Internal limiting membrane peeling with different dyes in the surgery of idiopathic macular hole: a systematic review of literature and network Meta-analysis

AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic macular hole(IMH). METHODS: A search was conducted using Pub Med, EMBASE, and CENTRAL(Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS: A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION: BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.

Displacement of the retina after idiopathic macular hole surgery with different internal limiting membrane peeling patterns

AIM:To explore retinal displacement after surgical treatment for idiopathic macular hole(IMH)with different internal limiting membrane(ILM)peeling patterns.METHODS:Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups,N-T group(11 eyes)and T-N group(11 eyes).For patients in N-T group,ILM was peeled off from nasal to temporal retina.For patients in T-N group,ILM was peeled off from temporal to nasal retina.Preoperative,postoperative 1,3,and 6 mo,autofluorescence fundus images were collected for manual measurement of distances of fixed nasal(N),temporal(T),superior(S),and inferior(I)retinal points(bifurcation or crossing of retinal vessels)around the macula to the optic disc(OD).These were respectively defined as N-OD,T-OD,S-OD,and I-OD.The retinal displacement,macular holeclosure rate,and best corrected visual acuity(BCVA)were compared between the two groups after surgery.RESULTS:At postoperative 1,3,and 6 mo,the macula slipped toward the OD,manifested by the decreased T-OD,N-OD,S-OD,and I-OD(P<0.05).No significant difference was found in the T-OD,N-OD,S-OD,and I-OD between N-T group and T-N group.IMH closure rate was 100%both in N-T group and T-N group.There was no significant difference in BCVA between two groups(P<0.05).CONCLUSION:The macula slips toward the OD after successful macular hole surgery.The two different ILM peeling pattern show similar visual outcome and retinal displacement,which means ILM peeling directions are not the influencing factor of postoperative retinal displacement.

Negative effects of enlarging internal limiting membrane peeling for idiopathic macular hole surgery

AIM: To observe the effects of the different extents of internal limiting membrane(ILM) peeling on the surgical success and anatomical and functional outcomes of idiopathic macular hole(IMH).METHODS: In this retrospective cohort study, 36 patients were reviewed and divided into two groups according to the extent of ILM peeling: group A(18 patients), with the peeling area within one-half of the optic disc macular distance as the radius;group B(18 patients), with the peeling area larger than that of group A but did not exceed the optic disc macular distance as the radius. The main outcomes included the best corrected visual acuity(BCVA), light-adaptive electroretinography, macular hole(MH) closure rate, central macular thickness(CMT), retinal nerve fiber layer(RNFL) and ganglion cell complex(GCC) thickness [nine regions based on the Early Treatment of Diabetic Retinopathy Study(ETDRS) ring] before and 1, 3, and 6mo after surgery.RESULTS: The closure rate was 94.4%(17/18) both in groups A and B. The BCVA in both groups improved significantly compared with the preoperative values, but there was no difference between the two groups. The b-wave amplitude of the electroretinogram analysis was significantly improved in both groups compared to that of the preoperative period, with a greater increase in group A than in group B at 6mo(P=0.017). The CMT in both groups gradually decreased after surgery, and there was no difference between the two groups. The RNFL thickness of the temporal outer ring region in group B was significantly lower than that in group A at 3 and 6mo after surgery(P=0.010, 0.032). The GCC thickness of the temporal outer ring region in group B was significantly lower than that in group A at 6mo after surgery(P=0.038).CONCLUSION: Enlarging the extent of ILM peeling doesn’t affect the IMH closure rate and visual acuity recovery, but the greater the extent of peeling, the greater the damage to the inner retinal structures.

