目的:本研究的目的是确定巨大的特发性黄斑裂孔的闭合率,行玻璃体切割术和360度带蒂内翻内界膜瓣治疗,不采用正面朝下姿势,并确定视力改善,黄斑裂孔闭合的类型,和外部视网膜完整性作为次要结果。
方法:本回顾性病例系列分析了所有接受玻璃体切除术治疗的患者,360度带蒂倒置内界膜瓣,还有气体填塞,术后没有正面朝下的姿势。年龄,性别,视力下降的时间,其他眼病,收集晶状体状态。在术前和术后随访期间(术后15天和2个月)记录最佳矫正视力和光学相干断层扫描结果。
结果:这项研究纳入了19例患者的20只眼,平均年龄是66岁.手术后2个月进行的光学相干断层扫描显示19只(95%)眼的孔闭合。中位最佳矫正视力从术前+1.08改善至术后2个月+0.66LogMAR(p<0.001),在早期治疗糖尿病视网膜病变研究图表上,视力改善的中位数为20个字母(0.4LogMAR)。观察到V(47.36%)和U(52.63%)类型的闭合。
结论:360度带蒂倒置内界膜瓣技术,没有面朝下的姿态,提供了很高的闭合率(95%),外层恢复,V型和U型中央凹闭合轮廓,除了在大多数黄斑裂孔(甚至黄斑裂孔>650μm)的情况下的视力改善。对于无法进行传统的术后面朝下定位进行大黄斑孔治疗的患者,该技术可能是可行的替代方法。
This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting membrane flap without face-down posturing and define visual improvement, types of macular hole closure, and external retina integrity as secondary outcomes.
This retrospective
case series analyzed all patients who were treated by vitrectomy, 360-degree pedicled inverted internal limiting membrane flap, and gas tamponade, without face-down posturing postoperatively. Age, sex, time of visual acuity reduction, other ocular pathologies, and lens status were collected. The best-corrected visual acuity and optical coherence tomography results were recorded during pre- and postoperative follow-up examinations (15 days and 2 months after surgery).
This study enrolled 20 eyes of 19 patients, and the mean age was 66 years. Optical coherence tomography performed 2 months after surgery revealed hole closure in 19 (95%) eyes. The median best-corrected visual acuity improved from +1.08 preoperatively to +0.66 LogMAR 2 months postoperatively (p<0.001), with a median of 20 letters of visual improvement (0.4 LogMAR) on the Early Treatment Diabetic Retinopathy Study chart. V (47.36%)- and U (52.63%)-types of closure were observed.
The 360-degree pedicled inverted internal limiting membrane flap technique, without face-down posturing, provided a high closure rate (95%), external layer recovery, and V- and U-type foveal closure contours, in addition to visual improvement in most cases of large macular holes (even macular holes >650 μm). This technique may be a viable alternative to patients in whom traditional postoperative face-down positioning for large macular hole treatment is not possible.