视网膜前膜对全层黄斑裂孔患者解剖结构和视觉预后的影响

Impact of Epiretinal Membrane on Anatomical and Visual Outcomes in Patients with Full-Thickness Macular Holes.

作者信息

Iwasaki Masanori, Nakashizuka Hiroyuki, Nezu Naoki, Omori Mai, Tanaka Koji, Mori Ryusaburo, Shimada Hiroyuki

机构信息

Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan.

出版信息

Ophthalmol Retina. 2025 Nov;9(11):1044-1052. doi: 10.1016/j.oret.2025.05.009. Epub 2025 May 9.

DOI:10.1016/j.oret.2025.05.009

PMID:40349984

Abstract

PURPOSE

This study aimed to evaluate the impact of an epiretinal membrane (ERM) on the postoperative outcomes of full-thickness macular hole (MH) repair, focusing on anatomical closure rates, postoperative visual acuity (VA), and recovery of the outer retinal layers.

DESIGN

A retrospective cohort study.

PARTICIPANTS

A total of 605 eyes from 594 patients who underwent MH surgery from 2015 to 2023.

METHODS

Patients were divided into 2 groups (MH with ERM [254 eyes] and MH without ERM [351 eyes]). Multiple regression analysis was employed to evaluate surgical outcomes, adjusting for minimum hole size and high myopia in relation to the initial MH closure rate and for preoperative VA and concurrent cataract surgery in relation to postoperative VA at 3 months. In all cases, ERM and internal-limiting membrane (ILM) peeling were performed, and the inverted ILM flap cover technique was added at the discretion of the surgeon. Patients with MH-associated retinal detachment, myopic foveoschisis and recurrent or traumatic MH were excluded.

MAIN OUTCOME MEASURES

The initial MH closure rate and postoperative VA at 3 months were evaluated using multiple regression analysis.

RESULTS

Our results indicated that ERM did not significantly impact MH closure rates (97.2% vs. 98.3%, P = 0.554), which was consistent with the findings of the multiple regression analysis (r = -0.310, P = 0.666). The inverted ILM flap technique effectively promoted MH closure even in the presence of an ERM (P = 0.021). The MH with ERM group had significantly worse postoperative VA at 3 months (P = 0.004) and significantly lower restoration rates of the outer nuclear layer (64.4% vs. 75.1%, P = 0.006) and external limiting membrane (82.2% vs. 90.1%, P = 0.007).

CONCLUSIONS

An ERM does not significantly affect anatomical MH closure. The inverted ILM flap technique is effective for MH closure, even in the presence of an ERM. An ERM negatively impacted postoperative VA and outer retinal layer restoration.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

摘要

目的

本研究旨在评估视网膜前膜（ERM）对全层黄斑裂孔（MH）修复术后结果的影响，重点关注解剖学闭合率、术后视力（VA）以及视网膜外层的恢复情况。

设计

一项回顾性队列研究。

参与者

2015年至2023年期间接受MH手术的594例患者共605只眼。

方法

患者分为两组（伴有ERM的MH [254只眼]和不伴有ERM的MH [351只眼]）。采用多元回归分析评估手术结果，针对初始MH闭合率，对最小裂孔大小和高度近视进行校正；针对3个月时的术后VA，对术前VA和同期白内障手术进行校正。所有病例均进行ERM和内界膜（ILM）剥除，并根据术者判断决定是否采用倒置ILM瓣覆盖技术。排除伴有MH相关视网膜脱离、近视性黄斑劈裂以及复发性或外伤性MH的患者。

主要观察指标

采用多元回归分析评估初始MH闭合率和3个月时的术后VA。

结果

我们的结果表明，ERM对MH闭合率无显著影响（97.2%对98.3%，P = 0.554），这与多元回归分析结果一致（r = -0.310，P = 0.666）。即使存在ERM，倒置ILM瓣技术也能有效促进MH闭合（P = 0.021）。伴有ERM的MH组在3个月时的术后VA显著更差（P = 0.004），外核层恢复率显著更低（64.4%对75.1%，P = 0.006），外界膜恢复率也显著更低（82.2%对90.1%，P = 0.007）。