The Preliminary Report of Pathological Changes of Epiretinal Membranes and Internal Limiting Membrane Removed during Idiopathic Macular Hole Surgery

Purpose:To investigate the pathological changes of epiretinal membranes(ERM)and internal limiting membrane (ILM) removed during idiopathic macular hole surgery.Methods:Ten consecutive patients with a unilateral idiopathic macular hole underwent pars plana vitrectomy(PPV) with the surgical removal of the ERMs overlying the hole and ILM surrounding the hole. The pathological features of the excised tissues were examined under the microscope. Results:According to the morphological changes, four ERMs showed cellular elements which looked like glia cells, macrophages, plasma cells, lymphocytes and fibroblast cells. Two of the ILM appeared as transparent membranes without cellular elements. The other eight ILM showed cellular elements on the transparent membranes.Conclusion: Our study supports the hypothesis that the tangential traction of vitreous and proliferative cellular elements on the inner surface of ILM causes idiopathic macular holes. Removal of the posterior cortical vitreous, ILM and proliferative cellular tissue is a valid treatment for IMH.

Internal limiting membrane dragging and peeling:a modified technique for macular holes closure surgery

AIM:To introduce a modified technique of internal limiting membrane(ILM)centripetal dragging and peeling to treat idiopathic macular hole(IMH)and to observe the ILM-retina adhesive forces.METHODS:Twenty-six consecutive patients with stage 3 to 4 IMH and followed up at least six months were enrolled.All patients underwent complete par plana vitrectomy,ILM dragging and peeling,fluid and gas exchange,15%C3 F8 tamponade and 2-week prone position.The best corrected visual acuity,macular hole evaluation by optical coherence tomography,and complications were evaluated.RESULTS:The mean diameter of IMH was 524±148μm(range:201-683μm),with 21 cases(80.8%)greater than 400μm.ILM dragging and peeling were successfully performed in all cases.Most of the ILM-retina adhesive forces are severe(42.3%,11/26),followed by mild(38.5%,10/26),and moderate(19.2%,5/26).The mean follow-up duration was 21.2±6.1 mo.The IMH was closed in 25(96.3%)eyes.Visual acuity(logMAR)improved significantly from 1.2±0.6 preoperatively to 0.7±0.5 postoperatively(P<0.001).CONCLUSION:Preexisting ILM-retina adhesive force is found in IMH patients.With assistance of this force,this modified technique may help to release the IMH edges and improve the closure rate of large IMH.

Retinal displacement after surgery for idiopathic macular hole

AIM:To review and summarize the mechanism hypothesis,influencing factors and possible consequences of macular retinal displacement after idiopathic macular hole(IMH)surgery.METHODS:PubMed and Web of Science database was searched for studies published before April 2023 on“Retinal displacement”,“Idiopathic macular holes”,and“Macular displacement”.RESULTS:Recently,more academics have begun to focus on retinal displacement following idiopathic macular holes.They found that internal limiting membrane(ILM)peeling was the main cause of inducing postoperative position shift in the macular region.Moreover,several studies have revealed that the macular hole itself,as well as ILM peeling method,will have an impact on the result.In addition,this phenomenon is related to postoperative changes in macular retinal thickness,cone outer segment tips line recovery,the occurrence of dissociated optic nerve fiber layer(DONFL)and the degree of metamorphopsia.CONCLUSION:As a subclinical phenomenon,the clinical significance of postoperative macular displacement cannot be underestimated as it may affect the recovery of anatomy and function.

光学相干断层扫描血管成像在特发性黄斑前膜中的应用研究进展

特发性黄斑前膜(iERM)是一种因黄斑区及周边视网膜形成非血管性纤维膜,继而因纤维膜的牵拉导致黄斑的变形、皱褶等导致患眼视力下降及视物变形的眼底疾病。光学相干断层扫描血管成像(OCTA)凭借无创、分辨率高、可分层显示视网膜血管、量化视网膜血管密度和无灌注血管区大小等优势,已被广泛应用于包括iERM在内的黄斑疾病的诊断中。OCTA除了可以提供视网膜微血管结构、血流灌注的数字化信息,揭示iERM对微血管结构的牵拉作用,还可以在疾病的随访中用于监测血流灌注的改变。虽然目前OCTA尚不能完全替代眼底血管造影检查,但其已经为进一步了解iERM的发病机制、疾病进程及预后因素带来了更加丰富的信息。本文就OCTA在iERM中的应用研究进展作一综述,以期为OCTA在iERM中的应用提供更多启示。

