内界膜瓣及植入技术改善黄斑裂孔性视网膜脱离的预后。

Internal Limiting Membrane Flap and Insertion Techniques Improve Prognosis in Macular Hole-Associated Retinal Detachment.

作者信息

Zhu Ke, Lei Boya, Wang Ling, Chen Ling, Ni Yingqin, Zhang Yanqiong, Huang Xin, Chang Qing, Xu Gezhi

机构信息

Eye Institute and Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China; Key Laboratory of Myopia and Related Eye Diseases, NHC, Chinese Academy of Medical Sciences, Shanghai, China.

出版信息

Ophthalmol Retina. 2025 Jul 11. doi: 10.1016/j.oret.2025.07.006.

DOI:10.1016/j.oret.2025.07.006

PMID:40653047

Abstract

PURPOSE

To compare the long-term anatomic and visual outcomes of macular hole (MH)-associated retinal detachment (MHRD) treated with internal limiting membrane (ILM) peeling, ILM insertion, or inverted ILM flap techniques.

DESIGN

Retrospective and comparative study.

PARTICIPANTS

Two hundred eighty-eight patients with MHRD who underwent pars plana vitrectomy and ILM technique were enrolled at the Eye and ENT Hospital of Fudan University.

METHODS

Two hundred ninety-five eyes were divided into ILM peeling (138 eyes), ILM insertion (54 eyes), and ILM flap (103 eyes) groups and subdivided according to the extent of retinal detachment, non-high/high myopia, proliferative vitreoretinopathy (PVR) grade, and chorioretinal atrophy (CA) grade. The initial retinal reattachment rate, MH closure rate, postoperative best-corrected visual acuity (BCVA), and improvement in BCVA were evaluated.

MAIN OUTCOME MEASURES

Anatomic and visual outcomes of MHRD treated with ILM peeling, insertion, or flap techniques.

RESULTS

The ILM flap and insertion techniques were associated with significantly better initial MH closure rate than ILM peeling (91% vs 87% vs 54%, P < 0.001) along with a greater BCVA improvement (P < 0.001). The proportion of eyes with BCVA improvement was higher for the ILM flap technique than for ILM insertion (96% vs 83%, P < 0.005). In eyes with non-high myopia (axial length <26 mm), the ILM flap technique demonstrated better postoperative BCVA improvement than ILM peeling, but without an anatomic advantage. In eyes with PVR grade C or CA grade 4, the ILM flap technique achieved greater MH closure rates than ILM peeling, but without visual benefits. Retinal detachment extending beyond the arcade, the ILM insertion, and ILM flap techniques were significantly associated with MH closure (P = 0.011, 0.001, and P < 0.001, respectively). Preoperative BCVA, retinal detachment beyond the arcade, CA grade, ILM insertion technique, and ILM flap technique were independently associated with the BCVA improvement (P = 0.003, 0.009, 0.006, and 0.014 and P < 0.001, respectively).

CONCLUSIONS

The ILM insertion and flap techniques were associated with greater MH closure rates and BCVA improvements compared with the ILM peeling technique for the treatment of MHRD. The ILM flap technique outperformed the ILM insertion technique in terms of functional recovery.

FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

摘要

目的

比较采用内界膜（ILM）剥除术、ILM植入术或倒置ILM瓣技术治疗黄斑裂孔（MH）相关视网膜脱离（MHRD）的长期解剖学和视觉效果。

设计

回顾性比较研究。

参与者

复旦大学附属眼耳鼻喉科医院收治的288例行玻璃体切除术及ILM技术的MHRD患者。

方法

295只眼被分为ILM剥除术组（138只眼）、ILM植入术组（54只眼）和ILM瓣组（103只眼），并根据视网膜脱离范围、非高度/高度近视、增殖性玻璃体视网膜病变（PVR）分级和脉络膜视网膜萎缩（CA）分级进一步细分。评估初始视网膜复位率、MH闭合率、术后最佳矫正视力（BCVA）及BCVA改善情况。

主要观察指标

采用ILM剥除术、植入术或瓣技术治疗MHRD的解剖学和视觉效果。

结果

ILM瓣和植入术技术的初始MH闭合率显著优于ILM剥除术（分别为91%、87%和54%，P<0.001），BCVA改善也更明显（P<0.001）。ILM瓣技术BCVA改善的眼比例高于ILM植入术（96%对83%，P<0.005）。在非高度近视（眼轴长度<26mm）眼中，ILM瓣技术术后BCVA改善优于ILM剥除术，但无解剖学优势。在PVR C级或CA 4级眼中，ILM瓣技术的MH闭合率高于ILM剥除术，但无视觉益处。视网膜脱离延伸至睫状血管弓以外，ILM植入术和ILM瓣技术与MH闭合显著相关（分别为P=0.011、0.001和P<0.001）。术前BCVA、睫状血管弓以外的视网膜脱离、CA分级、ILM植入术技术和ILM瓣技术与BCVA改善独立相关（分别为P=0.003、0.009、0.006、0.014和P<0.001）。