解剖学结果，每次随访时使用最佳矫正视力（BCVA）评估功能结果。使用Snellen视力表记录BCVA，并将其转换为最小分辨角对数（LogMAR）等效值。
所有10只眼均实现解剖学上的完全闭合。患者的平均年龄为64.3±7.53岁。黄斑裂孔的平均基底直径为1039.4μm（663 - 1526μm）。术前平均BCVA为1.29 log MAR±标准差0.25。术后，平均BCVA为0.925 log MAR±标准差0.143（p = 0.002）。术中及术后均无并发症。所有患者均随访3个月。
倒置ILM瓣对闭合大黄斑裂孔及恢复功能性视力有效。
