Berco Efraim, Arnon Roee, Kozlov Yuval, Shad Justin Lerann, Shoham-Hazon Nir, Tuli Raman, Hilely Assaf
Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.
Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Graefes Arch Clin Exp Ophthalmol. 2023 Dec;261(12):3395-3401. doi: 10.1007/s00417-023-06196-w. Epub 2023 Aug 5.
To propose a novel technique of an internal limiting membrane (ILM) flap using ophthalmic viscoelastic device (OVD) with no requirement for postoperative head posture for the treatment of lamellar macular hole (LMH) repair.
A retrospective analysis of 16 consecutive eyes of LMH patients who underwent vitrectomy with ILM flap with OVD. Best-corrected visual acuity (BCVA), central macular thickness (CMT), simultaneous cataract extraction, and ellipsoid zone disruption preoperatively and at the final follow-up were compared.
The mean age was 73.19 ± 7.26 years, and ten patients (62%) were females. The mean follow-up was 5.06±1.43 months (range 3-6). For all patients, BCVA was significantly improved at the final visit, from 0.65±0.36 logMAR units to 0.42±0.29 (p < 0.001). None of the patients had visual loss. Six patients had epiretinal membrane (ERM) foveoschisis, and the rest had LMH with epiretinal proliferation. Both subgroups presented a significant improvement in their BCVA with a trend for better improvement in the latter (p=0.09). Ellipsoid zone disruption was seen in 7 patients including one patient with a macular scar. There was no significant effect of ellipsoid zone disruption on the final BCVA (p=0.33). Twelve eyes (75%) underwent simultaneous cataract extraction. Mean BCVA at the final postoperative visit improved regardless of whether the eyes underwent simultaneous cataract surgery (p=0.39). CMT was also significantly improved at the final visit, from 200.06±46.8 μm preoperatively to 305.00±85.5 μm (p<0.001). No full-thickness macular holes were developed postoperatively. No intraoperative or postoperative complications were observed.
Treatment of LMH with ILM flap with OVD showed promising anatomical and functional results with no postoperative head position requirements.
提出一种使用眼科粘弹性装置（OVD）制作内界膜（ILM）瓣的新技术，用于治疗板层黄斑裂孔（LMH）修复，且术后无需特殊头位。
对16例连续行玻璃体切除术联合OVD辅助ILM瓣修复的LMH患者的术眼进行回顾性分析。比较术前及末次随访时的最佳矫正视力（BCVA）、黄斑中心厚度（CMT）、同期白内障摘除情况以及椭圆体带破坏情况。
患者平均年龄为73.19±7.26岁，10例（62%）为女性。平均随访时间为5.06±1.43个月（范围3 - 6个月）。所有患者末次随访时BCVA显著改善，从术前的0.65±0.36 logMAR单位提高到0.42±0.29（p < 0.001）。无一例患者视力下降。6例患者有视网膜前膜（ERM）性黄斑劈裂，其余患者为伴有视网膜前增殖的LMH。两个亚组的BCVA均显著改善，且后者改善趋势更明显（p = 0.09）。7例患者可见椭圆体带破坏，其中1例伴有黄斑瘢痕。椭圆体带破坏对末次随访时的BCVA无显著影响（p = 0.33）。12只眼（75%）同期行白内障摘除术。无论术眼是否同期行白内障手术，术后末次随访时的平均BCVA均有改善（p = 0.39）。末次随访时CMT也显著改善，从术前的200.06±46.8μm降至305.00±85.5μm（p < 0.001）。术后无全层黄斑裂孔形成。未观察到术中或术后并发症。
采用OVD辅助ILM瓣治疗LMH在解剖和功能方面均取得了良好效果，且术后无需特殊头位。
