内界膜剥除术与填塞术治疗特发性黄斑孔的效果比较

Comparison of efficacy between internal limiting membrane peeling and internal limiting membrane insertion for idiopathic macular hole

目的比较玻璃体切除联合内界膜剥除术与玻璃体切除联合内界膜填塞术治疗特发性黄斑孔(IMH)的效果及对黄斑微结构的影响。方法回顾性队列研究。将扬州大学附属苏北人民医院眼科2016年8月至2019年8月行手术治疗的IMH 43例(44眼)纳入研究。其中男7例(7眼),女36例(37眼)。分为内界膜剥除组(20眼)与内界膜填塞组(24眼)。比较两组术后黄斑孔闭合率、视力及椭圆体带缺损直径。所有患者随访1~20个月。结果剥除组孔的闭合率及Ⅰ型闭合率分别为90.00%(18/20)及88.89%(16/18),填塞组分别为91.67%(22/24)及86.36%(19/22)(Fisher检验P=1.000,1.000)。剥除组及填塞组术后视力(BCVA)均较手术前明显提高(t=5.609,5.279;P<0.001),但两组之间术后视力相似(t=-1.415,P=0.164)。剥除组术后椭圆体带缺损直径较术前减小(t=4.027,P=0.001),而填塞组术前术后相似(t=1.154,P=0.260),两组术后椭圆体带缺损直径比较,差异有统计学意义(t=-2.572,P=0.014)。结论玻璃体切除联合内界膜剥除术与玻璃体切除联合内界膜填塞术治疗IMH均安全有效,而内界膜剥除术对黄斑微结构扰动较小。

Objective To compare the efficacy between vitrectomy combined with internal limiting membrane peeling and internal limiting membrane insertion for idiopathic macular hole(IMH).Methods This was a retrospective cohort study.A total of 44 eyes of 43 cases of IMH who underwent pars plana vitrectomy from Aug.2016 to Aug.2019 in Northern Jiangsu People’s Hospital Affiliated to Yangzhou University were included.There were 7 eyes of 7 males and 37 eyes of 36 females.The patients were divided into two groups:internal limiting membrane peeling group with 20 eyes and internal limiting membrane insertion group with 24 eyes.The postoperative IMH closure rate,visual acuity and ellipsoid defect diameter were compared between the two groups.The follow-up time was 1-20 months.Results The IMH closure rate with typeⅠwere 90.00%(18/20)and 88.89%(16/18)in internal limiting membrane peeling group respectively,and 91.67%(22/24)and 86.36%(19/22)in internal limiting membrane insertion group respectively(P=1.000,1.000).Postoperative best-corrected visual acuity(BCVA)was improved obviously in the two groups compared to preoperative BCVA(t=5.609,5.279;P<0.001).The postoperative BCVA of the two groups was similar(t=-1.415,P=0.164).Postoperative ellipsoid defect diameter was evidently reduced after operation compared with that before operation in internal limiting membrane peeling group(t=4.027,P=0.001),the difference in internal limiting membrane insertion group was not statistically significant(t=1.154,P=0.260).There was statistically significant difference in postoperative ellipsoid defect diameter between the two groups(t=-2.572,P=0.014).Conclusion Vitrectomy combined with internal limiting membrane peeling and vitrectomy combined with internal limiting membrane insertion are both safe and effective for the treatment of IMH,but the disturbance to the macular microstructure in internal limiting membrane peeling group is slighter.