自体神经感觉视网膜移植治疗难治性巨大黄斑裂孔

Autologous neurosensory retinal transplantation for the treatment of refractory large macular hole

目的观察自体神经感觉视网膜移植治疗常规玻璃体切割手术(PPV)后未闭合巨大黄斑裂孔的疗效。方法前瞻性临床研究。选取2022年7月至2023年12月于郑州大学第一附属医院眼科接受自体神经感觉视网膜移植治疗的难治性黄斑裂孔患者12例12只眼纳入研究。患眼经PPV联合内界膜剥除或填塞治疗后裂孔仍未闭合,且裂孔直径>600μm。患眼均行最佳矫正视力(BCVA)、光相干断层扫描(OCT)检查。BCVA检查采用国际标准视力表进行,统计分析时换算为最小分辨角对数(logMAR)视力。手术中于上方视网膜周边切取一块比裂孔直径约大0.3个视盘直径的健康视网膜神经上皮组织作为移植片,在手术中OCT辅助下将植片嵌入裂孔中,手术完毕时玻璃体腔填充硅油或无菌空气。手术后随访时间6个月。手术后3d及1、3、6个月采用手术前相同设备测量视网膜移植片厚度。观察手术后6个月时裂孔闭合率和BCVA变化。手术前后BCVA比较采用配对t检验。结果12例12只眼中,男性5例5只眼,女性7例7只眼;年龄(50.4±12.6)岁。裂孔直径(1085.6±344.0)μm;眼轴长度(27.64±4.19)mm。手术后6个月时,所有患眼裂孔完全闭合(100.0%,12/12)。手术后3d及1、3、6个月,视网膜移植片厚度分别为(206.8±21.0)、(170.8±23.3)、(165.6±31.6)、(157.9±31.1)μm。手术前、手术后6个月时,患眼logMARBCVA分别为1.28±0.39、0.95±0.22;手术前后logMARBCVA比较,差异有统计学意义(t=3.40,P<0.05)。结论自体神经感觉视网膜移植短期内能有效提高难治性巨大黄斑裂孔闭合率,改善或稳定患者视力。

Objective To observe the therapeutic effect of autologous neurosensory retinal transplantation in repairing unhealed giant macular hole after pars plana vitrectomy(PPV).Methods A prospective clinical study.From July 2022 to December 2023,12 patients(12 eyes)with refractory large macular hole who received autologous neurosensory retinal transplantation treatment in Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University were selected for the study.The macular hole in affected eyes still did not close after PPV combined with inner limiting membrane removal or tamponade,and the diameter of macular hole were greater than 600μm.All affected eyes received best corrected visual acuity(BCVA)and optical coherence tomography(OCT)examinations.The BCVA examination employed the international standard visual acuity chart,with results converted to logarithm of the minimum angle of resolution(logMAR)visual acuity for statistical analysis.During the surgery,a piece of healthy retinal neuroepithelial tissue,approximately 0.3 optic disc diameters larger than the macular hole,was removed from the upper retinal periphery and used as a graft.The graft was inserted into the macular hole with the aid of intraoperative OCT.Post-surgery,the vitreous cavity was filled with silicone oil or sterile air.The follow-up period after surgery was 6 months.The thickness of the retinal grafts was measured using the same equipment as before surgery at 3 days,1,3,and 6 months post-surgery.The primary focus was on observing the macular hole closure rate and changes in BCVA at 6 months post-operation.A paired t-test was used to compare BCVA before and after surgery.Results In the sample of 12 cases(12 eyes),there were 5 males with 5 eyes and 7 females with 7 eyes.The mean age was(50.4±12.6)years.The mean macular hole diameter was(1085.6±344.0)μm;The mean eye axis length was(27.64±4.19)mm.At 6 months after surgery,all affected eyes showed macular hole were completely closed(100.0%,12/12).The thickness of the retinal graft was measured as(206.8±21.0),(170.8±23.3),(165.6±31.6),and(157.9±31.1)μm at 3 days,1,3,and 6 months post-surgery,respectively.At before and 6 months after surgery,the logMAR BCVA of the affected eyes was 1.28±0.39 and 0.95±0.22,respectively.The difference in logMAR BCVA before and after surgery was statistically significant(t=3.40,P<0.05).Conclusion Autologous neurosensory retinal transplantation could effectively improve the closure rate of refractory large macular hole and improve or stabilize vision in the short run.