特发性黄斑裂孔患者反转内界膜瓣术后黄斑区解剖及视功能的临床观察

Clinical Observation of Anatomical and Visual Outcomes of Macular Hole after Inverted Internal Limiting Membrane Flap in Patients with Idiopathic Macular.

机构信息

Department of Vitreoretinopathy, Shanxi Eye Hospital, Taiyuan, Shanxi, China.

Shanxi Medical University, Taiyuan, Shanxi, China.

出版信息

J Healthc Eng. 2023 Feb 15;2023:5816473. doi: 10.1155/2023/5816473. eCollection 2023.

DOI:10.1155/2023/5816473

PMID:36844949

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9946737/

Abstract

OBJECTIVE

To investigate anatomical and visual outcomes of macular hole (MH) after inverted internal limiting membrane (ILM) flap technique for idiopathic macular hole (IMH).

METHODS

A total of 13 IMH cases diagnosed in Shanxi Eye Hospital between January 2015 and June 2016 were included in the study. All patients underwent vitrectomy combined with indocyanine green-assisted inverted ILM flap technique. The MH closure rate, best-corrected visual acuity (BCVA), changes of ellipsoid zone (EZ), and external limiting membrane (ELM) were examined before operation and one, three, and six months after operation. Furthermore, 488 nm fundus autofluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT) were used to observe the dynamic changes in function of macular area after surgery.

RESULTS

One month after the surgery, the MH closure rate was 100% and the visual acuity (VA) was stable, with no recurrence. Additionally, the average logMAR BCVA before operation was 1.208 ± 0.158, and this value became 0.877 ± 0.105 one month after the operation, showing a significant decrease. Three months after surgery, the average logMAR BCVA was 0.792 ± 0.103, which was significantly lower than the level one month after the surgery but much higher than that six months after surgery (0.708 ± 0.131). Besides, the diameter of the EZ defect of the postoperative one month, three months, and six months was (1377.46 ± 198.65) m, (964.62 ± 336.26) m, and (817.08 ± 442.99) m, respectively. In postoperative one month, three months, and six months, the diameter of the ELM defect diameter was (969.62 ± 189.92) m, (649.92 ± 413.15) m, and (557.62 ± 412.50) m, respectively. The diameter of both EZ and ELM defects was significantly reduced with the passage of time after surgery.

CONCLUSION

Inverted ILM flap technique can reconstruct macular anatomical structure and improve VA. This technique is effective for the treatment of IMH with large MH minimum diameter and base diameter.

摘要

目的

探讨特发性黄斑裂孔（IMH）经反向内界膜（ILM）瓣技术治疗后的解剖和视力结果。

方法

本研究纳入 2015 年 1 月至 2016 年 6 月在山西眼科医院诊断的 13 例 IMH 患者。所有患者均接受玻璃体切除术联合吲哚青绿辅助反向 ILM 瓣技术。分别在术前和术后 1、3、6 个月检查黄斑裂孔闭合率、最佳矫正视力（BCVA）、椭圆体带（EZ）和外界膜（ELM）的变化。此外，使用 488nm 眼底自发荧光（FAF）和光谱域光学相干断层扫描（SD-OCT）观察术后黄斑区功能的动态变化。

结果

术后 1 个月，黄斑裂孔闭合率为 100%，视力（VA）稳定，无复发。此外，术前平均 logMAR BCVA 为 1.208±0.158，术后 1 个月降至 0.877±0.105，差异有统计学意义。术后 3 个月平均 logMAR BCVA 为 0.792±0.103，明显低于术后 1 个月，但高于术后 6 个月（0.708±0.131）。此外，术后 1 个月、3 个月和 6 个月时 EZ 缺损直径分别为（1377.46±198.65）μm、（964.62±336.26）μm 和（817.08±442.99）μm，ELM 缺损直径分别为（969.62±189.92）μm、（649.92±413.15）μm 和（557.62±412.50）μm。术后随着时间的推移，EZ 和 ELM 缺损直径均明显缩小。