Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland.
Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.
Eur J Ophthalmol. 2024 Jan;34(1):292-299. doi: 10.1177/11206721231201662. Epub 2023 Sep 12.
Various surgical techniques have been described for managing persistent macular holes after an unsuccessful vitrectomy with internal limiting membrane (ILM) peeling. However, the closure and functional improvement rates after these procedures are limited. Therefore, the aim of this study was to evaluate the usefulness of radial retinal incisions (retinotomies) in eyes with persistent large macula holes despite previous vitrectomy with ILM peeling.
In a retrospective case series, closure rate and best-corrected visual acuity (BCVA) were evaluated in eyes with persistent macular holes after an unsuccessful vitrectomy that included posterior vitreous detachment and ILM peeling.
22 eyes of 22 patients (10 men and 12 women) underwent re-vitrectomy with radial retinal incisions. All the patients had undergone an unsuccessful surgery before.
Small-incision re-vitrectomy with radial retinal incisions (retinotomies) and air tamponade was performed.
For all eyes, high-definition SD-OCT scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery; 1 week and 1 month after surgery; and at final follow-up. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best-corrected visual acuity (BCVA) in logMAR and Snellen at baseline, 1 and 4 months after operation, and at the final follow-up visit were analyzed.
The mean baseline macular hole diameter was 668.5 ± 226.8 μm. At the final examination, 16 (72.72%) of the 22 macula holes were closed. Visual acuity increased in 17 eyes, was stable in 3 eyes, and decreased in 2 eyes owing to central retinal atrophy in both. The mean BCVA increased from logMAR 1.04 ± 0.29 at baseline to 0.57 ± 0.31 (Snellen 0.11 ± 0.05 to 0.33 ± 0.18). In all successful cases, macula hole closure was attained after 3 days, and none of the eyes showed macula hole recurrence.
The results of this limited case series suggest that radial retinal incisions of the rim in persistent macula holes after initial surgery with ILM peeling increase the success rate of macula hole closure and results in a relevant increase in BCVA. However, as the number of eyes included in this series is limited, the results must be confirmed in a study with a larger sample size.
在玻璃体切除联合内界膜（ILM）剥除术后出现失败性持续性黄斑裂孔的情况下，已经描述了各种手术技术来进行处理。然而，这些手术后的裂孔闭合和功能改善率均有限。因此，本研究旨在评估在先前玻璃体切除联合 ILM 剥除术后出现持续性大黄斑裂孔的情况下，放射状视网膜切开术（视网膜切开术）的有用性。
在一项回顾性病例系列研究中，评估了在初始玻璃体切除联合 ILM 剥除术后出现失败性持续性黄斑裂孔的患者中，裂孔闭合率和最佳矫正视力（BCVA）。
22 只眼 22 例患者（10 名男性和 12 名女性）接受了放射状视网膜切开术的再次玻璃体切除术。所有患者之前均接受过不成功的手术。
行小切口再次玻璃体切除术联合放射状视网膜切开术（视网膜切开术）和空气填充。
所有眼在术前；术后 1 周和 1 个月；以及最终随访时，均行黄斑区高清 SD-OCT 扫描（SD-OCT Spectralis，德国海德堡工程公司）。此外，分析了年龄、性别、眼轴长度、黄斑裂孔直径、眼底生物显微镜评估和最佳矫正视力（BCVA）在 logMAR 和 Snellen 中的基线值、术后 1 个月和 4 个月以及最终随访时的情况。
平均黄斑裂孔直径为 668.5±226.8μm。在最终检查时，22 个黄斑裂孔中有 16 个（72.72%）闭合。17 只眼的视力提高，3 只眼的视力稳定，2 只眼的视力因视网膜中央萎缩而下降（均为双眼）。BCVA 从基线时的 logMAR 1.04±0.29 提高到 0.57±0.31（Snellen 0.11±0.05 到 0.33±0.18）。在所有成功的病例中，裂孔在术后 3 天闭合，且无眼出现裂孔复发。
本有限病例系列研究的结果表明，在初始玻璃体切除联合 ILM 剥除术后出现持续性黄斑裂孔的情况下，进行周边放射状视网膜切开术可提高裂孔闭合成功率，并使 BCVA 显著提高。然而，由于本研究系列中纳入的眼数有限，因此需要在更大样本量的研究中证实这些结果。
