Ahmed Khan Shaheryar, Goldsmith Craig, Thandar So Mya
Ophthalmology Department, James Paget University Hospital, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth NR31 6LA, UK.
Ophthalmology Department, James Paget University Hospital, Great Yarmouth, UK.
Ther Adv Ophthalmol. 2022 Jan 14;14:25158414211063288. doi: 10.1177/25158414211063288. eCollection 2022 Jan-Dec.
Macular hole surgery has been revolutionized since the 1990s' with the advent of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade, which is now extensively practiced and regarded as the gold standard procedure for surgical treatment of macular hole. Here, we report a simple adjunctive maneuver to conventional PPV with ILM peel and gas tamponade. We observed presence of a viscous fluid in the base of the macular hole in our series. In all, 40 eyes of 39 patients consecutively operated on from June 2019 to December 2020 for PPV with ILM peel and gas tamponade, were included in this study. The viscous plug was aspirated passively using a 25 gauge cannula with its tip above the macular hole, approaching only until a fluid-wave was visualized, which resulted in flattening of the fluid cuff area aiding the macular hole closure in a concentric pattern. Macular hole closure and complete success was seen in 39 out of 40 eyes (97.5%) and only 1 failure (2.5%) observed in this series. In our case series, we have observed the presence of a viscous fluid plug in the macular hole. We demonstrated that aspirating this thick fluid from the hole results in the flattening of the cuff of fluid and subsequent closure of the macular hole in a concentric manner in almost all cases in our series. The lack of concurrent control group means we cannot state a definitive effect of the intervention, but it does suggest the utility of a prospective randomized controlled trial.
自20世纪90年代以来，随着玻璃体切割联合内界膜剥除及气体填充术的出现，黄斑裂孔手术发生了变革，该手术目前已广泛应用，并被视为黄斑裂孔手术治疗的金标准。在此，我们报告一种针对传统玻璃体切割联合内界膜剥除及气体填充术的简单辅助操作。我们在本系列病例中观察到黄斑裂孔底部存在一种粘性液体。本研究纳入了2期手术的39例患者（40只眼），手术时间为2019年6月至2020年12月，手术方式为玻璃体切割联合内界膜剥除及气体填充。使用25G套管针在黄斑裂孔上方被动抽吸粘性堵塞物，仅在看到液波时靠近，这导致液性袖带区域变平，以同心圆方式辅助黄斑裂孔闭合。40只眼中有39只（97.5%）黄斑裂孔闭合且完全成功，本系列中仅观察到1例失败（2.5%）。在我们的病例系列中，我们观察到黄斑裂孔中存在粘性液体堵塞物。我们证明，从裂孔中抽吸这种浓稠液体几乎在本系列所有病例中都会导致液性袖带变平，随后黄斑裂孔以同心圆方式闭合。缺乏同期对照组意味着我们无法确定该干预措施的明确效果，但这确实表明了进行前瞻性随机对照试验的实用性。
