Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China.
Ophthalmic Res. 2023;66(1):569-578. doi: 10.1159/000529387. Epub 2023 Feb 3.
The aim of this study was to analyze the anatomical and visual outcomes after internal limiting membrane (ILM) peeling or ILM flap insertion in highly myopic macular holes (HMMHs) and try to compare these two surgical techniques in large HMMHs.
This is a retrospective, consecutive series study of patients with HMMH undergone vitrectomy from September 2016 to January 2021. We observed the outcomes of the HMMHs with ILM peeling and ILM flap insertion, respectively. Binary logistic regression and receiver operating characteristic (ROC) curve were used to analyze the relationship between the minimum linear diameter (MLD) of macular hole and the initial closure rate in ILM peeling group. Finally, we compared the surgical outcomes between these two surgical techniques in large HMMHs.
There were 69 HMMHs using ILM peeling with a mean MLD of 423.55 ± 190.99 µm and 33 HMMHs using ILM flap insertion with a mean MLD of 600.79 ± 187.85 µm. The initial type I closure rate was 86.9% (60/69) and 81.8% (27/33), respectively. MLD had a good correlation with the initial closure rate in HMMHs with ILM peeling (p = 0.046). The large HMMH (MLD >461.5 μm obtained by ROC curve) was present in 26 eyes with each surgical technique, and there was no significant difference of baseline characteristics between them. In large HMMHs, the initial closure rate of ILM peeling was 73.0% and that of ILM flap insertion was 84.6% (p = 0.499). Postoperative best-corrected visual acuity (BCVA) improved significantly in both groups (p < 0.001), and the BCVA at last follow-up was better in closed large HMMHs with ILM peeling (p = 0.034).
In HMMHs with ILM peeling, the initial closure rate was decreased when MLD >461.5 μm. ILM peeling may obtain better functional prognosis in eyes with closed large macular holes compared with ILM flap insertion.
本研究旨在分析高度近视黄斑裂孔（HMMH）中内界膜（ILM）剥除或 ILM 瓣插入后的解剖和视力结果，并尝试比较这两种手术技术在大 HMMH 中的效果。
这是一项回顾性、连续系列研究，纳入了 2016 年 9 月至 2021 年 1 月接受玻璃体切除术治疗的 HMMH 患者。我们分别观察了 ILM 剥除和 ILM 瓣插入治疗 HMMH 的结果。二项逻辑回归和受试者工作特征（ROC）曲线用于分析 ILM 剥除组中黄斑孔最小线性直径（MLD）与初始闭合率之间的关系。最后，我们比较了这两种手术技术在大 HMMH 中的手术效果。
共有 69 例 HMMH 采用 ILM 剥除，平均 MLD 为 423.55 ± 190.99 µm，33 例 HMMH 采用 ILM 瓣插入，平均 MLD 为 600.79 ± 187.85 µm。初始 I 型闭合率分别为 86.9%（60/69）和 81.8%（27/33）。在 ILM 剥除的 HMMH 中，MLD 与初始闭合率具有良好的相关性（p = 0.046）。ROC 曲线得出的大 HMMH（MLD >461.5 µm）在 26 只眼中分别采用了这两种手术技术，且两组间的基线特征无显著差异。在大 HMMH 中，ILM 剥除的初始闭合率为 73.0%，ILM 瓣插入的初始闭合率为 84.6%（p = 0.499）。两组术后最佳矫正视力（BCVA）均显著提高（p < 0.001），且 ILM 剥除后闭合的大 HMMH 的 BCVA 在末次随访时更好（p = 0.034）。
在 MLD >461.5 µm 的 HMMH 中，ILM 剥除的初始闭合率降低。与 ILM 瓣插入相比，ILM 剥除可能在闭合的大黄斑裂孔眼中获得更好的功能预后。
