Jia Qinlang, Zhang Ke, Qi Biying, Yang Xiaohan, Wu Xijin, Wang Xinbo, Feng Xiao, Liu Wu
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
Retina. 2025 Feb 1;45(2):222-230. doi: 10.1097/IAE.0000000000004288.
To investigate the anatomical and visual outcomes of inverted internal limiting membrane flap insertion versus single-layered i-internal limiting membrane flap covering in highly myopic macular holes associated with macular retinoschisis.
A retrospective study compared 23 G vitrectomy with inverted-internal limiting membrane flap insertion (30 eyes) or covering (31 eyes) in highly myopic macular holes patients. Pre- and postoperative optical coherence tomography images and best-corrected visual acuity (BCVA) were evaluated. Macular hole schisis was classified into three types based on the extent of outer layer schisis. Regression analysis identified predictors of closure rate and postoperative BCVA.
The baseline data of the two groups were matched, including BCVA, axial length, and minimum linear diameter, except for a higher hole height in insertion group ( P = 0.038). After a mean follow-up of 11.7 months, type I closure rates were 83.3% (25/30) in the insertion group and 90.3% (28/31) in the covering group ( P = 0.335), respectively. The intact external limiting membrane in the covering group (7/28) was higher compared with the insertion group (1/28) finally ( P = 0.026). Final BCVA improved significantly in both groups ( P < 0.001); the BCVA was better in closed highly myopic macular holes in the covering group ( P = 0.011). Multivariate linear regression analysis revealed that preoperative BCVA (β = 0.386, P = 0.001) and Macular hole schisis stage (β = 0.309, P = 0.004) were independent predictive factors for the final BCVA.
The single-layered inverted-internal limiting membrane flap covering favored foveal structure recovery and provided a better visual prognosis in closed highly myopic macular holes compared with insertion. The preoperative BCVA and macular hole schisis stage were independent predictors of visual outcomes in patients with highly myopic macular holes.
研究在伴有黄斑视网膜劈裂的高度近视性黄斑裂孔患者中，倒置内界膜瓣插入术与单层内界膜瓣覆盖术的解剖学和视觉效果。
一项回顾性研究比较了23G玻璃体切除术中，高度近视性黄斑裂孔患者行倒置内界膜瓣插入术（30只眼）或覆盖术（31只眼）的情况。评估术前和术后的光学相干断层扫描图像以及最佳矫正视力（BCVA）。根据外层劈裂的程度将黄斑裂孔视网膜劈裂分为三种类型。回归分析确定了闭合率和术后BCVA的预测因素。
两组的基线数据相匹配，包括BCVA、眼轴长度和最小线性直径，但插入组的裂孔高度较高（P = 0.038）。平均随访11.7个月后，插入组的I型闭合率为83.3%（25/30），覆盖组为90.3%（28/31）（P = 0.335）。最终，覆盖组完整的外界膜比例（7/28）高于插入组（1/28）（P = 0.026）。两组的最终BCVA均有显著改善（P < 0.001）；覆盖组闭合的高度近视性黄斑裂孔的BCVA更好（P = 0.011）。多因素线性回归分析显示，术前BCVA（β = 0.386，P = 0.001）和黄斑裂孔视网膜劈裂分期（β = 0.309，P = 0.004）是最终BCVA的独立预测因素。
与插入术相比，单层倒置内界膜瓣覆盖术有利于黄斑中心凹结构恢复，在闭合的高度近视性黄斑裂孔中提供更好的视觉预后。术前BCVA和黄斑裂孔视网膜劈裂分期是高度近视性黄斑裂孔患者视觉效果的独立预测因素。
