近视牵引性黄斑病变玻璃体切除术后黄斑裂孔形成的危险因素和结局：SCHISIS 报告 2 号。

Risk Factors and Outcomes of Postoperative Macular Hole Formation after Vitrectomy for Myopic Traction Maculopathy: SCHISIS Report No. 2.

机构信息

Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

出版信息

Ophthalmol Retina. 2023 Sep;7(9):779-787. doi: 10.1016/j.oret.2023.05.017. Epub 2023 May 29.

DOI:10.1016/j.oret.2023.05.017

PMID:37257585

Abstract

PURPOSE

To evaluate the incidence, pathogenesis, risk factors, and treatment outcomes of postoperative macular hole (MH) after pars plana vitrectomy (PPV) for myopic traction maculopathy (MTM).

DESIGN

Multicenter, interventional, retrospective case series.

SUBJECTS

Consecutive eyes that underwent PPV for MTM with a minimum 6-month follow-up.

METHODS

We investigated the characteristics and treatment outcomes of postoperative MH after MTM surgery.

MAIN OUTCOME MEASURES

Incidence, risk factors, and anatomic and visual outcomes of postoperative MH.

RESULTS

We included 207 eyes (207 patients) with a mean follow-up of 25.9 months. During follow-up, 24 (11.6%) eyes developed MH (10 with concurrent MH retinal detachment); 15 eyes within 30 days (early), 4 eyes between 31 and 180 days (intermediate), and 5 eyes after 180 days (late). Logistic regression analysis revealed male gender (odds ratio [OR], 2.917; 95% confidence interval [CI], 1.198-7.100; P = 0.018), thinner preoperative choroidal thickness (OR, 0.988; 95% CI, 0.976-1.000; P = 0.048), and use of indocyanine green for internal limiting membrane peeling (OR, 2.960; 95% CI, 1.172-7.476; P = 0.022) as significant risk factors for postoperative MH. Internal limiting membrane peeling with a fovea-sparing technique tended to protect against postoperative MH, but it was not statistically significant (P = 0.096), because 1 eye still developed MH. Postoperative MHs were treated by observation (6 eyes), in-office octafluoropropane (CF) gas injection (7 eyes), or PPV (11 eyes). Macular hole closure was achieved in 20 eyes (83%). The hole closure rate was 67% (4/6 eyes) after observation, 71% (5/7 eyes) after CF gas injection, and 91% (10/11 eyes) after PPV. However, visual outcomes were significantly worse for eyes with postoperative MH than those without (0.38 ± 0.43 vs. 0.68 ± 0.46; P = 0.002).

CONCLUSIONS

Postoperative MH may occur in 11.6% of patients with MTM at any time after surgery. Retreatment resulted in relatively favorable anatomic closure but unfavorable visual outcomes.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

摘要

目的

评估特发性黄斑裂孔（MH）在孔源性视网膜脱离（RRD）手术后的发生率、发病机制、危险因素和治疗结果。

设计

多中心、干预性、回顾性病例系列研究。

对象

连续接受特发性黄斑裂孔（RRD）手术后至少 6 个月随访的患者。

方法

我们研究了特发性黄斑裂孔（RRD）手术后 MH 的特征和治疗结果。

主要观察指标

术后 MH 的发生率、危险因素以及解剖和视力结果。

结果

我们纳入了 207 只眼（207 例患者），平均随访 25.9 个月。在随访期间，24 只眼（11.6%）发生 MH（10 只眼同时发生 MH 视网膜脱离）；15 只眼在术后 30 天内（早期），4 只眼在术后 31 至 180 天（中期），5 只眼在术后 180 天以后（晚期）。Logistic 回归分析显示，男性（比值比[OR]，2.917；95%置信区间[CI]，1.198-7.100；P=0.018）、术前脉络膜较薄（OR，0.988；95%CI，0.976-1.000；P=0.048）和使用吲哚菁绿进行内界膜剥除（OR，2.960；95%CI，1.172-7.476；P=0.022）是术后 MH 的显著危险因素。保留中心凹的内界膜剥除技术有预防术后 MH 的趋势，但无统计学意义（P=0.096），因为 1 只眼仍发生 MH。术后 MH 采用观察（6 只眼）、门诊八氟丙烷（CF）气体注射（7 只眼）或玻璃体切除术（PPV）（11 只眼）治疗。20 只眼（83%）的 MH 闭合。观察后 MH 闭合率为 67%（4/6 眼），CF 气体注射后为 71%（5/7 眼），PPV 后为 91%（10/11 眼）。然而，与无 MH 的眼相比，术后 MH 眼的视力结果明显较差（0.38±0.43 与 0.68±0.46；P=0.002）。