Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Rd, Taipei City, 10002, Taiwan, ROC.
School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan District, Taoyuan City, 33302, Taiwan, ROC.
Sci Rep. 2019 Nov 5;9(1):16030. doi: 10.1038/s41598-019-52447-4.
Differences in the pathogenesis and clinical characteristics between lamellar macular hole (LMH) with and without LMH-associated epiretinal proliferation (LHEP) can have surgical implications. This study investigated the effects of treating LHEP by foveolar internal limiting membrane (ILM) non-peeling and epiretinal proliferative (EP) tissue repositioning on visual acuity and foveolar architecture. Consecutive patients with LHEP treated at our institution were enrolled. The eyes were divided into a conventional total ILM peeling group (group 1, n = 11) and a foveolar ILM non-peeling group (group 2, n = 22). In group 2, a doughnut-shaped ILM was peeled, leaving a 400-μm-diameter ILM without elevated margin over the foveola after EP tissue repositioning. The EP tissue was elevated, trimmed, and inverted into the LMH. Postoperatively, the LMH was sealed in all eyes in group 2, with significantly better best-corrected visual acuity (-0.26 vs -0.10 logMAR; p = 0.002). A smaller retinal defect (p = 0.003), a more restored ellipsoid zone (p = 0.002), and a more smooth foveal depression (p < 0.001) were achieved in group 2. Foveolar ILM non-peeling and EP tissue repositioning sealed the LMH, released the tangential traction, and achieved better visual acuity. The presumed foveolar architecture may be reconstructed surgically. LMH with LHEP could have a combined degenerative and tractional mechanism.
层间黄斑裂孔（LMH）伴或不伴 LMH 相关的视网膜前增殖（LHEP）在发病机制和临床特征上存在差异，可能具有手术意义。本研究探讨了通过黄斑内界膜（ILM）不剥离和视网膜前增殖（EP）组织复位治疗 LHEP 对视力和黄斑中心凹结构的影响。连续纳入在我院治疗的 LHEP 患者。将这些眼分为常规全 ILM 剥离组（1 组，n=11）和黄斑内界膜非剥离组（2 组，n=22）。在 2 组中，切除环形 ILM，保留黄斑中心凹上方 400μm 直径的无抬举 ILM，然后将 EP 组织复位。抬高、修剪并翻转 EP 组织进入 LMH。术后，所有 2 组患者的 LMH 均闭合，最佳矫正视力明显提高（-0.26 比-0.10 logMAR；p=0.002）。2 组的视网膜缺损更小（p=0.003），椭圆体带恢复更好（p=0.002），黄斑中心凹凹陷更平滑（p<0.001）。黄斑内界膜不剥离和 EP 组织复位可封闭 LMH，释放切线牵引力，提高视力。黄斑中心凹的结构可能通过手术重建。伴有 LHEP 的 LMH 可能具有退行性和牵引性的混合发病机制。