内界膜剥除术与内界膜翻转遮盖术对特发性黄斑裂孔术后视力及视网膜结构的影响

目的评估内界膜(ILM)翻转遮盖术与ILM剥除术在特发性黄斑裂孔(IMH)手术中的效果,观察2种手术方法对黄斑裂孔闭合方式及术后视力的影响。方法回顾性分析2021年6月—2022年3月于我院就诊的IMH患者54例(54眼)的临床资料。根据不同手术方式将患者分为2组,采用ILM剥除术28例(28眼),采用ILM翻转遮盖术26例(26眼),比较2组患者术后6个月时最佳矫正视力(BCVA)、黄斑孔闭合形态及视网膜外层结构。结果术后6个月时,剥除组和翻转组平均视力(LogMAR)分别为0.85±0.25和0.71±0.19,2组视力较术前均有所提高,差异有统计学意义(t_(1)=12.67,P1<0.001;t_(2)=11.47,P_(2)<0.001)。术后视力翻转组较剥除组更好(t=2.20,P=0.033)。术后6个月时,剥除组黄斑裂孔(MH)成功闭合24例(85.7%),其中U型闭合11例(45.8%),EZ完整10例(41.7%),外界膜(ELM)完整17例(70.8%);翻转组MH成功闭合24例(92.3%),U型闭合18例(75.05%),EZ完整16例(66.7%),EIM完整20例(83.3%),翻转遮盖组术后U型闭合及EZ、ELM恢复均高于剥除组。结论2种手术方式在提高MH闭合率方面均有有效性,ILM翻转遮盖术更有利于裂孔沿着原有解剖形态愈合,有效恢复术后视网膜外层结构,提高患者预后视力。

玻璃体切除联合黄斑前膜剥除术及内界膜剥除术在特发性黄斑前膜患者中的治疗效果分析

目的 探究玻璃体切除联合黄斑前膜剥除术及内界膜剥除在特发性黄斑视网膜前膜(简称“特发性黄斑前膜”)患者中的治疗效果。方法 选取2019年5月—2023年5月常熟市第一人民医院眼科收治的60例特发性黄斑前膜患者作为研究对象,按照随机数表法分为两组。对照组(n=30)实施玻璃体切除联合黄斑前膜剥除术,研究组(n=30)在对照组基础上联合内界膜剥除治疗,对比两组视力(Best-corrected Visual Acuity,BCVA)、黄斑中心凹视网膜厚度(Central Macular Thickness,CMT)、平均视物变形评分、并发症发生率。结果术后1个月,研究组的BCVA优于对照组,差异有统计学意义(P<0.05);研究组术后3个月CMT低于对照组,差异有统计学意义(P<0.05);两组患者术后1个月、3个月平均视物变形评分均低于术前,差异有统计学意义(P均<0.05),组间比较,差异无统计学意义(P均>0.05);研究组并发症总发生率与对照组比较,差异无统计学意义(P>0.05)。结论 玻璃体切除联合黄斑前膜剥除术和内界膜剥除术两种手术方式对特发性黄斑前膜患者治疗均具备良好的治疗效果,安全性较好,但在改善视网膜厚度方面,玻璃体切除联合黄斑前膜剥除及内界膜剥除术后更低,体现出一定优势,但临床还需更大样本量进一步研究,根据患者实际给予合理手术方式的选择。

