孔源性视网膜脱离合并黄斑裂孔的治疗结果

Treatment Outcome of Macular Hole Associated with Rhegmatogenous Retinal Detachment.

作者信息

Okonkwo O N, Akanbi T, Onwuegbuna A A

机构信息

Department of Ophthalmology, Eye Foundation Hospital and Eye Foundation Retina Institute, Lagos, Nigeria.

Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria.

出版信息

Niger J Clin Pract. 2024 Nov 1;27(11):1273-1281. doi: 10.4103/njcp.njcp_331_24. Epub 2024 Dec 4.

DOI:10.4103/njcp.njcp_331_24

PMID:39627668

Abstract

BACKGROUND

Macular holes are an infrequent association with rhegmatogenous retinal detachment, increasing the complexity of surgery and affecting outcome.

AIM

To report the visual outcome, macular hole (MH) closure, and retinal reattachment rate after vitrectomy with silicone oil plus different MH closure techniques for MH associated with rhegmatogenous retinal detachment and to compare the visual outcome between the techniques.

MATERIALS AND METHODS

A retrospective, comparative study. Review of pre and postoperative Snellen best corrected visual acuity (BCVA) and the logarithm of minimum angle of resolution (LogMAR) conversion for nine eyes of 9 consecutively treated macular hole in rhegmatogenous retinal detachment patients. Pre and postoperative optical coherence tomography (OCT) macula scans and retinal reattachment three months post silicone oil removal were assessed.

RESULTS

Surgical techniques: Inverted internal limiting membrane flap (n = 4; 44.45%), internal limiting membrane (ILM) plug (n = 4; 44.45%), and autologous retinal transplant (n = 1; 11.1%). Outcome: Single-surgery retinal reattachment rate was 88.9% (8/9 eyes), and 100% with second surgery. Primary MH closure was 100%. One reopened MH with retinal re-detachment, post silicone oil removal, required additional surgery. The mean preoperative BCVA was 2.53 ± 0.93 LogMAR, and mean postoperative BCVA was 0.94 ± SD 0.43 LogMAR (P = 0.000). Mean change in Snellen line = 2.22 ± 1.72. The postoperative vision was the same as preoperative in 22.2% and improved in 77.8%. Mean postoperative vision for the inverted ILM flap group (n = 4) was 1.10 ± 0.62 LogMAR (P = 0.038), and for the ILM plug group (n = 4) 0.83 ± 0.23 LogMAR (P = 0.002). The surgical technique did not influence postoperative BCVA (P = 0.85). Only one eye had an outer retina on OCT evaluation. Complications were macular atrophy (55.6%), macular edema (44.4%), and epiretinal membrane (33.3%).

CONCLUSION

Single-surgery retinal reattachment rate and macular hole closure using any of the techniques is high, and none showed superiority.

摘要

背景

黄斑裂孔与孔源性视网膜脱离的关联并不常见，这增加了手术的复杂性并影响手术效果。

目的

报告玻璃体切除联合硅油填充及不同黄斑裂孔封闭技术治疗孔源性视网膜脱离合并黄斑裂孔后的视力结果、黄斑裂孔闭合情况及视网膜复位率，并比较不同技术之间的视力结果。

材料与方法

一项回顾性比较研究。回顾9例连续治疗的孔源性视网膜脱离合并黄斑裂孔患者9只眼术前及术后的Snellen最佳矫正视力（BCVA）以及最小分辨角对数（LogMAR）转换情况。评估术前及术后黄斑区光学相干断层扫描（OCT）以及硅油取出后3个月的视网膜复位情况。

结果

手术技术：倒置内界膜瓣（n = 4；44.45%）、内界膜（ILM）填塞（n = 4；44.45%）和自体视网膜移植（n = 1；11.1%）。结果：单次手术视网膜复位率为88.9%（8/9只眼），二次手术后为100%。原发性黄斑裂孔闭合率为100%。1只眼在硅油取出后黄斑裂孔重新开放并伴有视网膜再脱离，需要再次手术。术前平均BCVA为2.53±0.93 LogMAR，术后平均BCVA为0.94±标准差0.43 LogMAR（P = 0.000）。Snellen视力行数平均变化为2.22±1.72。术后视力与术前相同者占22.2%，改善者占77.8%。倒置ILM瓣组（n = 4）术后平均视力为1.10±0.62 LogMAR（P = 0.038），ILM填塞组（n = 4）为0.83±0.23 LogMAR（P = 0.002）。手术技术对术后BCVA无影响（P = 0.85）。OCT评估仅有1只眼存在视网膜外层。并发症包括黄斑萎缩（55.6%）、黄斑水肿（44.4%）和视网膜前膜（33.3%）。