ABSTRACT
Objective To evaluate and compare the curative effects between extensive and standard internal limited membrane peeling (ILMP) during vitrectomy for idiopathic macular hole (IMH) with closed index＜0.7 and provide an alternative basis for IMH.Methods The clinical data of ninety-six eyes of 96 patients of IMH with closed index ＜0.7 who received vitrectomy with extensive (48 eyes) or standard ILMP (4-8 eyes) procedures from May 2012 to May 2016 in the Second Affiliated Hospital of Nanchang University under the informed consent of patients were retrospectively analyzed.Best corrected visual acuity (BCVA),central vision,direct ophthalmoscope examination,slit lamp microscope with preset lens,optical coherence tomography (OCT),intraocular pressure,Amsler grid table and fundus photography inspection were performed before surgery and 1 month,6 and 12 months after surgery.The healing rate of IMH and the correction rate of Amsler grid table were also observed.Based on the OCT image,U-like closure was thought to be normal fovea,V-like closure was steep fovea and W-like closure exhibited the defect of sensory layer.Three types were considered as hole closure.Results OCT showed that retinal nurosensory layer was defect at macular area in both extensive ILMP group and standard ILMP group before surgery.At 12 months after operation,43 cases had U type closure,1 case had V type closure and 1 case had W type closure in the extensive ILMP group,while 33 cases had U type closure,1 case had V type closure and 3 cases had W type closure in standard ILMP group.The BCVA was significantly better in the extensive ILMP group than that in the standard ILMP group in postoperative 1 month,6 months and 12 months (all at P＜0.05).Compared with preoperation BCVA,the number of eyes with central and paracentral scotomas was decreased in both extensive ILMP group and standard ILMP group at the end of the following up (central scotoma:x2 =80.98,56.99,both at P＜0.05;paracentral scotoma:x2 =88.21,80.98,both at P＜0.05),and the number of eyes with central scotoma in the extensive ILMP group was significantly less than that in the standard ILMP group (3 vs.11) (x2 =4.10,P＜0.05).The closure rate of IMH was 93.75％ in the extensive ILMP group and 77.08％ in the standard ILMP group,showing a significant difference between the two groups (x2 =4.10,P＜0.05).The corrected rate of Amsler grid abnormality was 93.75％ in the extensive ILMP group,which was evidently higher than 75.00％ in the standard ILMP group,with a significant difference between the two groups (x2 =5.06,P＜0.05).Conclusions Both extensive ILMP and standard ILMP during vitrectomy for IMH with MCHI＜0.7 are effective,and vitrectomy combined with extensive ILMP has a better outcome in comparison to vitrectomy combined with standard ILMP.
ABSTRACT
Background Giant idiopathic macular hole (IMH) severely affects visual acuity and increases operative difficulty during the surgery,so modifying or optimizing the operation method is helpful for improving the prognosis.Objective This study aimed to evaluate the efficacy and safty of vitrectomy combined with free internal limiting membrane transplantation for large IMH.Methods A prospective serial cases-observational study was carried out under the informed consent of each patient.Forty-two eyes of consecutive 42 patients with IMH of mean diameter (814.31±112.95)μm were included in the Second Hospital of Hebei Medical University from January 2013 to November 2015.All the eyes received vitrectomy combined with free internal limiting membrane transplantation and 12％ C3F8 filling.The best corrected visual acuity (BCVA) (LogMAR),inner segment/outer segment (IS/OS) defect range,external limiting membrane defect range,retinal thickness at macular fovea were measured with slit lamp microscope,indirect ophthalmoscope and spectral-domain optical coherence tomography (SD-OCT) before surgery and 1,3,6 and 12 months after surgery.Results IMH complete closure in 97.6％ eyes (41/44) at 12 months after surgery.BCVA was improved after operation and showed a significant difference among various time points (F =28.032,P＜0.001).The IS/OS defect range was (1 112.00±45.44),(859.00±84.55),(649.00±52.47),(486.00±46.88) and (320.00±45.13) μm before surgery and 1,3,6 and 12 months after surgery,showing a significant difference among different time points (F=38.761,P＜0.001),and the IS/OS defect range was gradually shrinked after operation compared with that before operation (all at P＜0.05).The mean defect range of external limiting membrane was (1 038.00 ±39.63),(748.00±64.12),(585.00±48.88),(438.00±42.84) and (265.00±28.97)μm before surgery and 1,3,6 and 12 months after surgery,with a significant difference among various time points (F=36.459,P＜0.001),and the mean defect range of external limiting membrane was evidently reduced (all at P＜0.05).The foveal retinal thickness value was increased at 3,6 and 12 months after surgery,which was significantly higher than that 1 month after surgery (all at P＜0.05).The high reflect signal was faded away at 3 months after operation,indicating that implanted internal limiting membrane was decomposed and metabolized.Conclusions Vitrectomy combined with autologous internal limiting membrane transplantation seems to be safe and effective for large IMH.