特发性黄斑前膜术后视力与黄斑区形态结构和血流密度的相关性

目的:利用光学相干断层扫描血管成像(OCTA)观察特发性黄斑前膜(IMEM)患者术后黄斑区形态结构及血流密度的变化,分析其与视力的相关性。方法:前瞻性研究。连续收集2020-01/2021-07就诊于我院的IMEM患者45例45眼,观察术前、术后1wk,1、3、6mo最佳矫正视力(BCVA)、中央黄斑区厚度(CMT)、中心凹无血管区(FAZ)面积、中心凹视网膜浅层毛细血管丛(SCP)血流密度的变化。结果:与术前比较,纳入患者术后1wk BCVA无明显变化(P>0.05),术后1、3、6mo均明显改善(P<0.05);术后1wk CMT明显增厚(P<0.05),术后1、3、6mo均明显降低(P<0.05);术后1wk,1mo FAZ面积无明显变化(P>0.05),术后3、6mo明显扩大(P<0.05);术后1wk,1、3mo SCP血流密度均无明显变化(P>0.05),术后6mo明显减少(P<0.05)。术后3、6mo纳入患者BCVA与CMT呈正相关(r=0.457、0.615,P=0.032、0.012)。结论:特发性黄斑前膜手术后1mo内视力恢复快,之后趋于平稳,而中心凹形态及血流分布的恢复滞后于视力恢复,且与视力无明显相关性。

25G+玻璃体切除黄斑前膜剥除术联合玻璃体腔小剂量曲安奈德治疗特发性黄斑前膜的临床观察

目的观察特发性黄斑前膜(IMEM)行25G+玻璃体切除剥除前膜联合小剂量曲安奈德玻璃体腔注射治疗的临床疗效。方法于2020年1月至2021年3月就诊于我院的IMEM患者接受玻璃体手术联合玻璃体腔曲安奈德(2mg/0.5ml)注射,收集患者资料,包括手术前后最佳矫正视力(BCVA logMAR)、眼压、黄斑中心凹厚度(CMT),观察其临床效果。结果共入组26例26眼,术后1周、1月、3月、6月视力较术前均有明显提高(P<0.05)。术后1周眼压较术前降低(P<0.05),其余时间较术前均无明显变化(P>0.05)。术后1周、1月、3月、6月CMT较术前均有明显降低(P<0.05)。结论玻璃体切除黄斑前膜剥除术联合玻璃体腔注射小剂量曲安奈德治疗特发性黄斑前膜安全有效,能有效提高患者视力,减轻黄斑水肿。

地塞米松玻璃体内植入剂在特发性黄斑前膜玻璃体手术中的应用

目的比较特发性黄斑前膜患者玻璃体手术联合与不联合玻璃体腔地塞米松玻璃体内植入剂注药术后视网膜黄斑区超微结构与视功能变化。方法收集2019年1月至2022年12月接受手术治疗的特发性黄斑前膜患者94例(94只眼)。按术毕时是否联合玻璃体腔内注射地塞米松玻璃体内植入剂将患者分为注药组59例(59只眼)和对照组35例(35只眼)。2组患者行玻璃体切除术剥除黄斑前膜及内界膜,术后随访>12个月。观察2组患者手术前后最佳矫正视力(BCVA)、黄斑中心凹厚度、异常中心凹内层厚度的变化情况。结果患者术前及术后1、3、6、12个月最佳矫正视力(LogMAR)分别为0.71±0.14、0.62±0.15、0.51±0.16、0.48±0.29、0.36±0.20,注药组和对照组术后最佳矫正视力LogMAR视力均较术前明显提高(Waldχ^(2)=3428.83,P<0.001;Waldχ^(2)=445.67,P<0.001)。在术后3、6、12个月,2组间最佳矫正视力差异有统计学意义(Waldχ^(2)=8.31,P=0.004;Waldχ^(2)=11.31,P=0.001;Waldχ^(2)=22.54,P<0.001)。黄斑中心凹视网膜厚度分别为(472.64±69.69)、(423.68±83.56)、(380.08±104.98)、(319.55±95.83)、(294.55±104.88)μm,差异有统计学意义(Waldχ^(2)=1322.92,P<0.001)。在术后3、6、12个月,2组间黄斑中心凹厚度差异有统计学意义(Waldχ^(2)=12.47,P<0.001;Waldχ^(2)=21.15,P<0.001;Waldχ^(2)=28.88,P<0.001)。异常中心凹内层厚度分别为(189.87±38.22)、(164.05±40.17)、(142.08±47.80)、(112.51±52.87)、(91.49±53.25)μm,差异有统计学意义(Waldχ^(2)=969.82,P<0.001)。在术后3、6、12个月,2组间异常中心凹内层厚度差异有统计学意义(Waldχ^(2)=11.25,P=0.001;Waldχ^(2)=15.93,P<0.001;Waldχ^(2)=11.98,P=0.001)。结论特发性黄斑前膜患者术毕时玻璃体腔注射地塞米松玻璃体内植入剂可以辅助于黄斑超微结构和视功能的恢复。

