Chantarasorn Yodpong, Kritfuangfoo Thanaporn, Pokawattana Itsara, Hemarat Kornwipa, Tangjitwilaikul Chosita
Department of Ophthalmology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen St. Vajira Hospital, Dusit, Bangkok, 10300, Thailand.
Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Ophthalmol Ther. 2025 May;14(5):923-939. doi: 10.1007/s40123-025-01114-1. Epub 2025 Mar 14.
This study aimed to investigate postoperative outcomes of minimal gas vitrectomy (MGV) combined with a reduced period of gas-fovea contact in the management of idiopathic full-thickness macular holes (MHs).
This retrospective cohort study included patients who underwent surgery for MHs with minimal hole diameters of 250-800 µm and categorized them into two groups: conventional fluid-gas exchange (FGX) (38 eyes) and MGV (28 eyes), with FGX replaced by a 1.0-1.2 mL injection of pure sulfur hexafluoride after internal limiting membrane peeling. Postoperatively, patients in the MGV group were kept in a face-down position, switching to face-forward or no positioning (pseudophakia) once MH closure was confirmed by optical coherence tomography, performed every few days during the first postoperative week. The maximum duration of face-down positioning was 5 days.
Most baseline characteristics were comparable between the two groups except for the proportion of combined cataract surgery and the use of non-expansile gas, which were higher in the FGX group. Prone positioning time in the MGV group was shorter than that in the control group (3.8 days vs. 11.9 days). Subfoveal fluid pocket was present in 73.0% and 5.2% of eyes in the MGV and FGX groups, respectively. Twenty-seven eyes (96.4%) in the MGV group showed MH closure within 3 months. At 12 months, compared to the FGX group, the MGV group exhibited less disruption of the ellipsoidal zone (28.5% vs. 57.8%), superior visual acuity (0.33 ± 0.18 vs. 0.54 ± 0.28), and comparable MH closure rates.
In the treatment of medium-sized MHs, when compared to the FGX method, the use of a smaller volume of gas tamponade may be associated with earlier photoreceptor restoration. This method individualized prone positioning period without an immediate impact on central vision post surgery.
本研究旨在探讨在特发性全层黄斑裂孔（MH）的治疗中，微创玻璃体切除术（MGV）联合缩短气体与黄斑接触时间的术后效果。
这项回顾性队列研究纳入了接受手术治疗的最小裂孔直径为250 - 800 µm的MH患者，并将其分为两组：传统液-气交换（FGX）组（38只眼）和MGV组（28只眼），在剥除内界膜后，FGX组用1.0 - 1.2 mL纯六氟化硫注射液替代。术后，MGV组患者保持面朝下体位，术后第一周每隔几天通过光学相干断层扫描确认MH闭合后，改为面朝上或无体位限制（人工晶状体眼）。面朝下体位的最长持续时间为5天。
除联合白内障手术的比例和非膨胀性气体的使用情况外，两组的大多数基线特征具有可比性，FGX组这两项指标更高。MGV组的俯卧位时间短于对照组（3.8天 vs. 11.9天）。MGV组和FGX组分别有73.0%和5.2%的眼存在黄斑下液性暗区。MGV组27只眼（96.4%）在3个月内MH闭合。在12个月时，与FGX组相比，MGV组椭圆体带的破坏较少（28.5% vs. 57.8%），视力更好（0.33±0.18 vs. 0.54±0.28），且MH闭合率相当。
在治疗中等大小的MH时，与FGX方法相比，使用较小体积的气体填塞可能与更早的光感受器恢复相关。这种方法可个体化俯卧位时间，且对术后中心视力无即时影响。
