ABSTRACT
@#AIM: To evaluate the efficacy of pars plana vitrectomy combined with internal limiting membrane(ILM)insertion for the treatment of refractory macular holes(MH)by spectral-domain optical coherence tomography(SD-OCT). <p>METHODS: Retrospective analysis was conducted in 17 patients(17 eyes)with refractory MH from July 2019 to December 2020. All patients were treated with pars plana vitrectomy combined with ILM insertion. Preoperative and postoperative best corrected visual acuity(BCVA)were compared. Quantified evaluation of the postoperative macular restoration was performed by SD-OCT. <p>RESULTS: The widths of ellipsoid zone disruption were 839.00-1577.50μm, with an average of 1182.90±226.68μm. During the follow-up period(3-12mo), 17 cases achieved successful closure(100%), and no recurrence was seen. Postoperative BCVA was significantly improved compared with preoperative(<i>P</i><0.01). The widths of external limiting membrane disruption and ellipsoid zone disruption were smaller gradually at 1wk and 3mo after surgery compared with preoperative(all <i>P</i><0.01). But the continuity was still not restored. The thickness of the central fovea of macula(within 1mm diameter range)at 1wk and 3mo after surgery decreased significantly compared with preoperative(all <i>P</i><0.01).<p>CONCLUSION: Pars plana vitrectomy combined with ILM insertion proves to be effective to achieve anatomical and functional improvement in the treatment of refractory MH. SD-OCT has important clinical value in the diagnosis and postoperative follow-up evaluation of refractory MH.
ABSTRACT
@#AIM: To observe the effect of pars plana vitrectomy(PPV)internal limiting membrane(ILM)insertion and nerve growth factor(NGF)injection in the treatment of large idiopathic macular hole(IMH). <p>METHODS: This was a retrospective clinical study which included 16 patients(16 eyes)with large IMH diagnosed in the Affiliated Eye Hospital of Nanjing Medical University from May 2018 to May 2020. All patients were treated with PPV combined with ILM insertion and NGF injection and the follow-up period was at least 6mo. Macular hole closure rates, best-corrected visual acuity(BCVA)(LogMAR), and optical coherence tomography(OCT)findings including ellipsoid zone(EZ)and external limiting membrane(ELM)were analyzed, the complications were also observed postoperatively.<p>RESULTS: The BCVA was 1.15±0.21 before operation, and the follow-up of BCVA was 1.02±0.19 and 0.87±0.24 respectively at 3 and 6mo after operation(<i>F</i>=34.966, <i>P</i><0.01); The BCVA was improved 3 and 6mo after operation(<i>P</i><0.01), and the BCVA at 6mo after operation was better than that at 3mo(<i>P</i><0.01). The closure rate of the MH was 100% and 11 eyes showed U-shaped closure in OCT(69%), 3 eyes were V-shaped closure(19%)and 2 eyes were irregular closure(13%). The BCVA of U-shaped closure group, V-shaped closure group and irregular closure group were 0.75±0.18, 1.1±0.19, and 1.20±0.00 respectively(<i>F</i>=6.937, <i>P</i><0.01). The recovery of BCVA in U-shaped closure group was significantly better than that in V-shaped closure group and irregular closure group(<i>P</i>=0.027, 0.007). Six months after operation, 10 eyes(91%)of ELM and 7 eyes(64%)of ellipsoid zone resumed continuity in U-shaped closure group, 2 eyes(67%)of ELM and 1 eye(33%)of resumed continuity in V-shaped closure group. ELM and ellipsoidal zone were not recovered continuously in irregular closure group(<i>P</i><0.05). During the follow-up period, we found no ocular or systemic complications.<p>CONCLUSION: PPV combined with ILM insertion and NGF injection is safe and effective in treating large IMH. The synergetic effect of NGF and ILM can obviously promote the closure of IMH, which is beneficial to the recovery of photoreceptor layer integrity and the improvement of visual function after operation.