Efficacy and safety of vitrectomy with internal limiting membrane peeling for diabetic macular edema: a Meta-analysis

AIM： To evaluate the efficacy and safety of vitrectomy with internal limiting membrane（ILM） peeling for diabetic macular edema（DME）. METHODS： The PubMed, Embase, Web of Science, Cochrane, SionMed, ClinicalTrials.gov, CNKI databases and Wanfang databases, published until Oct. 2017, were searched to identify studies comparing the clinical outcomes following vitrectomy with and without ILM peeling, for treating DME. Pooled results were expressed as odds ratios（ORs） with corresponding 95% confidence intervals（CI） for vitrectomy with and without ILM peeling with regard to best corrected visual acuity（BCVA）, central macular thickness（CMT）, and complication incidents. RESULTS： A total of 14 studies involving 857 eyes were included of which three studies were Chinese and the rests were English literatures. Meta-analysis indicated that compared with vitrectomy alone, vitrectomy with ILM peeling could improve BCVA more obviously（OR=1.66, 95%CI： 1.12-2.46, P=0.01） and had higher rate of CMT reduction（OR=3.89, 95%CI： 1.37-11.11, P=0.01）. There were significant statistical differences between the two surgical methods for both BCVA and CMT（P〈0.05）. For the incidence of intraoperative and postoperative complications, the incidence of epiretinal membrane（ERM） was slightly lower in the ILM peeling group than the group without ILM peeling（OR=0.38, 95%CI： 0.07-2.00, P=0.25）, although insignificant statistically. Other incidences of overall complications, iatrogenic peripheral retinal break and increased intraocular pressure indicated no significant difference between two groups（OR=1.19, 95%CI： 0.82-1.73, P=0.36; OR=1.21, 95%CI： 0.66-2.21, P=0.53; OR=1.34, 95%CI： 0.75-2.40, P=0.32）. CONCLUSION： Vitrectomy is effective for DME and the effect can be improved by additional ILM peeling, especially for anatomical efficacy, without increasing the incidence of intraoperative and postoperative complications. However, it is imperative to gain more evaluation in the future due to the paucity of prospective randomized study.

Efficacy of internal limiting membrane peeling for diabetic macular edema after preoperative anti-vascular endothelial growth factor injection

AIM:To explore the efficacy of minimally invasive vitrectomy(MIV)with or without internal limiting membrane(ILM)peeling on the treatment of diabetic macular edema(DME)in proliferative diabetic retinopathy(PDR)combining with preoperative anti-vascular endothelial growth factor(anti-VEGF)injection.METHODS:Totally 132 eyes(132 patients)diagnosed PDR with DME were included between June 2015 and June 2018 in Tianjin Eye Hospital.The single MIV treatment group included 68 eyes and the MIV combined with ILM peeling group included 64 eyes.Anti-VEGF drugs were injected intravitreally 1wk before the operation and the period of follow-up was 1 to 3y.Best-corrected visual acuity(BCVA),central retinal thickness(CRT),total macular volume(TMV),macular edema(ME)severity,intraocular pressure(IOP),and complications were recorded.Prognostic factors of visual acuity following ILM peeling were analyzed.RESULTS:The BCVA was higher than preoperative values at 1,3,6,and 12mo after surgery in both groups(all P<0.05).At 6 and 12mo,the BCVA of the combined group was significantly higher than that of the MIV only group(0.52±0.23 v/s 0.64±0.29 IogMAR,P=0.011 in 6mo;0.41±0.25\/s 0.52±0.25 IogMAR,P=0.008 in 12mo).Mean CRT values postoperative were significantly lower than preoperative values in both groups from the 1^(st) month(lmo 397.65±106.18 vs 451.94±118.88 μm in MIV only group;388.88±108.68 v/s 464.36±111.53 μm in combined group;both P<0.05)and decreased gradually.The differences between the two groups were statistically significant at 3,6,and 12mo(P=0.004,0.003,0.00 respectively).The TMV was decreased from the 3^(rd) month in the single treatment group(3mo 11.14±1.66 vs 12.20±2.09 mm^(3),P<0.05).At 12mo,the proportion of eyes with edema that had CRT more than 350μm was significantly lower than before surgery(13.24%vs 77.94%in MIV only group;1.56%vs 81.25%in combined group;both P<0.05).There was no significant difference in the recurrence incidence of macular epiretinal membrane,ME,transient IOP increase,vitreous rebleeding,or traction retinal detachment between the two groups.BCVA after ILM excision was positively correlated with the CRT and ME degree before and after surgery(r=0.430,0.485,respectively;P<0.05).CONCLUSION:MIV combined with ILM peeling accelerates the absorption of ME,improves vision,reduces the postoperative CRT and TMV,and reduces the recurrence rate of postoperative ME.