玻璃体联合内界膜手术治疗黄斑裂孔的效果

目的 探究玻璃体切除术联合内界膜翻转覆盖术治疗底径>800μm特发性黄斑裂孔的临床效果。方法 将本院收治的106例底径>800μm特发性黄斑裂孔患者以信封法随机分两组,对照组53例(53眼)采用25G玻璃体切除术联合内界膜填塞术治疗;观察组53例(54眼)采用25G玻璃体切除术联合内界膜翻转覆盖术治疗。对比治疗后裂孔闭合率、手术前后的最佳矫正视力变化(BCVA)以及术后并发症情况。结果 观察组治疗后裂孔闭合率98.15%(53/54)明显高于对照组裂孔闭合率79.25%(42/53)(χ^(2)=9.599,P<0.05);术前两组BCVA未见明显差异(P>0.05)。观察组术后1周、术后1个月、术后6个月BCVA均较对照组明显下降(P<0.05);两组术后视网膜裂孔、视网膜脱离、晶状体浑浊发生率对比无明显差异(P>0.05)。结论 玻璃体切除术联合内界膜翻转覆盖术治疗底径>800μm特发性黄斑裂孔患者的临床效果显著,不仅能有效提高裂孔闭合率,还能改善患者视力,且术后并发症少,安全性较高,可在临床推广应用。

SD-OCT参数评估黄斑裂孔内界膜撕除术后视力改善的应用价值

目的:分析频域光学相干断层扫描(SD-OCT)参数评估黄斑裂孔内界膜撕除术后视力改善情况的应用价值。方法:回顾性分析2019-05/2021-02于我院行玻璃体切除+内界膜撕除+长效气体填充术治疗的特发性黄斑裂孔(IMH)患者82例82眼的临床资料,分析术后3mo IMH闭合情况与SD-OCT参数的相关性,并评估影响术后视力改善不良的危险因素。结果:Spearman秩相关分析显示,术后3mo IMH闭合情况与术前外界膜(ELM)缺损直径呈正相关(r_(s)=0.308,P<0.05),与术前黄斑裂孔指数(MHI)呈负相关(r_(s)=-0.266,P<0.05)。Logistic回归分析显示,术前MHI≥0.5是影响术后视力改善不良的保护因素(OR=0.691,P<0.05)。结论:SD-OCT可通过检测术前MHI及ELM缺损直径等参数预测手术疗效,对判断视功能改善情况有利。

