Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmol Retina. 2020 Apr;4(4):369-376. doi: 10.1016/j.oret.2019.09.015. Epub 2019 Oct 2.
To evaluate the structural and visual outcomes after pars plana vitrectomy (PPV) for idiopathic full-thickness macular hole (MH) with at least 5 years of follow-up information.
Retrospective case series.
Patients with idiopathic MH who had at least 5 years of follow-up information after PPV.
Best-corrected visual acuity (BCVA) was recorded preoperatively and, when available, at 1, 2, 3, 5, 8, and 10 years after surgery. Reestablishment of the postoperative integrity of the ellipsoid zone (EZ) and the external limiting membrane (ELM) and presence of cystoid spaces were evaluated using spectral-domain (SD) OCT.
Postoperative BCVA and its correlation with different SD OCT parameters.
Eighty-seven eyes of 80 patients with a mean age at surgery of 68.9±7.03 years were included. The mean postoperative follow-up was 9.6±4.3 years (median, 9 years; range, 5-22 years). The mean preoperative BCVA was 0.20±0.14 (range, 0.03-0.66). Postoperative BCVA was improved at all time points compared with preoperative BCVA (P < 0.05). Improvement in the postoperative BCVA remained stable 10 years after surgery. Initial successful closure of MH was achieved in 82 eyes (94%). Macular hole reopening occurred in 7 eyes (8.0%). Eleven eyes (13%) were reoperated: 4 eyes (4.5%) for persistence and 7 eyes (8.0%) for reopening of MH. Indocyanine green (ICG) stain was used in 22 eyes (25.2%). Among 57 patients (66%) who were phakic before surgery, 52 eyes (91.2%) underwent cataract extraction after PPV at a mean duration of 32.7±38.5 months (range, 2-187 months). Postoperative EZ integrity was restored in 52 eyes (60%), ELM integrity was restored in 54 eyes (62%), and cystoid spaces of variable severity were observed in 28 eyes (32%). Preoperative BCVA of 20/60 or better and postoperative reestablished ELM and EZ integrity were associated significantly with better postoperative BCVA at different postoperative follow-up visits (P < 0.05).
Visual acuity improvement after MH surgery continued during the first 3 years after PPV and was maintained thereafter in a substantial fraction of patients, and final BCVA correlated with better preoperative BCVA and better postoperative OCT parameters.
评估特发性全层黄斑孔（MH）行玻璃体切除术（PPV）后至少 5 年的结构和视觉结果。
回顾性病例系列。
接受 PPV 治疗且至少有 5 年随访信息的特发性 MH 患者。
记录术前最佳矫正视力（BCVA），并在术后 1、2、3、5、8 和 10 年时（如果有）进行记录。使用谱域（SD）OCT 评估术后后椭圆体带（EZ）和外部限制膜（ELM）的完整性以及是否存在囊样空间。
术后 BCVA 及其与不同 SD OCT 参数的相关性。
纳入 80 例 87 只眼患者，平均手术年龄为 68.9±7.03 岁。平均术后随访时间为 9.6±4.3 年（中位数为 9 年；范围为 5-22 年）。平均术前 BCVA 为 0.20±0.14（范围为 0.03-0.66）。与术前 BCVA 相比，所有时间点的术后 BCVA 均得到改善（P <0.05）。术后 BCVA 的改善在手术后 10 年保持稳定。初始 MH 成功闭合 82 只眼（94%）。7 只眼（8.0%）出现 MH 再开放。11 只眼（13%）接受了再次手术：4 只眼（4.5%）为持续性，7 只眼（8.0%）为 MH 再开放。22 只眼（25.2%）使用吲哚菁绿（ICG）染色。在术前为 57 例（66%）的白内障患者中，52 只眼（91.2%）在 PPV 后平均 32.7±38.5 个月（范围为 2-187 个月）时行白内障摘除术。术后 52 只眼（60%）的 EZ 完整性得到恢复，54 只眼（62%）的 ELM 完整性得到恢复，28 只眼（32%）观察到不同严重程度的囊样空间。术前 BCVA 为 20/60 或更好和术后重新建立的 ELM 和 EZ 完整性与不同术后随访时更好的术后 BCVA 显著相关（P <0.05）。
MH 手术后视力改善在 PPV 后 3 年内持续，此后在很大一部分患者中得到维持，最终 BCVA 与更好的术前 BCVA 和更好的术后 OCT 参数相关。
