ABSTRACT
Surgical management of idiopathic macular hole (IMH) is a hot topic in the field of fundus disease,and its classical surgery is internal limiting membrane peeling.In recent years,many researchers explored inverted internal limiting membrane flap technique for IMH.However,how large the IMH is necessary for inverted internal limiting membrane flap technique? Does the inverted internal limiting membrane flap technique have more advantages in operating procedure,anatomical and functional recovery of IMH in comparison with internal limiting membrane peeling? Our clinical researches and relative literature showed that it is better to use inverted internal limiting membrane flap technique for ＞550 μm IMH.There is still no available evidence showed inverted internal limiting membrane flap technique is of more benefit to the anatomical repair and functional restoration in comparison with internal limiting membrane peeling for IMH.Some viewpoints in this field are open to question.
ABSTRACT
Objective To evaluate the therapeutic effects of flute-needle vacuum assistant hole closure technique for large idiopathic macular hole (IMH).Methods The clinical data of 25 eyes with IMH of 408-939 μm in 23 patients who received pars plana vitrectomy with internal limiting membrane (ILM) peeling and flute-needle vacuum assistant hole closure technique from Feburary in 2017 to June in 2018 in Peking University International Hospital were retrospectively analyzed.The changes of best corrected visual acuity (BCVA) before and after operation were evaluated.The shapes of the hole closure were categorized,and the manifestations of outer retina were observed by optical coherence tomography (OCT),including external limiting membrane (ELM) and ellipsoid zone(EZ).Results The hole closure rate after surgery were 100％ (25/25),with the U type closure in 16 eyes and V type closure in 9 eyes.The BCVA was 0.76 ± 0.27 after operation,which was significantly improved in comparison with 1.05 ±0.29 before operation (t =3.61,P =0.01).The ELM of OCT image was (1 050.00±380.39)μm before operation,and that after operation reduced to (623.32 ± 328.66) μm,showing a significant difference between them (t =6.63,P=0.00).A fully reduced EZ band was seen after operation in comparison with before operation ([1 147.28±354.41] μm versus ([818.28±247.33] μm) (t=4.12,P=0.00).Conclusions A combination procedure of vitrectomy with flute-needle vacuum assistant hole closure technique is effective for large IMH,which is beneficial to the anatomical repair and functional recovery of outer retina.
ABSTRACT
Objective To evaluate the relationship of retinal sensitivity (MS) with vision-related quality of life in patients with idiopathic macular hole (IMH).Methods A prospective cohort study was performed in this study.Thirty-one monocular IMH patients were enrolled in Beijing Tongren Hospital from May to September of 2017.Vision-related quality of life (VR-QoL) was analyzed in 31 patients with National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) (Chinese version),and MS in the affected eye and the fellow eye in these patients was detected by Microperimeter-3.MS and best corrected visual acuity (BCVA) between the affected eye and the fellow eye were compared.The correlations among BCVA,age,MS,minimum macular hole diameter,composite scores and subscales score were evatuateds.This study protocol was approved by Ethic Committee of Beijing Tongren Hospital.This study complied with Declaration of Helsinki.Results There were significant correlations between composite scores and MS in the affected eye and the fellow eye (affected eye:ρ=0.484,P=0.006;fellow eye:ρ=0.387,P =0.031).Significante correlations were shown in near activities (affected eye:ρ =-0.353,P =0.048;fellow eye:ρ =0.352,P =0.048) and distance activities (affected eye:ρ =0.496,P =0.004;fellow eye:ρ =0.415,P =0.015).No obvious correlations were shown between VR-QoL and BCVA or minimum hole diameter.The correlation between composite scores and the MS in the affected eye was the most strong.Conclusions MS can reflect the retinal function in patients of IMH more widely.The correlations VR-QoL and MS is correlated in the affected eye and fellow eye in patients of monocular IMH,however,patient's VR-QoL dependes more on the affected eye.IMH can violate the patient's near and distance activities.