特发性黄斑前膜手术前后嵌合体带改变与视功能的相关性

目的:探讨特发性黄斑前膜(IMEM)患者手术前后黄斑区微结构与术后视功能恢复的相关性。方法:选取2017-01/2019-12就诊于我院的IMEM患者43例43眼,术前、术后3、6、9mo均检测最佳矫正视力(BCVA),进行视物变形(M-chart评分表)评分,并采用频域光学相干断层扫描(SD-OCT)测量中心凹视网膜厚度(CFT)、中心凹下脉络膜厚度(SFCT)、神经节细胞-内丛状层(GC-IPL)厚度及嵌合体(IZ)带缺损长度。结果:术后3、6、9mo,纳入患者BCVA和视物变形程度均较术前逐渐改善(均P<0.05),且BCVA与CFT、IZ带缺损长度均呈正相关(P<0.05),与SFCT、GC-IPL厚度均无相关性(P>0.05);视物变形评分与CFT均呈正相关(P<0.05),与SFCT、GC-IPL厚度、IZ带缺损长度均无相关性(P>0.05)。结论:CFT和IZ带缺损长度与IMEM术后BCVA具有显著相关性,这两项指标可作为预测IMEM术后视功能恢复的指标。

内界膜剥离术治疗特发性黄斑裂孔的研究进展

玻璃体切除联合内界膜(ILM)剥离是特发性黄斑裂孔(IMH)的有效治疗方法。IMH的预后与裂孔大小及病程长短密切相关。直径<400μm的裂孔有自发闭合的可能,>400μm的裂孔很少能够自行闭合,需要玻璃体切除联合ILM剥离解除玻璃体黄斑牵引,才能达到理想的裂孔闭合率。部分直径>400μm、病程长(6~12个月)的IMH,单纯ILM剥除效果欠佳,常在ILM剥离的基础上联合应用气体填充、孔周按摩、自体血填充等手术方式优化治疗效果。但是,有研究者认为ILM剥离会造成视网膜显微结构及视功能损害。近些年ILM剥离技术不断改进,衍生出保留中心凹ILM剥离、向心牵引ILM剥离、根据黄斑裂孔(MH)形状定制ILM剥离、各种类型的ILM瓣等技术,以及ILM磨损、奥克纤溶酶药物治疗等其他方法,在保证治疗效果的基础上尽可能降低对视网膜的损害。本文基于国内外学者的临床经验,对ILM剥离治疗IMH最新进展进行综述,明确不同治疗和手术方式的特点和适用性,为临床上IMH的治疗提供参考。

内界膜剥除术与填塞术治疗特发性黄斑裂孔的效果比较

目的 比较内界膜剥除术与填塞术治疗较大直径陈旧性特发性黄斑裂孔(idiopathic macular hole,IMH)的效果。方法 回顾性分析2019年1月—2021年6月广州市第一人民医院收治的裂孔直径大于600μm的IMH患者30例(30眼),按手术方式分为2组。内界膜剥除组(15例)行玻璃体切除联合内界膜剥除术及惰性气体眼内填充,内界膜填塞组(15例)行玻璃体切除联合内界膜填塞术及惰性气体眼内填充,比较术后1个月2组患者裂孔闭合情况、视力、椭圆体带缺损直径及视网膜内复合体厚度变化。结果 术后1个月2组患者裂孔闭合情况、视力、椭圆体带缺损直径及视网膜内复合体厚度比较,差异均无统计学意义(P>0.05)。结论 对于裂孔直径大于600μm的IMH,内界膜填塞术较剥除术无明显短期预后改善效果,无证据支持临床中应优先选择内界膜填塞术。

