Xu Zhengbo, Wang Yuelin, Chen Youxin
4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, No.9 Dongdansantiao Street, Dongcheng District, Beijing, 100730, China.
Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, No. 49 Garden North Road, Haidian, Beijing, 100191, China.
BMC Ophthalmol. 2025 Apr 7;25(1):173. doi: 10.1186/s12886-025-04019-6.
Idiopathic full-thickness macular hole (FTMH) is a vision-threatening disease treated by the "gold standard" pars planar vitrectomy followed by internal limiting membrane peeling. This conventional surgical approach, while yielding a promising 90% closure rate, has a low success rate in large macular holes. Autologous blood has been proven to significantly enhance the healing process and has been introduced into ophthalmic surgeries. The aim of this study is to compare visual and anatomical outcomes of full-thickness macular holes with and without the use of autologous whole blood.
This retrospective study included 150 patients (150 eyes) diagnosed with FTMH and underwent primary surgery during 2020-2022. Patients with a minimum of 12 months follow-up were divided into whole blood (WB) group (n = 22) and control group (n = 128). An 1:3 propensity score matching (PSM) was performed based on sex, age, cataract history, diabetes, hypertension, injury, minimum linear diameter (MLD), basal diameter (BD) and preoperative best-corrected visual acuity (BCVA). Postoperative BCVA and optical coherence tomography (OCT) findings were collected for postoperative analysis.
After 1:3 PSM, 22 patients in WB group were matched to 66 patients in control group. The demographic characteristics showed no significant difference except for the MLD in WB group being significantly larger than control group: 762.50 ± 353.11 μm compared to 505.91 ± 193.52 μm (p = 0.003). Despite this unfavorable condition, all MHs were closed in the WB group, while in the control group 14 MHs (21.21%) remained open (p < 0.017). The WB group showed significantly better postoperative mean BCVA than control group (p = 0.016). Also, significantly more patients had improvement in BCVA by 0.2 logMAR or more after surgery in the WB group than in the control group (p = 0.05). After surgery with WB, a rugged retinal surface was observed in MHs larger than 1000 μm via OCT imaging.
The incorporation of PSM can greatly reduce the bias incurred by confounders in this retrospective study. The adjuvant use of WB significantly improves the functional and anatomical outcomes after MH surgery. Especially in patients with large MHs, WB can precipitate the proliferation and migration of Müller cells which ensures foveal structure restoration.
特发性全层黄斑裂孔（FTMH）是一种威胁视力的疾病，采用“金标准”的玻璃体切除术联合内界膜剥除术进行治疗。这种传统的手术方法虽然有高达90%的闭合率，但在治疗大的黄斑裂孔时成功率较低。自体血已被证明能显著促进愈合过程，并已被引入眼科手术。本研究的目的是比较使用和不使用自体全血治疗全层黄斑裂孔的视觉和解剖学结果。
这项回顾性研究纳入了150例（150只眼）在2020年至2022年期间被诊断为FTMH并接受初次手术的患者。随访至少12个月的患者被分为全血（WB）组（n = 22）和对照组（n = 128）。根据性别、年龄、白内障病史、糖尿病、高血压、外伤史、最小线性直径（MLD）、基底直径（BD）和术前最佳矫正视力（BCVA）进行1:3倾向评分匹配（PSM）。收集术后BCVA和光学相干断层扫描（OCT）结果进行术后分析。
经过1:3 PSM后，WB组的22例患者与对照组的66例患者匹配。除WB组的MLD显著大于对照组外，人口统计学特征无显著差异：分别为762.50±353.11μm和505.91±193.52μm（p = 0.003）。尽管存在这一不利情况，但WB组的所有黄斑裂孔均已闭合，而对照组有14个黄斑裂孔（21.21%）仍未闭合（p < 0.017）。WB组术后平均BCVA显著优于对照组（p = 0.016）。此外，WB组术后BCVA提高0.2 logMAR或更多的患者明显多于对照组（p = 0.05）。使用WB进行手术后，通过OCT成像观察到大于1000μm的黄斑裂孔处视网膜表面不平整。
在这项回顾性研究中，PSM的应用可以大大减少混杂因素引起的偏差。WB的辅助使用显著改善了黄斑裂孔手术后的功能和解剖学结果。特别是对于大黄斑裂孔患者，WB可促使Müller细胞增殖和迁移，从而确保黄斑结构的恢复。
