Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10 66280, Sulzbach, Germany.
Klaus Heimann Eye Research Institute, Sulzbach, Germany.
Graefes Arch Clin Exp Ophthalmol. 2021 Jul;259(7):1781-1790. doi: 10.1007/s00417-021-05252-7. Epub 2021 Jun 2.
This study aims to analyze the success rate and functional outcome after revision surgery of persistent idiopathic full-thickness macular holes in a large patient cohort and to identify the optimal tamponade strategy and the value of new adjunctive manipulation techniques for persistent macular hole (pMH) closure.
Retrospective, comparative, non-consecutive case series of all revisional surgeries for idiopathic pMH between 2011 and 2019 at the Eye Clinic Sulzbach were identified. Of 1163 idiopathic MH surgeries, 74 eyes of 74 patients had pMH. Of those, group 1 (n = 38) had vitrectomy with tamponade alone (20% sulfur hexafluoride gas, 15% hexafluoroethane gas, silicone oil 5000, Densiron®), while group 2 (n = 36) included tamponade with adjuvant manipulation (internal limiting membrane (ILM) translocation, subretinal fluid injection, epiretinal amniotic membrane, free retina graft, or autologous blood). Main statistical outcomes were anatomic closure rate, visual acuity (VA), minimum linear diameter (MLD), and base diameter (BD).
Overall total anatomical success rate was 81.1% and mean VA improved 3.5 lines from LogMAR 1.03 ± 0.30 to 0.68 ± 0.38 (p < .001). Preoperative MLD or BD had no effect on total anatomic success (p = 0.074, p = 0.134, respectively). When comparing the two groups, slightly better anatomic success rates were achieved in group 1 (84.2%) compared to that in group 2 (77.8%) (p = 0.68). Final VA in group 1 (LogMAR 0.67 ± 0.39) outperformed group 2 (LogMAR 0.86 ± 0.38) (p = 0.03).
Revisional surgery for persistent idiopathic MH with tamponade alone had comparable anatomical closure but better VA outcomes, compared to tamponade with adjuvant manipulation.
本研究旨在分析大量患者队列中特发性全层黄斑裂孔（idiopathic full-thickness macular holes，iMH）翻修手术后的成功率和功能结果，并确定最佳的填塞策略以及新的辅助手术技术对持续性黄斑裂孔（persistent macular hole，pMH）闭合的价值。
回顾性比较非连续病例系列研究，纳入了 2011 年至 2019 年在 Sulzbach 眼科诊所接受特发性 iMH 翻修手术的所有患者。在 1163 例特发性 MH 手术中，74 只眼（74 例患者）为 pMH。其中，第 1 组（n=38）接受单纯玻璃体切除术+填塞（20%六氟化硫气体、15%六氟乙烷气体、硅油 5000、Densiron®），第 2 组（n=36）接受填塞+辅助手术（内界膜（internal limiting membrane，ILM）转位、视网膜下液注射、视网膜表面羊膜、游离视网膜移植或自体血）。主要的统计学结果是解剖学闭合率、视力（VA）、最小线性直径（minimum linear diameter，MLD）和基底直径（base diameter，BD）。
总的解剖学成功率为 81.1%，平均 VA 从 LogMAR 1.03±0.30 提高到 0.68±0.38（p<0.001）。术前 MLD 或 BD 对总解剖成功率无影响（p=0.074，p=0.134）。比较两组患者，第 1 组（84.2%）的解剖成功率略高于第 2 组（77.8%）（p=0.68）。第 1 组的最终 VA（LogMAR 0.67±0.39）优于第 2 组（LogMAR 0.86±0.38）（p=0.03）。
与填塞+辅助手术相比，单纯填塞治疗特发性 iMH 翻修手术具有相似的解剖学闭合率，但 VA 结果更好。
