Yin Lan, Liu An-Qi, Jin Xin, Jia Liang, Wang Feng-Xiang
Senior Department of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing 100413, China.
Int J Ophthalmol. 2022 Aug 18;15(8):1305-1309. doi: 10.18240/ijo.2022.08.12. eCollection 2022.
To compare the efficacy of vitrectomy combined with air or silicone oil in the treatment of idiopathic macular hole (IMH).
According to the results of high-definition optical coherence tomography (HD-OCT), 75 cases (75 eyes) of IMH in stage II-IV (Gass stage) in the General Hospital of Chinese PLA from January 2017 to December 2019 were collected for this retrospective study. The best corrected visual acuity (BCVA) and minimum diameter of IMH (MMHD) were measured. Eyes underwent vitrectomy combined with internal limiting membrane peeling operation, and were divided into disinfection air group (30 eyes) and silicone oil group (45 eyes) according to the intraocular tamponade. For MMHD≤400 µm (MMHD1), there were 23 eyes in air group and 16 eyes in silicone oil group. For MMHD2>400 µm (MMHD2), there were 7 eyes in air group and 29 eyes in silicone oil group. One month after surgery, the closure rates of IMH and BCVA were compared and analyzed. According to HD-OCT, the closure shape was graded with A (bridge closure) and B (good closure).
The closure rates of air group and silicone oil group were 86.67% and 95.56% respectively with no significant difference (>0.05); For MMHD1, those of air group and silicone oil group were 95.65% and 100% respectively with no significant difference (>0.05); For MMHD2, those of air group and silicone oil group were 57.14% and 93.10% respectively, and those of the silicone oil group were higher than the air group (<0.05). There was no significant difference in the closure shape grade between MMHD1 air group and silicone oil group (>0.05). The proportion of Grade B in MMHD2 silicone oil group was higher than that in the air group (<0.05). BCVA of each group after operation was better than that before operation, and there was no significant difference between air group and silicone oil group. While among them, MMHD1 air group was better than silicone oil group (<0.05), and there was no significant difference between MMHD2 air group and silicone oil group (>0.05).
For smaller IMH (≤400 µm), the efficacy of vitrectomy combined with air should be considered better than silicone oil; for larger IMH (>400 µm), the efficacy of silicone oil may be better than air.
比较玻璃体切除术联合空气或硅油治疗特发性黄斑裂孔（IMH）的疗效。
根据高清光学相干断层扫描（HD-OCT）结果，收集2017年1月至2019年12月解放军总医院75例（75眼）Ⅱ-Ⅳ期（Gass分期）IMH患者进行回顾性研究。测量最佳矫正视力（BCVA）和IMH最小直径（MMHD）。所有患眼均行玻璃体切除术联合内界膜剥除术，并根据眼内填充情况分为空气填充组（30眼）和硅油填充组（45眼）。对于MMHD≤400 µm（MMHD1），空气填充组23眼，硅油填充组16眼。对于MMHD＞400 µm（MMHD2），空气填充组7眼，硅油填充组29眼。术后1个月，比较分析IMH闭合率和BCVA。根据HD-OCT对闭合形态进行A（桥接闭合）和B（良好闭合）分级。
空气填充组和硅油填充组的闭合率分别为86.67%和95.56%，差异无统计学意义（＞0.05）；对于MMHD1，空气填充组和硅油填充组的闭合率分别为95.65%和100%，差异无统计学意义（＞0.05）；对于MMHD2，空气填充组和硅油填充组的闭合率分别为57.14%和93.10%，硅油填充组高于空气填充组（＜0.05）。MMHD1空气填充组与硅油填充组的闭合形态分级差异无统计学意义（＞0.05）。MMHD2硅油填充组B级比例高于空气填充组（＜0.05）。各组术后BCVA均优于术前，空气填充组与硅油填充组差异无统计学意义。其中，MMHD1空气填充组优于硅油填充组（＜0.05），MMHD2空气填充组与硅油填充组差异无统计学意义（＞0.05）。
对于较小的IMH（≤400 µm），玻璃体切除术联合空气填充的疗效可能优于硅油填充；对于较大的IMH（＞400 µm），硅油填充的疗效可能优于空气填充。
