Department of Ophthalmology of University of Padova, Padova, Italy.
Eye (Lond). 2022 Jul;36(7):1344-1354. doi: 10.1038/s41433-020-01330-y. Epub 2021 Jan 21.
This review aims to collect the proposed surgical techniques for treating full thickness macular hole (FTMH) refractory to pars plana vitrectomy and internal limiting membrane (ILM) peeling and to analyse and compare anatomical and functional outcomes in order to evaluate their efficacy. The articles were grouped according to the surgical techniques used. Refractory FTMH closure rate and best-corrected visual acuity (BCVA) gain were the two analysed parameters. Thirty-six articles were selected. Ten surgical technique subgroups were defined: autologous platelet concentrate (APC); lens capsular flap transplantation (LCFT); autologous free ILM flap transplantation (free ILM flap); enlargement of ILM peeling, macular hole hydrodissection (MHH), autologous retinal graft (ARG), silicon oil (SO), human amniotic membrane (hAM), perifoveal relaxing retinotomy, arcuate temporal retinotomy. Refractory FTMH closure rate was similar among subgroups, not significant heterogeneity emerged (p = 0.176). BCVA gain showed a significant dependence on surgical technique (p < 0.0001), significant heterogeneity among subgroups emerged (p < 0.0001). Three sets of surgical technique subgroups with a homogeneous BCVA gain were defined: high BCVA gain (hAM); intermediate BCVA gain (APC, ARG, LCFT, MHH, SO); low BCVA gain (free ILM flap, enlargement of peeling, arcuate temporal retinotomy). In terms of visual recovery, the most efficient technique for treating refractory FTMH is hAM, lens capsular flap and APC that allow to obtain better functional outcomes than free ILM flap. MHH, ARG, perifoveal relaxing and arcuate temporal retinotomy require complex and unjustified surgical manoeuvres in view of the surgical alternatives with overlapping anatomical and functional results.
本文旨在收集治疗经玻璃体切割和内界膜（ILM）剥除术治疗后仍未愈合的全层黄斑裂孔（FTMH）的手术技术，并对其进行分析和比较，以评估其疗效。这些文章是根据所使用的手术技术进行分组的。分析的参数是难治性 FTMH 闭合率和最佳矫正视力（BCVA）的提高。共选择了 36 篇文章。定义了 10 个手术技术亚组：自体血小板浓缩物（APC）；晶状体囊瓣移植（LCFT）；自体游离 ILM 瓣移植（游离 ILM 瓣）；扩大 ILM 剥除、黄斑裂孔水分离（MHH）、自体视网膜移植（ARG）、硅油（SO）、人羊膜（hAM）、黄斑旁松解性视网膜切开术、弧形颞侧视网膜切开术。各组之间难治性 FTMH 闭合率相似，无显著异质性（p=0.176）。BCVA 增益与手术技术显著相关（p<0.0001），各组之间存在显著异质性（p<0.0001）。定义了三组具有相似 BCVA 增益的手术技术亚组：高 BCVA 增益（hAM）；中 BCVA 增益（APC、ARG、LCFT、MHH、SO）；低 BCVA 增益（游离 ILM 瓣、扩大剥除、弧形颞侧视网膜切开术）。在视力恢复方面，治疗难治性 FTMH 最有效的技术是 hAM、晶状体囊瓣和 APC，它们比游离 ILM 瓣能获得更好的功能结果。MHH、ARG、黄斑旁松解和弧形颞侧视网膜切开术需要复杂和不合理的手术操作，因为这些手术与具有重叠解剖和功能结果的手术替代方案相比。
