Wallsh Josh, Asahi Masumi G, Gallemore Ron
Retina Macula Institute and Research Center, Torrance, CA, USA.
Clin Ophthalmol. 2021 Apr 16;15:1607-1619. doi: 10.2147/OPTH.S303890. eCollection 2021.
To evaluate the long-term anatomic and visual outcomes of macular hole (MH) repair utilizing triamcinolone acetonide (TA) visualization of the internal limiting membrane (ILM) treated at a tertiary care retina practice.
Retrospective chart review of eyes undergoing MH repair with ILM peel utilizing TA visualization followed by gas tamponade and facedown positioning between 2014 and 2020. Pre- and post-operative visual acuity (VA), IOP, and anatomic closure based on optical coherence tomography were documented.
Seventy-eight eyes were followed for 2.3±0.2 years after primary repair with anatomic closure in 73 (94%) eyes at their final visit and excluding eyes with pathologic myopia, 97%, and for stage 2 and small MHs, 100%. In all eyes, VA significantly improved from 0.97±0.04 (Snellen: 20/187) to 0.66±0.06 (20/91) logMAR (p < 0.0001). There were 16 eyes with 4 years of follow-up, 10 (63%) eyes achieving a VA ≥20/30 at that follow-up visit. Stage 2 and 3 MHs had significantly greater improvements in VA than Stage 4 MHs, -0.46 ± 0.06 versus -0.11 ± 0.11 logMAR (p = 0.021). Of the 13 (17%) eyes with recurrent MHs, 6 (46%) had pathologic myopia and 8 (61.5%) had associated cystoid macular edema. Cataract progression was reported in 52 (96%) phakic eyes and 2 eyes required Ahmed valve placement for management of pre-existing glaucoma.
Long-term results of MH repair with TA for ILM visualization demonstrate that it is safe and effective. Visual acuity continued to improve throughout the follow-up. Pre-existing glaucoma may progress and recurrence is associated with pathologic myopia and macular edema.
评估在三级视网膜专科医疗中心，使用曲安奈德（TA）可视化内界膜（ILM）进行黄斑裂孔（MH）修复的长期解剖学和视觉效果。
对2014年至2020年间接受TA可视化ILM剥除术并联合气体填塞和俯卧位的MH修复手术的患者进行回顾性病历审查。记录术前和术后的视力（VA）、眼压（IOP）以及基于光学相干断层扫描的解剖学闭合情况。
78只眼睛在初次修复后随访2.3±0.2年，末次随访时73只（94%）眼睛实现解剖学闭合，排除病理性近视患者的眼睛后为97%，2期和小型MH患者的眼睛为100%。所有眼睛的VA从0.97±0.04（Snellen：20/187）显著提高到0.66±0.06（20/91）logMAR（p < 0.0001）。有16只眼睛随访了4年，其中10只（63%）眼睛在该次随访时视力≥20/30。2期和3期MH患者的VA改善明显大于4期MH患者，分别为-0.46±0.06与-0.11±0.11 logMAR（p = 0.021）。13只（17%）复发性MH患者的眼睛中，6只（46%）患有病理性近视，8只（61.5%）伴有黄斑囊样水肿。52只（96%）有晶状体眼报告有白内障进展，2只眼睛因原有青光眼需要植入艾哈迈德瓣膜进行治疗。
使用TA可视化ILM进行MH修复术的长期结果表明，该方法安全有效。在整个随访过程中视力持续改善。原有青光眼可能进展，复发与病理性近视和黄斑水肿有关。
