Mohsin Fatima, Awan Muhammad Amer
Ophthalmology, Shifa International Hospitals Limited, Islamabad, PAK.
Ophthalmology, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, PAK.
Cureus. 2024 Dec 21;16(12):e76120. doi: 10.7759/cureus.76120. eCollection 2024 Dec.
To describe the anatomical and functional outcome of autologous internal limiting membrane (ILM) transplant with 27-gauge plus (27G+) three ports pars plana vitrectomy (PPV) in failed and recurrent full-thickness macular holes (MH) in a spectrum of pathologies.
Observational cohort study Methods: Seven eyes of seven patients who had failed or recurrent MH were included from January 2017 to January 2022. A single vitreoretinal surgeon performed all surgeries using a 27G+ PPV system in a tertiary care hospital. An autologous ILM transplant was performed in each case, using hexafluoroethane or perfluoropropane as tamponade agents. The primary outcomes encompassed achieving MH closure, determining the best possible vision achieved during the 12-month follow-up period, and assessing any post-operative complications.
The average age of the patients enrolled in this study was 49.4 years. Four of the cohort of seven patients were male, while three were female. All individuals underwent successful surgery, with the closure of MH postoperatively. Swept-source optical coherence tomography was used to examine the closure of the MH on the first day after surgery, which was further validated by the absorption of gas. Over 12 months, the mean best corrected visual acuity in the logarithm of the minimum angle of resolution (Log MAR) improved significantly, progressing from 1.60 to 0.60. This favorable trend persisted throughout the 12-month follow-up, with MH remaining consistently closed. One patient encountered a subsequent retinal re-detachment, necessitating prompt and effective surgical intervention, resulting in successful management.
An autologous ILM transplant with a 27G+ PPV is a delicate and effective technique for closing MH in complicated cases. We recommend this technique for failed and recurrent MH in different pathologies.
描述在一系列病理情况下，采用27G+三通道经睫状体平坦部玻璃体切除术（PPV）联合自体视网膜内界膜（ILM）移植治疗失败及复发性全层黄斑裂孔（MH）的解剖和功能结果。
观察性队列研究
纳入2017年1月至2022年1月期间7例失败或复发性MH患者的7只眼。在一家三级护理医院，由一名玻璃体视网膜外科医生使用27G+PPV系统进行所有手术。每例均进行自体ILM移植，使用六氟乙烷或全氟丙烷作为填塞剂。主要结果包括实现MH闭合、确定12个月随访期内达到的最佳视力以及评估任何术后并发症。
本研究纳入患者的平均年龄为49.4岁。7例患者中有4例为男性，3例为女性。所有患者均成功接受手术，术后MH闭合。采用扫频光学相干断层扫描在术后第一天检查MH的闭合情况，并通过气体吸收进一步验证。在12个月期间，最小分辨角对数（Log MAR）的平均最佳矫正视力显著提高，从1.60提高到0.60。在整个12个月的随访中，这种良好趋势持续存在，MH始终保持闭合。1例患者随后发生视网膜再脱离，需要及时有效的手术干预，最终成功处理。
27G+PPV联合自体ILM移植是一种治疗复杂病例中MH闭合的精细且有效的技术。我们推荐该技术用于不同病理情况下失败及复发性MH的治疗。