基于OCT不同分期的特发性黄斑前膜患者手术前后视力及黄斑区微结构变化

目的观察基于OCT不同分期的特发性黄斑前膜(IMEM)手术前后视力及黄斑微结构的改变。方法选取2021年10月至2023年1月于沧州爱尔眼科医院确诊为IMEM的患者82眼纳入研究,所有患者行25G经睫状体扁平部玻璃体切除联合黄斑前膜及内界膜(ILM)剥除、空气填充,其中59眼联合白内障超声乳化摘除、人工晶体植入术。依据2017年IMEM分期标准分为A组21眼(2期),B组39眼(3期),C组22眼(4期)。分别于术前及术后3个月行最佳矫正视力(BCVA)、光学相干断层成像(OCT)检查。结果3组术后BCVA(LogMAR)较术前均降低(P均<0.05)。术前3组比较BCVA(LogMAR)差异无统计学意义(P>0.05);术后3组BCVA(LogMAR)比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05)。A组术后黄斑中心凹厚度(CMT)较术前差异无统计学意义(P=0.393);B组和C组术后CMT较术前均降低(P均<0.01)。术前3组CMT比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05);术后3组CMT比较差异有统计学意义(P<0.01),A组和B组、A组和C组比较差异均有统计学意义(P均<0.01),B组和C组比较差异无统计学意义(P>0.05)。82眼术后BCVA(LogMAR)与术前BCVA(LogMAR)、术前CMT、术后CMT均呈正相关(P均<0.01)。En face OCT发现7眼黄斑区可见同心圆状改变,B扫描呈柱状或锯齿状改变。结论特发性黄斑前膜患者OCT分期越早,术后视力及黄斑微结构恢复越好。应用OCT进行分期可以为手术时机选择及预后判断提供重要的依据。

特发性黄斑裂孔的诊治研究现状

特发性黄斑裂孔(IMH)是指无其他明显诱发眼病的相对健康眼出现黄斑区神经上皮层的局限性全层缺损,临床表现主要为视力下降、视物变形和中央暗点。随着眼科检查设备的更新以及对发病机制研究的深入,治疗方式也趋于多样化和精准化。该文对黄斑裂孔的发病机制、分类、治疗等的研究现状进行了综述。

玻璃体切割联合内界膜(ILM)剥除术与玻璃体切割联合ILM瓣覆盖术治疗不同直径特发性黄斑裂孔的疗效和安全性对比分析

目的比较玻璃体切割联合内界膜(inner limiting membrane,ILM)剥除术和玻璃体切割联合ILM瓣覆盖术治疗不同直径特发性黄斑裂孔(idiopathic macular hole,IMH)的疗效和安全性。方法采用玻璃体切割联合ILM剥除或ILM覆盖的方法治疗IMH共127例127眼,根据IMH的最小直径分为小裂孔(63眼,直径≤500μm)和大裂孔(64眼,直径>500μm);依据不同的手术方法进行分组:剥除1组(小裂孔32眼)和剥除2组(大裂孔33眼)采取玻璃体切割联合ILM剥除术;覆盖1组(小裂孔31眼)和覆盖2组(大裂孔31眼)采取玻璃体切割联合ILM瓣覆盖术。对患者术前、术后最佳矫正视力和黄斑裂孔愈合情况进行检查随访。结果术后12个月时各组最佳矫正视力分别与术前相比,均有不同程度提高;术后剥除1组和覆盖1组(t=0.112 2,P>0.05),剥除2组和覆盖2组(t=0.750 8,P>0.05)相比,最佳矫正视力差异均无统计学意义。剥除1组和覆盖1组在术后6个月时闭合率均为100.00%,两组差异无统计学意义(P>0.05);剥除2组和覆盖2组在术后6个月闭合率分别为84.85%和100.00%,差异有统计学意义(P<0.05)。术前剥除2组和覆盖2组内外节交界面连接带缺损直径差异无统计学意义(P>0.05);剥除2组和覆盖2组术后1个月时,内外节交界面连接带缺损直径差异无统计学意义(P>0.05);术后3个月、6个月、12个月时差异均有统计学意义(均为P<0.05),覆盖2组的内外节交界面连接带缺损直径比剥除2组小。各时间点剥除1组和覆盖1组内外节交界面连接带缺损直径差异均无统计学意义(均为P>0.05)。结论相对于传统的ILM剥除,ILM瓣覆盖术有助于直径大于500μm裂孔愈合,对于小裂孔愈合两种术式疗效无明显差异。