Efficacy of Phacovitrectomy Combined with Internal Limiting Membrane Peeling for Macular Diseases

Purpose:To observe the efficacy of vitrectomy with internal limiting membrane.(ILM) peeling combined with phacoemulsification with intraocular lens.(IOL) implantation in the treatment of cataract with co-existing macular diseases.Methods:A total of 28 cataract patients (28 eyes) with coexisting macular diseases were admitted to Aier Eye Hospital between May 2008 and May 2011.The clinical characteristics were analyzed in this study.Subjects included 6 men and 22 women,aged from 56 to 77 years (mean 64 years),with duration of disease ranging from 2 to 36 months (mean 9.3 months).All patients underwent phacoemulsification with implantation of a hydrophobic acrylic IOL into the capsular bag and pars plana vitrectomy with ILM peeling.Results:Postoperatively,patients underwent 3-to 18-months of follow-up.(mean 7.2 months).Only one eye had macular hole failing to close.Normal macular structure was restored in the other 27 eyes.The presenting visual acuity and best corrected visual acuity.(BCVA) did not differ significantly (t =-1.724,P =0.096),with the BCVA in 27 eyes.(96.4%).improving by 2 lines or more.The improvement in minimum angle of resolution.(MAR).was > 0.3 in 21 eyes,≥0.1 in 6 eyes and<0.1 in 1 eye.The mean spherical equivalent.(SE) was-4.67±5.98D preoperatively and-0.38±0.69D postoperatively (t=4.157,P<0.005).Conclusion:Combined phacovitrectomy surgery is a reliable and safe procedure in the treatment of cataract complicated by macular disease.

Vitrectomy with residual internal limiting membrane covering and autologous blood for a secondary macular hole:A case report

BACKGROUND Myopic foveoschisis(MF)is a common complication of pathological myopia.A macular hole(MH)usually results from the natural progression of MF and is a common complication of vitrectomy.Vitrectomy combined with residual internal limiting membrane(ILM)covering and autologous blood was effective for closing a secondary MH.CASE SUMMARY A 52-year-old woman presented to our clinic with a complaint of blurred vision in the right eye for 7 years.Her best corrected visual acuity(BCVA)was 20/100,axial length was 25.79 mm and standard equivalent refractive error was-10.5 dioptres.Preoperative optical coherence tomography revealed foveoschisis in the right eye.Vitrectomy with fovea-sparing ILM peeling was performed.An MH developed and gradually expanded 5 mo after the initial vitrectomy.Vitrectomy with residual ILM covering and autologous blood was performed.The MH closed 3 wk after the second vitrectomy.CONCLUSION Fovea-sparing ILM peeling can provide residual ILM for the treatment of MH secondary to vitrectomy for MF.Vitrectomy combined with residual ILM covering and autologous blood is effective for closing secondary MH and improving BCVA.

Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment:presumed role of glial cells for foveal structure stabilization

AIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema(CME) without and with internal limiting membrane(ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS: A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS: The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer(HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer(NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy(MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION: The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD.

Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema

BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.

Inverted internal limiting membrane flap technique for very large macular hole

AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 &#x000b5;m using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 &#x000b5;m who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure.RESULTSMean age was 63.2&#x000b1;8.4y with all 5 subjects being females. Mean duration of symptoms was 11&#x000b1;14mo with a mean postoperative follow up of 13.2&#x000b1;13mo. The mean base diameter of the macular holes was 1420&#x000b1;84.8 &#x000b5;m (1280-1480 &#x000b5;m). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen’s equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen’s equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted.CONCLUSIONThe inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.

Free autologous internal limiting membrane transplantation in the treatment of large macular hole

We evaluated the clinical efficacy of free internal limiting membrane(ILM) flap transplantation for the treatment of large macular hole over 500 μm in 42 consecutive patients. Quantified evaluation of the post-operative macular anatomy restoration was performed by spectral-domain optical coherence tomography in the 12 mo follow-up. The results showed 41 eyes achieved successful closure(97.6%). Postoperative best corrected visual acuity, ellipsoid layer, and external limiting membrane disruption were significantly improved at all follow-up time points. The central foveal thickness was significantly higher at 1 mo. We concluded that free ILM flap transplantation proves to be effective to achieve anatomical and functional improvement for the treatment of large macular hole.

