Garcin Thibaud, Gain Philippe, Thuret Gilles
Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France.
Ophthalmology Department, University Hospital, Saint-Etienne, France.
Acta Ophthalmol. 2022 Mar;100(2):e598-e608. doi: 10.1111/aos.14909. Epub 2021 May 16.
To report the long-term outcomes of large diameter epiretinal lyophilized amniotic membranes (lAMs) in recurrent or persistent macular holes (MHs) with or without rhegmatogenous retinal detachment (RRD), in a prospective interventional case series.
Ten eyes of 10 patients underwent pars plana vitrectomy for MH-associated RRD (n = 5) or persistent MH without RRD (n = 5), in a university Hospital. A 3 or 4 mm diameter disc of lAM, stained with 0.06% trypan blue, was inserted with a catheter through a sclerotomy and positioned over the MH. Gas or silicone-oil tamponade was used. At 1 year, the main outcome was anatomic success defined as complete MH closure. Secondary outcomes were best corrected visual acuity (BCVA) recovery, changes in ellipsoid zone (EZ) and external limiting membrane (ELM) defects, complications. Mean follow-up was 13.8 ± 2.9 months (range, 12-18).
Mean baseline data were minimum and maximum diameters, respectively, 945 ± 330 and 1507 ± 717 μm; axial length 26.58 ± 3.38 mm; and number of prior surgeries 1.4 ± 0.96. At 1 year, anatomic success was achieved in eight eyes (80%), and two had reduced diameter of MH. All RRDs were reattached without recurrence. Mean logMAR BCVA improved from 1.92 ± 0.58 to 1.17 ± 0.57 (p < 0.001), with nine eyes (90%) achieving ≥0.3 logMAR improvement. Mean EZ and ELM defects decreased (p = 0.004, p = 0.003, respectively). Postoperative complications were RRD (n = 1) reattached by subsequent surgery, lAM slightly retracted under silicone (n = 1), foveal atrophy after early lAM displacement (n = 1).
A 1-year follow-up highlighted that epiretinal large discs of blue-stained lAM can help safely close refractory MHs, and provide satisfactory visual recovery.
在一项前瞻性干预性病例系列研究中，报告大直径冻干羊膜（lAM）治疗伴有或不伴有孔源性视网膜脱离（RRD）的复发性或持续性黄斑裂孔（MH）的长期结果。
在一家大学医院，10例患者的10只眼接受了玻璃体切除术，其中5例为与MH相关的RRD，5例为无RRD的持续性MH。将一片直径3或4毫米、用0.06%台盼蓝染色的lAM圆盘，通过一根导管经巩膜切口插入并置于MH上方。使用气体或硅油填充。1年后，主要结局指标为解剖学成功，定义为MH完全闭合。次要结局指标为最佳矫正视力（BCVA）恢复、椭圆体带（EZ）和外界膜（ELM）缺损的变化、并发症。平均随访时间为13.8±2.9个月（范围12 - 18个月）。
平均基线数据分别为最小和最大直径，945±330和1507±717μm；眼轴长度26.58±3.38mm；既往手术次数1.4±0.96次。1年后，8只眼（80%）实现了解剖学成功，2只眼的MH直径减小。所有RRD均复位且无复发。平均logMAR BCVA从1.92±0.58提高到1.17±0.5 (p < 0.001)，9只眼（90%）的logMAR改善≥0.3。平均EZ和ELM缺损减少（分别为p = 0.004，p = 0.003）。术后并发症包括1例RRD经后续手术复位，1例lAM在硅油下轻度回缩，1例早期lAM移位后黄斑萎缩。
1年的随访结果表明，视网膜表面的蓝色染色大直径lAM圆盘可安全地帮助闭合难治性MH，并实现令人满意的视力恢复。
