黄斑裂孔(MH)是影响中心视力的全层视网膜缺损。虽然内界膜(ILM)剥离玻璃体切除术是常规的MH治疗,非手术替代方案对降低手术风险越来越感兴趣.本研究对非手术MH管理进行了全面的文献回顾和分析。在PubMed上进行了系统的文献检索,Embase,Scopus,科克伦图书馆从1973年1月1日至2023年9月13日。治疗包括激光治疗,碳酸酐酶抑制剂(CAIs),非甾体抗炎药(NSAIDs),类固醇(局部,subtenons,球周,玻璃体内),玻璃体内气体,抗血管内皮生长因子(VEGF)和奥氏酶注射。数据提取涵盖了研究细节,患者特征,MH特性,治疗结果,和复发率。最初的搜索产生了3352篇文章,细化到83篇符合筛选纳入标准的文章。激光光凝术的总报告解剖闭合率为36%,37%与玻璃体内ocriplasmin,55%用玻璃体内气体。局部NSAIDs更频繁地观察到封闭(79%),类固醇(84%)和CAIs(73%)。在MH较小和存在囊性黄斑水肿的患者中,更常观察到闭合。尽管非手术MH管理方法显示出保守治疗的潜力,证据仅限于支持常规使用。第1阶段和创伤性MH可能会从短时间的观察中受益,但是全层MH的金标准方法仍然是ILM剥离的玻璃体切除术。
Macular holes (MH) are full-thickness retinal defects affecting central vision. While vitrectomy with inner limiting membrane (ILM) peel is the conventional MH treatment, non-surgical alternatives are gaining interest to mitigate surgical risks. This study conducted a comprehensive literature
review and analysis of nonsurgical MH management. A systematic literature search was conducted on PubMed, Embase, Scopus, and the Cochrane Library from January 1, 1973, to September 13, 2023. Treatments included laser therapy, carbonic anhydrase inhibitors (CAIs), nonsteroidal antiinflammatory drugs (NSAIDs), steroids (topical, subtenons, peribulbar, intravitreal), intravitreal gas, anti-vascular endothelial growth factors and ocriplasmin injections. Data extraction covered study details, patient characteristics, MH features, treatment outcomes, and recurrence rates. The initial search yielded 3352 articles, refined to 83 articles that met inclusion criteria following screening. Overall reported anatomical closure rates were 36% with laser photocoagulation, 37% with intravitreal ocriplasmin, 55% with intravitreal gas. Closures were more frequently observed with topical NSAIDs (79%), steroids (84%) and CAIs (73%). Closures were more often observed in patients with smaller MH and in the presence of cystic macular oedema. Although non-surgical MH management approaches show potential for conservative therapy, evidence is limited to support routine use. Stage 1 and traumatic MH may benefit from a short period of observation, but the gold standard approach for full-thickness MH remains to be vitrectomy with ILM peel.