内界膜填塞与翻转覆盖治疗难治性黄斑裂孔的效果比较
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摘要
目的针对内界膜填塞及翻转覆盖治疗难治性黄斑裂孔临床效果进行比较,评价两种方法的治疗效果。方法对安徽医科大学第二附属医院眼科2016年3月至2018年3月收治的难治性黄斑裂孔患者31例(32只眼)进行研究。分为A组(内界膜填塞)和B组(内界膜翻转覆盖)分别进行手术,比较术前及术后1个月及3个月的最佳矫正视力(BCVA),并行相干光断层扫描(OCT)检查了解裂孔的闭合形态,根据结果分析两种方法的手术效果。结果术后1个月填塞组裂孔愈合9只眼,外层视网膜不规则13只眼;覆盖组裂孔愈合12只眼,外层视网膜不规则8只眼。3个月复查时填塞组裂孔愈合12只眼,外层视网膜不规则8只眼;覆盖组裂孔愈合14只眼,外层视网膜不规则6只眼。A组视力(logMAR)术前1.49±0.34、1个月1.15±0.35、3个月0.99±0.32;B组视力术前1.43±0.38、1个月1.12±0.36、3个月0.88±0.29;随访过程中两组视力恢复差异不明显;均较术前视力提高。结论内界膜填塞及翻转覆盖都是治疗难治性黄斑裂孔切实有效的方法。翻转覆盖方法术后的裂孔闭合率更高,外层视网膜形态恢复较佳,具有更大的改善视功能的潜力,是较好的手术方法。
Objective To compare the clinical effects of internal limiting membrane(ILM) tamping and inverted ILM fap for the treatment of refractory macular hole.Methods 31 patients(32 eyes) with refractory macular hole treated in the ophthalmology department of the second affiliated hospital of Anhui Medical University from March 2016 to March 2018 were enrolled, and divided into group A(ILM tamping) and group B(inverted ILM flap), respectively. To compare the clinical effect of these two methods, the pre-, 1 month and 3 months post-surgical best corrected visual acuity(BCVA) were measured, and the closure patterns of macular holes were assessed by optical coherence tomography(OCT). Results At 1 month after the surgery, 9 cases developed macular hole closure and 13 cases developed irregular outer retinas in the ILM tamping group. While the corresponding numbers in the inverted ILM flap group was 12 and 8, respectively. At 3 month after the surgery, 10 cases developed macular hole closure and 13 cases developed irregular outer retinas ILM tamping group, while 14 cases developed hole closure and 6 cases developed irregular outer retinas in the inverted ILM flap group. During the follow-up, there was no significant difference in BCVA between the two groups(LogMAR unit: pre-surgery, 1.49±0.34 vs. 1.43±0.38; 1 month post-surgery, 1.15±0.35 vs. 1.12±0.36, 3 months post-surgery, 0.99±0.32 vs. 0.88±0.29). The visual acuity was improved after the surgery in both groups. Conclusions ILM tamping and inverted ILM flap are effective methods for the treatment of refractory macular hole. The inverted ILM flap surgery has a higher rate of macular hole closure, better recovery of outer retinal morphology, and greater potential to improve visual function, and thus is a better surgical option.
Objective To compare the clinical effects of internal limiting membrane(ILM) tamping and inverted ILM fap for the treatment of refractory macular hole.Methods 31 patients(32 eyes) with refractory macular hole treated in the ophthalmology department of the second affiliated hospital of Anhui Medical University from March 2016 to March 2018 were enrolled, and divided into group A(ILM tamping) and group B(inverted ILM flap), respectively. To compare the clinical effect of these two methods, the pre-, 1 month and 3 months post-surgical best corrected visual acuity(BCVA) were measured, and the closure patterns of macular holes were assessed by optical coherence tomography(OCT). Results At 1 month after the surgery, 9 cases developed macular hole closure and 13 cases developed irregular outer retinas in the ILM tamping group. While the corresponding numbers in the inverted ILM flap group was 12 and 8, respectively. At 3 month after the surgery, 10 cases developed macular hole closure and 13 cases developed irregular outer retinas ILM tamping group, while 14 cases developed hole closure and 6 cases developed irregular outer retinas in the inverted ILM flap group. During the follow-up, there was no significant difference in BCVA between the two groups(LogMAR unit: pre-surgery, 1.49±0.34 vs. 1.43±0.38; 1 month post-surgery, 1.15±0.35 vs. 1.12±0.36, 3 months post-surgery, 0.99±0.32 vs. 0.88±0.29). The visual acuity was improved after the surgery in both groups. Conclusions ILM tamping and inverted ILM flap are effective methods for the treatment of refractory macular hole. The inverted ILM flap surgery has a higher rate of macular hole closure, better recovery of outer retinal morphology, and greater potential to improve visual function, and thus is a better surgical option.
引文
[1] 刘海芸,孙晓东.内界膜翻转手术治疗高度近视黄斑裂孔视网膜脱离[J].中华眼底病杂志,2018,34(2):107-110.
