Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
Br J Ophthalmol. 2022 Oct;106(10):1463-1468. doi: 10.1136/bjophthalmol-2021-319001. Epub 2021 Apr 29.
To ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH).
Retrospective collaborative study of FTMH that closed without surgical intervention.
A total of 78 patients (mean age 57.9 years) included 18 patients with blunt ocular trauma, 18 patients that received topical or intravitreal therapies and 42 patients with idiopathic FTMH. Mean±SD of the initial corrected visual acuity (VA) in logMAR improved from 0.65±0.54 to 0.34±0.45 (p<0.001) at a mean follow-up of 33.8±37.1 months. FTMH reopened in seven eyes (9.0%) after a mean of 8.6 months. Vitreomacular traction was noted in 12 eyes (15.8%), perifoveal posterior vitreous detachment in 42 (53.8%), foveal epiretinal membrane in 10 (12.8%), cystoid macular oedema (CME) in 49 (62.8%) and subretinal fluid (SRF) in 20 (25.6%). By multivariate analysis, initial VA correlated to the height (p<0.001) and narrowest diameter of the hole (p<0.001) while final VA correlated to the basal diameter (p<0.001). Time for closure of FTMH (median 2.8 months) correlated to the narrowest diameter (p<0.001) and the presence of SRF (p=0.001). Mean time for closure (in months) was 1.6 for eyes with trauma, 4.3 for eyes without trauma but with therapy for CME, 4.4 for eyes without trauma and without therapy in less than 200 µm in size and 24.7 for more than 200 µm.
Our data suggest an observation period in new onset FTMH for non-surgical closure, in the setting of trauma, treatment of CME and size <200 µm.
确定有助于全层黄斑裂孔（FTMH）非手术封闭的解剖因素。
回顾性协作研究未经手术干预而闭合的 FTMH。
共纳入 78 例患者（平均年龄 57.9 岁），包括 18 例钝挫伤患者、18 例接受局部或玻璃体内治疗的患者和 42 例特发性 FTMH 患者。初始矫正视力（VA）的平均标准差（logMAR）从 0.65±0.54 提高到 0.34±0.45（p<0.001），平均随访时间为 33.8±37.1 个月。在平均 8.6 个月后，7 只眼（9.0%）的 FTMH 重新开放。12 只眼（15.8%）存在玻璃体黄斑牵引，42 只眼（53.8%）存在周边性后玻璃体脱离，10 只眼（12.8%）存在黄斑内视网膜前膜，49 只眼（62.8%）存在囊样黄斑水肿（CME），20 只眼（25.6%）存在视网膜下液（SRF）。多变量分析显示，初始 VA 与孔的高度（p<0.001）和最小直径（p<0.001）相关，而最终 VA 与基底部直径（p<0.001）相关。FTMH 闭合时间（中位数 2.8 个月）与最小直径（p<0.001）和 SRF 的存在（p=0.001）相关。有创伤的眼的平均闭合时间（以月计）为 1.6，无创伤但有 CME 治疗的眼为 4.3，无创伤且大小<200μm的眼无治疗的眼为 4.4，大小>200μm的眼为 24.7。
我们的数据表明，在创伤、CME 治疗和<200μm 大小的情况下，新发生的 FTMH 存在非手术闭合的观察期。
