Chen Yiqi, Xu Yijun, Ye Xin, Yu Jiafeng, Wang Chenxi, Zhang Zhengxi, Mao Jianbo, Shen Lijun
Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Front Med (Lausanne). 2023 Feb 9;10:1103593. doi: 10.3389/fmed.2023.1103593. eCollection 2023.
To compare the changes in anatomical structure and visual function after idiopathic macular hole (iMH) treatment with internal limiting membrane (ILM) peeling and inverted ILM flap and determine the value of the inverted ILM flap for the treatment of iMH.
Forty-nine patients with iMH (49 eyes) were included in this study and followed up for 1 year (12 months) after treatment with inverted ILM flap and ILM peeling respectively. The main foveal parameters assessed included the preoperative minimum diameter (MD), intraoperative residual fragments, and postoperative ELM reconstruction. Visual function was assessed using best-corrected visual acuity.
The hole closure rate was 100% for 49 patients; 15 patients were treated with the inverted ILM flap, and 34 patients underwent ILM peeling. There were no differences between the postoperative best-corrected visual acuities and the rates of ELM reconstruction for the flap and peeling groups with different MDs. In the flap group, ELM reconstruction was associated with the preoperative MD, presence of an ILM flap, and hyperreflective changes in the inner retina 1 month after surgery. In the peeling group, ELM reconstruction was associated with the preoperative MD, intraoperative residual fragments at the hole edge, and hyperreflective changes in the inner retina.
The inverted ILM flap and the ILM Peeling were both able to obtain high closure rate. However, the inverted ILM flap showed no obvious advantages related to anatomical morphology and visual function over ILM peeling.
比较特发性黄斑裂孔（iMH）采用内界膜（ILM）剥除术和反转ILM瓣治疗后解剖结构和视觉功能的变化，并确定反转ILM瓣治疗iMH的价值。
本研究纳入49例iMH患者（49只眼），分别采用反转ILM瓣和ILM剥除术治疗，术后随访1年（12个月）。评估的主要黄斑中心凹参数包括术前最小直径（MD）、术中残留碎片及术后ELM重建情况。采用最佳矫正视力评估视觉功能。
49例患者裂孔闭合率均为100%；15例采用反转ILM瓣治疗，34例行ILM剥除术。不同MD的瓣组和剥除组术后最佳矫正视力及ELM重建率无差异。瓣组中，ELM重建与术前MD、ILM瓣的存在及术后1个月内视网膜内层高反射改变有关。剥除组中，ELM重建与术前MD、裂孔边缘术中残留碎片及视网膜内层高反射改变有关。
反转ILM瓣和ILM剥除术均能获得较高的闭合率。然而，与ILM剥除术相比，反转ILM瓣在解剖形态和视觉功能方面无明显优势。
