Sinawat Suthasinee, Jumpawong Sukita, Ratanapakorn Tanapat, Bhoomibunchoo Chavakij, Yospaiboon Yosanan, Sinawat Supat
KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Clin Ophthalmol. 2021 Feb 11;15:521-529. doi: 10.2147/OPTH.S294190. eCollection 2021.
To evaluate anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) in large idiopathic full-thickness macular holes (FTMH). Predictive factors also formed part of the study.
A retrospective review of medical charts and optical coherence tomography images of patients with large idiopathic FTMH (≥400 µm) was conducted.
One hundred and fifty-eight eyes of 155 patients with a mean age of 62.94±7.50 years were included in the study. Mean preoperative visual acuity (VA) was 1.26±0.36 logMAR. Mean preoperative minimum linear diameter (MLD) and basal linear diameter (BLD) were 644.89±136.85 µm and 1208.11±307.14 µm, respectively. At 12 weeks postoperative follow-up, FTMH closure rate was 61.39% and mean postoperative BCVA was 0.92±0.36 logMAR. Multivariate logistic regression analyses showed the anatomical outcome was significantly associated with BLD ≤1200 µm, preoperative vitreomacular interface (VMI) disorder and extended ILMP (a radius of 2 disc diameters), whereas only postoperative ellipsoid loss ≤500 µm was significantly associated with visual outcome. In subgroup analyses, the large FTMH group (400-600 µm) had significantly better results in closure rate (70.97% vs 55.21%, = 0.047) and visual results ( = 0.031) than the extra-large FTMH group (>600 µm).
PPV with conventional ILMP provided relatively low closure rate in large FTMH. Surgical success was significantly associated with BLD ≤1200 µm, no preoperative VMI abnormality, extended ILMP and postoperative ellipsoid defect ≤500 µm. Therefore, we suggest the extended ILMP if conventional ILMP technique is used. The large FTMH group had significantly better surgical outcomes than the extra-large group, so there is a need for reclassification of large FTMH.
评估在特发性全层黄斑裂孔（FTMH）较大时，经平坦部玻璃体切除术（PPV）联合内界膜剥除术（ILMP）的解剖学和视觉效果。预测因素也是该研究的一部分。
对特发性FTMH较大（≥400 µm）患者的病历和光学相干断层扫描图像进行回顾性分析。
研究纳入了155例患者的158只眼，平均年龄为62.94±7.50岁。术前平均视力（VA）为1.26±0.36 logMAR。术前平均最小线性直径（MLD）和基底线性直径（BLD）分别为644.89±136.85 µm和1208.11±307.14 µm。术后12周随访时，FTMH闭合率为61.39%，术后平均最佳矫正视力（BCVA）为0.92±0.36 logMAR。多因素逻辑回归分析显示，解剖学结果与BLD≤1200 µm、术前玻璃体黄斑界面（VMI）紊乱和扩大的ILMP（2个视盘直径半径）显著相关，而仅术后椭圆体丢失≤500 µm与视觉结果显著相关。亚组分析中，大型FTMH组（400 - 600 µm）在闭合率（70.97%对55.21%，P = 0.047）和视觉结果（P = 0.031）方面显著优于超大型FTMH组（>600 µm）。
在较大的FTMH中，采用传统ILMP的PPV提供的闭合率相对较低。手术成功与BLD≤1200 µm、术前无VMI异常、扩大的ILMP和术后椭圆体缺损≤500 µm显著相关。因此，如果使用传统ILMP技术，我们建议采用扩大的ILMP。大型FTMH组的手术效果明显优于超大型组，因此有必要对大型FTMH进行重新分类。