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.

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.

Malfunction of outer retinal barrier and choroid in the occurrence and progression of diabetic macular edema

Diabetic macular edema(DME) is the most common cause of vision loss in diabetic retinopathy,affecting 1 in 15 patients with diabetes mellitus(DM).The disruption of the inner blood-retina barrier(BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris,in the occurrence and evolution of DME.The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition.In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.

人羊膜填塞与内界膜翻转填塞对高度近视黄斑裂孔性视网膜脱离疗效比较

目的对比玻璃体切割(PPV)联合人羊膜填塞术或内界膜翻转填塞术治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。方法采用非随机对照临床研究方法,纳入2020年7月至2021年8月就诊于上海交通大学医学院附属第九人民医院的高度近视MHRD患者15例16眼。所有患者均接受PPV,根据术中黄斑裂孔填塞材料的不同将患者分为人羊膜填塞组7例7眼和内界膜填塞组8例9眼。分别于术前及术后1周、1个月、3个月和6个月测定术眼最佳矫正视力(BCVA)、眼压;采用裂隙灯显微镜联合前置镜、激光扫描检眼镜及光学相干断层扫描(OCT)检查眼底情况并判定黄斑裂孔闭合及视网膜复位情况。结果人羊膜填塞组6眼初次手术后视网膜即复位,内界膜填塞组所有术眼均实现一次手术后视网膜复位。初次手术后,人羊膜填塞组5眼黄斑裂孔闭合,内界膜填塞组8眼黄斑裂孔闭合,2个组间黄斑裂孔闭合率比较差异无统计学意义(P>0.05)。2个组患者手术前后不同时间点间BCVA总体比较差异有统计学意义(F_(时间)=4.420,P<0.05);术后不同时间点BCVA均优于术前值,但差异无统计学意义(均P>0.05)。2个组间BCVA总体比较差异无统计学意义(F_(组别)=0.183,P>0.05)。人羊膜填塞组和内界膜填塞组分别有2眼和4眼出现术后一过性高眼压,给予降眼压治疗1周后均恢复正常。结论PPV联合人羊膜填塞术及内界膜填塞术治疗高度近视MHRD均安全有效,且人羊膜填塞术在伴随复杂的眼底情况时也能保持良好的视网膜解剖学复位及功能恢复。

Ozurdex植入联合内界膜剥除治疗特发性黄斑前膜的效果观察

目的观察地塞米松玻璃体内植入剂(Ozurdex)植入联合内界膜(ILM)剥除术治疗特发性黄斑前膜(IEM)的有效性和安全性。方法回顾性分析2020年1月至2023年2月佛山市第二人民医院共21例(21眼)3~4期IEM患者均接受25G经睫状体平坦部玻璃体切除术(PPV)联合IEM及ILM剥除及Ozurdex植入术治疗的效果。主要观察指标为术后1、3、6、12个月时最佳矫正视力(BCVA)和黄斑视网膜厚度(CMT)。结果术后1、3、6、12个月患者BCVA均比术前改善,差异有统计学意义(P<0.05),分别较术前改善了0.30 logMAR、0.40 logMAR、0.40 logMAR、0.50 logMAR。术后1、3、6、12个月患者CMT均比术前组改善,差异有统计学意义(P<0.05),分别较术前下降了185.41、214.05、233.82、230.02μm。患者高眼压发生率为28.57%,PPV术后白内障手术率为46.15%,行白内障摘除术时间间隔为(6.50±1.40)个月。结论Ozurdex植入联合ILM剥除治疗IEM,可促进黄斑水肿消退、有效提高视力,但需注意白内障进展及高眼压症。

