目的:报告2型黄斑毛细血管扩张症(MacTel)的黄斑裂孔修复。
方法:全球,多中心,回顾性病例系列。
方法:接受MacTel相关全厚度黄斑裂孔(MTMH)手术的患者。
方法:向所有外科医生分发了一份标准化的数据收集表。
方法:MTMH的解剖闭合和视觉结果:来自30名外科医生的47例MTMH患者的63例手术。平均年龄为68.1岁,62%的女性,72%的白种人,21%的东亚或南亚人,2%非洲裔美国人,2%西班牙裔或拉丁裔。程序包括34内部限制膜(ILM)单独剥离,22侧倾襟翼,5自体视网膜移植(ART),1个视网膜切开术,和1个视网膜下泡.对于ILM果皮,术前最佳可用视力(VA)为logMAR0.667±0.423。最小孔径(MHD)为305.5±159.4μm(范围34-573μm)。34例ILM果皮中有16例导致MTMH闭合,成功率为47%。术后6个月VA稳定在logMAR为0.608±0.516(P=0.65)。VA在43%中改进了至少2个品系,在24%中改进了至少4个品系。对于ILM襟翼,术前VA为logMAR0.878±0.552。MHD为440.8±175.5μm(范围97-697μm),显着大于ILM果皮(P<0.01)。22个ILM皮瓣中有20个导致MTMH闭合,成功率为90%,ILM皮瓣明显高于ILM果皮(P<0.01)。术后6个月VA改善至logMAR为0.555±0.405(P<0.05)。VA在56%中改进了至少2个品系,在28%中改进了至少4个品系。对于ART,术前VA为logMAR1.460±0.391。MHD为390.2±203.7μm(范围132-687μm)。所有5例ART均导致MTMH闭合,成功率为100%。术后6个月VA稳定在logMAR1.000±0.246(P=0.08)。VA在25%中提高了至少2个品系。
结论:手术闭合黄斑裂孔可改善57%的MTMHs的VA。与单独的ILM剥离相比,ILM皮瓣获得了更好的解剖和功能结果。ART可能是难治性MTMHs的一种选择。
OBJECTIVE: To report on macular hole repair in macular telangiectasia type 2 (MacTel2).
METHODS: Global, multicenter, retrospective case series.
METHODS: Patients undergoing surgery for MacTel2-associated full-thickness macular hole (MTMH).
METHODS: Standardized data collection sheet distributed to all surgeons.
METHODS: Anatomic closure and visual outcomes of MTMH.
RESULTS: Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% female, 72% White, 21% East or South Asian, 2% African American, and 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peeling, preoperative visual acuity (VA) was 0.667 ± 0.423 logarithm of the minimum angle of resolution (logMAR). Minimum hole diameter (MHD) was 305.5 ± 159.4 μm (range, 34-573 μm). Sixteen of 34 ILM peels (47%) resulted in MTMH closure. At postoperative month 6, VA was stable at 0.602 ± 0.516 logMAR (P = 0.65). VA improved by at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was 0.878 ± 0.552 logMAR. MHD was 440.8 ± 175.5 μm (range, 97-697 μm), which was significantly larger than for ILM peels (P < 0.01). Twenty of 22 ILM flaps (90%) resulted in MTMH closure, which was significantly higher than for ILM peels (P < 0.01). At postoperative month 6, VA improved to 0.555 ± 0.405 logMAR (P < 0.05). VA improved by at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was 1.460 ± 0.391 logMAR. MHD was 390.2 ± 203.7 μm (range, 132-687 μm). All 5 ARTs (100%) resulted in MTMH closure. At postoperative month 6, VA was stable at 1.000 ± 0.246 logMAR (P = 0.08). Visual acuity improved at least 2 lines in 25%.
CONCLUSIONS: Surgical closure of macular holes improved VA in 57% of MTMHs. Internal limiting membrane flaps achieved better anatomic and functional outcomes than ILM peeling alone. Autologous retinal transplantation may be an option for refractory MTMHs.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.