Kumagai Kazuyuki, Horie Eiji, Fukami Marie, Furukawa Mariko
Kamiiida Daiichi General Hospital, Nagoya, Aichi, 462-0802, Japan.
Yata Eye Clinic, 165-1 Takyo, Izunokuni, Shizuoka, 410-2315, Japan.
Clin Ophthalmol. 2024 Jul 10;18:1981-1989. doi: 10.2147/OPTH.S466140. eCollection 2024.
To evaluate the outcomes of macular hole (MH) surgery as a historical perspective after its inception in 1991.
Retrospective review of 1032 eyes of 949 patients with an idiopathic MH who were followed for at least one year after the initial surgery. All surgeries were performed from 1990 to 2016 by one surgeon (NO) and included phacovitrectomy for patients of ≥40-years-of-age, a removal of the posterior hyaloid and epiretinal membrane, and SF6 gas tamponade with a 1-week face-down. After 1998, internal limiting membrane (ILM) peeling became the conventional procedure. All surgeries were classified into four periods based on the year of the initial surgery. The first period was 19901995 (n = 222), the second period was 19961999 (n=327), the third period was 20002004 (n = 234), and the last period was 20052016 (n=249).
The mean follow-up period was 81.3, 79.8, 88.4, and 77.3 months; hole size was 0.33, 0.28, 0.25, and 0.24 disk diameter; hole duration was 15.1, 10.6, 8.2, and 6.1 months; the decimal visual acuity (VA) was 0.13, 0.15, 0.17, and 0.19. The initial closure rate was 61.3, 78.0, 96.6, and 96.4%. The final decimal visual acuity was 0.33, 0.50, 0.66, and 0.79. The rate of a final decimal VA of 0.5 or better was 48.2, 66.4, 82.1, and 88.8%. The rate of a final decimal visual acuity of 1.0 or more was 17.6, 29.3, 43.6, and 58.2%. Multiple regression analyses showed that hole duration and ILM peeling were significantly associated with both the anatomic and functional outcomes.
The favorable outcomes of MH surgery was primarily achieved by earlier surgery and conventional ILM peeling. Favorable results might be obtained using only conventional ILM peeling.
从历史角度评估1991年黄斑裂孔（MH）手术开展以来的治疗效果。
回顾性分析949例特发性MH患者的1032只眼，这些患者在初次手术后至少随访1年。所有手术均由一名外科医生（NO）于1990年至2016年完成，其中年龄≥40岁的患者行晶状体玻璃体切除术，切除后玻璃体膜和视网膜前膜，并采用SF6气体填塞，术后需面部朝下1周。1998年后，内界膜（ILM）剥除成为常规手术。根据初次手术年份，所有手术分为四个时期。第一个时期为19901995年（n = 222），第二个时期为19961999年（n = 327），第三个时期为20002004年（n = 234），最后一个时期为20052016年（n = 249）。
平均随访时间分别为81.3、79.8、88.4和77.3个月；裂孔大小分别为0.33、0.28、0.25和0.24视盘直径；裂孔持续时间分别为15.1、10.6、8.2和6.1个月；小数视力（VA）分别为0.13、0.15、0.17和0.19。初始闭合率分别为61.3%、78.0%、96.6%和96.4%。最终小数视力分别为0.33、0.50、0.66和0.79。最终小数视力达到0.5或更好的比例分别为48.2%、66.4%、82.1%和88.8%。最终小数视力达到1.0或更高的比例分别为17.6%、29.3%、43.6%和58.2%。多元回归分析显示，裂孔持续时间和ILM剥除与解剖和功能结局均显著相关。
MH手术的良好效果主要通过早期手术和常规ILM剥除实现。仅采用常规ILM剥除可能也能获得良好结果。