保留视网膜下液的内界膜瓣填塞治疗高度近视黄斑孔视网膜脱离

目的探讨玻璃体切除(PPV)联合保留视网膜下液(SRF)的内界膜(ILM)瓣填塞治疗高度近视黄斑孔视网膜脱离(MHRD)的疗效。方法回顾性病例研究。纳入华中科技大学同济医学院附属协和医院眼科2020年8月至2023年6月的30例高度近视MHRD(32眼),伴后巩膜葡萄肿及脉络膜视网膜萎缩,眼轴长度为(30.32±1.71)mm。均接受PPV,保留SRF,黄斑孔(MH)鼻上起瓣(借助视盘的力量,固定脱离的视网膜),制作MH边缘带蒂的ILM瓣,反转填塞MH,手术结束时采用硅油填充,观察SRF吸收、视网膜再附着、MH闭合及视力变化。结果术后1周内OCT检查,25眼MH闭合SRF吸收,6眼MH闭合残留SRF,1眼MH未愈合。随访期间,7眼残留的SRF吸收时间分别为术后1年内5例,18月和21月各1例。32眼一次硅油取出后视网膜再附着,视网膜复位率为100%。MHⅠ型闭合者90.62%(29/32),其中U形闭合22眼、V形闭合5眼、W形转变为U形瘢痕闭合2眼;MHⅡ型(W形)闭合者9.38%(3/32)。术后最佳矫正视力(BCVA)有改善,从术前(1.90±0.34)[最小分辨角的对数(logMAR)]提高到(1.14±0.37)(log MAR),差异有统计学意义(t=11.11,P<0.01)。结论在残留SRF的情况下,使用ILM瓣反转填塞技术成功关闭了MH。PPV联合保留SRF、ILM瓣填塞和硅油填充,为长眼轴伴后巩膜葡萄肿的高度近视MHRD提供了一种首选治疗方法。

Surgical Management of Retinal Detachment Resulting from Macular Hole in a Setting of High Myopia

Purpose:To evaluate the anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM).peeling and use of retinal tamponade for retinal detachments resulting from macular hole (MHRD) in highly myopic eyes. Methods:.Twenty-nine highly myopic patients.(29 eyes) underwent PPV with ILM peeling and retinal tamponade for MHRD were enrolled. Demographics and best-corrected visual acuity.(BCVA).were measured preoperatively and at final follow-up. Anatomical success and macular hole closure were analyzed. Results:.Patients' mean age of patients was 58.7±10.6 years, mean follow-up was 11.7±7.4 months. Twenty three eyes (23/26,88.5%)undergoing primary PPV combined with ILM peeling had successful initial retinal reattachment, including 19 eyes (19/19, 100%) with silicone oil tamponade and in 4 eyes (4/7,57.1%).with sulfur hexafluoride.(C3F8).tamponade. Overall anatomical success was achieved in 27 eyes (27/29, 93.1%)..The macular hole closure was observed in 17 eyes (17/26, 65.4%) with final anatomical success. Compared to preoperative BCVA,.the mean postoperative BCVA in the eyes with anatomical success was significantly improved (P = 0.007, Wilcoxon signed rank test). Conclusion:.As a primary or secondary procedure,.PPV combined with ILM peeling and usage of retinal tamponade serves as an effective method for MHRD in highly myopic eyes.

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。

玻璃体切割手术对青年糖尿病患者黄斑水肿的治疗作用

目的研究分析玻璃体切割手术治疗青年糖尿病患者黄斑水肿的效果。方法回顾性病例对照研究。搜集北京市顺义区空港医院2017年1月至2021年6月期间就诊的45岁以下,因糖尿病视网膜病变行玻璃体切割手术且合并有糖尿病黄斑水肿的患者,根据玻璃体切割术中是否联合行内界膜剥除,分为单纯玻璃体切割组和联合内界膜剥除组,分析两组的视力预后,黄斑区视网膜厚度以及术后糖尿病黄斑水肿反复治疗需求情况。结果研究搜集34例患者(41只眼),均为2型糖尿病患者。单纯玻璃体切割组纳入18只眼,患者平均年龄(40.67±5.25)岁。联合内界膜剥除组纳入23只眼,患者平均年龄(42.48±4.01)岁。统计结果显示,两组患者术后3个月最佳矫正视力不具有统计学差异,黄斑厚度在术后第1个月(t=-2.603,P=0.013),第3个月(t=-2.463,P=0.018)具有显著差异,但术后6个月时两组不具有统计学差异(t=-1.881,P=0.067)。根据病情需要,两组在3个月、6个月再次需要玻璃体注药治疗的情况差异不具有统计学意义。结论玻璃体切割手术是青年糖尿病黄斑水肿的安全有效治疗措施,但并不必要对所有患者联合进行内界膜剥除操作。

