玻璃体切除联合非翻瓣内界膜转位手术治疗大直径黄斑裂孔

Transposition of internal limiting membrane with a non-inverted flap technique for large macular hole

目的:观察玻璃体切除联合带蒂的非翻瓣内界膜(ILM)转位手术治疗大直径黄斑裂孔(macular hole,MH)的效果。方法:前瞻性研究。2016-12/2017-02于江苏省人民医院收治的9例10眼经频域光学相干断层扫描(SD-OCT)确诊为大直径MH患者(MH>400μm),进行玻璃体切除联合ILM转位术。术前、术后1d,1 wk,1、3、6mo随访SD-OCT、最佳矫正视力(best corrected visual acuity,BCVA)及微视野检查。结果:患者裂孔闭合率为100%;术前BCVA(LogMAR)1.19±0.54,术后视力提高显著,末次随访0.70±0.50(P=0.005);黄斑8°平均视网膜光敏感度(MS)值术前3.14±4.52dB、术后末次随访8.91±5.53dB(P=0.008);黄斑2°MS值术前1.46±2.94dB、术后末次随访6.33±4.90dB(P=0.008)。术前固视不稳定8眼,术后末次随访固视不稳定1眼。结论:玻璃体切除联合内界膜转位手术可以有效治疗大直径MH,具有较高的裂孔闭合率,术后视功能改善显著。

AIM:To explore the effectiveness of a new non-inverted pedicle internal limiting membrane(ILM)flap transposition technique in the treatment of large macular holes(MH).METHODS:This was a prospective pilot study which included 9 patients with 10 eyes in Jiangsu Province People's Hospital from December 2016 to February 2017.All patients was diagnosed with large MH(size>400m)by the spectra-domain optical coherence tomography(SD-OCT)and underwent the non-inverted pedicle ILM flap transposition surgery.Best-corrected visual acuity(BCVA),SD-OCT images,and MP-1 microperimetry tests were performed pre-operation,1d,1wk,1,3,and 6mo post-operation.RESULTS:The macular hole closure rate after 6mo was 100%.The averaged BCVA improved from 1.19~0.54(LogMAR)pre-operation to 0.70~0.50(LogMAR)postoperation(P=0.005).The mean retinal sensitivity within 8°and 2°improved from 3.14~4.52dB to 8.91~5.53dB(P=0.008),and 1.46~2.94dB to 6.33~4.90dB(P=0.008)respectively.Preoperative unstable fixation in seven eyes resolved at the last postoperative follow-up.CONCLUSION:Our non-inverted pedicle internal ILM flap transposition technique shows effectiveness in the treatment of large macular holes with high MH closure rate and improving visual function.