[2] Almony A,Nudleman E,Shah GK,et al.Techniques,rationale,and outcomes of internal limiting membrane peeling[J].Retina,2012,32(5):877-891.
[3] Kelly NE,Wendel RT.Vitreous surgery for idiopathic macular holes.Results of a pilot study[J] Arch Ophthalmol,1991,109(5):654-659.
[4] Kase S,aito W,Mori S,et al.Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique[J].Clin Ophthalmol,2017,11:9-14.
[5] Lai CC,Chen YP,Wang NK,et al.Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes[J].Ophthalmology,2015,122(9):1889-1898.
[6] Michalewska Z,Michalewski J,Adelman RA,et al.Inverted internal limiting membrane flap technique for large macular holes[J].Ophthalmology,2010,117(10):2018-2025.
[7] Michalewska Z,Michalewski J,Dulczewska-Cichecka K,et al.Temporal inverted internal limiting membrane fap technique versus classic inverted internal limiting membrane fap technique:a comparative study[J].Retina,2015,35(9):1844-1850.
[8] Chen Z,Zhao C,Ye JJ,et al.Inverted internal limiting membrane fap technique for repair of large macular holes:a short term follow up of anatomical and functional outcomes[J].Chin Med J (Engl),2016,129(5):511-517.
[9] Kadonosono K,Itoh N,Uchio E,et al.Staining of internal limiting membrane in macular hole surgery[J].Arch Ophthalmol,2000,118(8):1116-1118.
[10] Shin MK,Park KH,Park SW,et al.Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery[J].Retina,2014,34(9):1905-1910.
[11] Goker YS,Koc M,Yuksel K,et al.Relationship between peeled internal limiting membrane area and anatomic outcomes following macular hole surgery:a quantitative Analysis[J].J Ophthalmol,2016,2016:5641273.
[12] Chung H,Byeon SH.New insights into the pathoanatomy of macular holes based on features of optical coherence tomography[J].Surv Ophthalmol,2017,62(4):506-521.
[13] Morizane Y,Shiraga F,Kimura S,et al.Autologous transplantation of the internal limiting membrane for refractory macular holes[J].Am J Ophthalmol,2014,157(4):861-869.
[14] Baba T,Hagiwara A,Sato E,et al.Comparison of vitrectomy with brilliant blue G or indocyanine green on retinal microstructure and function of eyes with macular hole[J].Ophthalmology,2012,119(12):2609-2615.
[15] Gosala S,Manchikanty SM.Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia[J].Am J Ophthalmol,2016,166:210-211.
[2] Almony A,Nudleman E,Shah GK,et al.Techniques,rationale,and outcomes of internal limiting membrane peeling[J].Retina,2012,32(5):877-891.
[3] Kelly NE,Wendel RT.Vitreous surgery for idiopathic macular holes.Results of a pilot study[J] Arch Ophthalmol,1991,109(5):654-659.
[4] Kase S,aito W,Mori S,et al.Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique[J].Clin Ophthalmol,2017,11:9-14.
[5] Lai CC,Chen YP,Wang NK,et al.Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes[J].Ophthalmology,2015,122(9):1889-1898.
[6] Michalewska Z,Michalewski J,Adelman RA,et al.Inverted internal limiting membrane flap technique for large macular holes[J].Ophthalmology,2010,117(10):2018-2025.
[7] Michalewska Z,Michalewski J,Dulczewska-Cichecka K,et al.Temporal inverted internal limiting membrane fap technique versus classic inverted internal limiting membrane fap technique:a comparative study[J].Retina,2015,35(9):1844-1850.
[8] Chen Z,Zhao C,Ye JJ,et al.Inverted internal limiting membrane fap technique for repair of large macular holes:a short term follow up of anatomical and functional outcomes[J].Chin Med J (Engl),2016,129(5):511-517.
[9] Kadonosono K,Itoh N,Uchio E,et al.Staining of internal limiting membrane in macular hole surgery[J].Arch Ophthalmol,2000,118(8):1116-1118.
[10] Shin MK,Park KH,Park SW,et al.Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery[J].Retina,2014,34(9):1905-1910.
[11] Goker YS,Koc M,Yuksel K,et al.Relationship between peeled internal limiting membrane area and anatomic outcomes following macular hole surgery:a quantitative Analysis[J].J Ophthalmol,2016,2016:5641273.
[12] Chung H,Byeon SH.New insights into the pathoanatomy of macular holes based on features of optical coherence tomography[J].Surv Ophthalmol,2017,62(4):506-521.
[13] Morizane Y,Shiraga F,Kimura S,et al.Autologous transplantation of the internal limiting membrane for refractory macular holes[J].Am J Ophthalmol,2014,157(4):861-869.
[14] Baba T,Hagiwara A,Sato E,et al.Comparison of vitrectomy with brilliant blue G or indocyanine green on retinal microstructure and function of eyes with macular hole[J].Ophthalmology,2012,119(12):2609-2615.
[15] Gosala S,Manchikanty SM.Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia[J].Am J Ophthalmol,2016,166:210-211.