玻璃体切除联合重水辅助内界膜填塞术治疗黄斑裂孔性视网膜脱离

目的观察玻璃体切除联合重水辅助内界膜填塞术治疗黄斑裂孔性视网膜脱离(MHRD)的疗效。方法回顾性病例对照研究。纳入2020年1月至2022年10月在我院诊断MHRD并行玻璃体切除(PPV)联合内界膜(ILM)填塞术的患者;其中,2020年1月至2021年4月20例(20只眼)MHRD患者归于对照组(内界膜直接填塞组),2021年5月至2022年10月20例(20只眼)MHRD患者归于实验组(重水辅助内界膜填塞组)。随访至术后6个月,观察记录患者的最佳矫正视力(BCVA)、黄斑裂孔愈合及网膜复位情况,有无术后并发症如高眼压等。以术后6个月的检查结果作为最终的疗效结果。结果末次随访结束,所有患者脱离的网膜均复位,MH均闭合,随访过程中未出现高眼压、眼内炎等并发症。末次随访结束,对照组黄斑裂孔I型闭合9只眼(其中U形愈合只眼,V形愈合4只眼),II型闭合11只眼;实验组黄斑裂孔I型闭合16只眼其中U形愈合13只眼,V形愈合3只眼,II型闭合4只眼;两组间MH不同类型愈合占比比较差异有统计学意义(P=0.022)。两组术前BCVA(log⁃MAR)差异无统计学意义(P=0.744);两组术后6个月BCVA(logMAR)较术前均有改善(P<0.001),两组间术后6个月BCVA(logMAR)比较,试验组(重水辅助内界膜填塞组)视力改善优于对照组(内界膜直接填塞组)(P<0.001)。结论PPV联合重水辅助内界膜填塞是一种有效安全的手术方式,可以提高裂孔的I型愈合率,一定程度上改善术后视力。

PPV联合内界膜翻转填塞术治疗高度近视黄斑裂孔性视网膜脱离

目的:探究玻璃体切除(PPV)联合内界膜翻转填塞术治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的临床疗效。方法:回顾性临床研究。选取2017-10/2021-10本院收治的高度近视MHRD患者63例64眼为研究对象,根据手术方式的不同分为A组(34例35眼,接受PPV联合内界膜翻转填塞术治疗)和B组(29例29眼,接受PPV联合内界膜剥除术治疗)。术后随访6mo,比较两组患者的裂孔闭合率、视网膜脱离复位率;术前,术后1wk,1、3、6mo时最佳矫正视力(BCVA);记录术后并发症发生情况。结果:术后6mo内,A组的裂孔闭合率明显高于B组(P<0.05);两组患者的视网膜脱离复位率比较无差异(P>0.05)。术后随着时间的延长,两组患者的BCVA较术前明显改善(P<0.05);术前,术后1wk,1、3、6mo时,两组患者的BCVA比较无明显差异(P>0.05)。术后两组患者均出现一定并发症,但两组患者的并发症发生率比较无差异(P<0.05)。结论:PPV联合内界膜翻转填塞术治疗高度近视MHRD具有良好的临床疗效,能有效改善患者的BCVA,提高裂孔闭合率,且不会影响患者眼压,安全有效。

内界膜剥除联合曲安奈德对糖尿病性黄斑水肿患者视力水平及效果分析

目的 探讨内界膜剥除联合曲安奈德对糖尿病性黄斑水肿患者视力水平及效果。方法 前瞻性选取2018年1月~2022年1月在石家庄市人民医院眼科接受治疗的糖尿病性黄斑水肿病例102例,随机数表法分为观察组和对照组,各51例。两组均施展内界膜剥除术,在术后,对照组未作特殊处理,观察组采用曲安奈德玻璃体腔内注射。对比两组总有效率、视网膜厚度、最佳矫正视力、眼压、各项评分(舒适度、睡眠及生活质量)。结果 观察组治疗总有效率更高于对照组,差异有统计学意义(P <0.05)。治疗后,对比于对照组,观察组中黄斑中心凹视网膜厚度与中央视网膜厚度均更低,最佳矫正视力更高,眼压更高,差异有统计学意义(P <0.05)。治疗后,与对照组相比,观察组中舒适度评分、生活质量评分均更高,观察组中睡眠质量评分更低,差异有统计学意义(P <0.05)。结论 对于糖尿病性黄斑水肿患者,在内界膜剥除术后应用曲安奈德玻璃体腔内注射,可更好地控制黄斑水肿情况,促使黄斑中心凹和中央视网膜厚度减少,有利于改善视力,对患者睡眠质量的改善作用良好。