目的:评估板层黄斑裂孔(LMH)的自然史和手术结果。
方法:回顾性和连续病例系列。
方法:来自多个三级护理中心的LMH患者。
方法:回顾了临床图表和光学相干断层扫描。
方法:研究两组的视力(VA)变化和全厚度黄斑裂孔(FTMH)的发生率。在运营的集团内,探讨了与6个月VA和(FTMH)发展相关的因素。
结果:共178只眼,其中89人接受了监测,89人接受了手术。在观察组中,平均VA从0.25±0.18下降到0.28±0.18logMAR(p=0.13),14只眼睛(15.7%)损失了0.2logMARVA或更多,45.7±33.3个月后。9只眼睛(10.1%)自发发展FTMH。在手术组中,平均VA在6个月时从0.47±0.23增加到0.35±0.25logMAR(p<0.001),在24.1±30.1个月后从0.36±0.28logMAR(p=0.001)。通过多变量分析,更好的基线VA(p<0.001),视网膜前膜的存在(p=0.03),和ILM的剥离(p=0.02),具有更大的ILM孔周节约效果,与更大的6个月VA相关。通过单变量分析,孔周ERP的保留与更好的术后VA相关(p=0.03),但通过多变量分析,这并不显著.八眼(9.0%)发生了术后FTMH。使用cox比例风险比,基线假晶状体眼(HR=0.06[0.00-0.75],p=0.03)和ILM的剥离(HR=0.05[0.01-0.39],p=0.004)是保护因素,而椭圆体区破坏(HR=10.5[1.04-105],p=0.05)与FTMH风险增加相关。
结论:观察有LMH经验的眼睛,平均而言,渐进式VA损失。患有LMH和视力改变的患者可以从手术中受益。内限膜剥离,在周孔ILM保留的情况下,代表手术的关键步骤与更大的VA和更低的术后FTMH风险相关。
OBJECTIVE: To assess the natural history and surgical outcomes of lamellar macular holes (LMHs).
METHODS: Retrospective and consecutive case series.
METHODS: Patients with LMHs from multiple tertiary care centers.
METHODS: Clinical charts and OCT scans were reviewed.
METHODS: The visual acuity (VA) changes and the occurrence rate of full-thickness macular hole (FTMH) were studied in both groups. Within the operated group, factors associated with 6-month VA and development of FTMH were explored.
RESULTS: One hundred seventy-eight eyes were included, of which 89 were monitored and 89 underwent surgery. In the observation group, the mean VA decreased from 0.25 ± 0.18 to 0.28 ± 0.18 logarithm of the minimum angle of resolution (logMAR; P = 0.13), with 14 eyes (15.7%) that lost ≥ 0.2 logMAR VA, after 45.7 ± 33.3 months. Nine eyes (10.1%) spontaneously developed an FTMH. In the operated group, the mean VA increased from 0.47 ± 0.23 to 0.35 ± 0.25 logMAR at 6 months (P < 0.001) and 0.36 ± 0.28 logMAR (P = 0.001) after 24.1 ± 30.1 months. By multivariate analysis, better baseline VA (P < 0.001), the presence of an epiretinal membrane (P = 0.03), and the peeling of the internal limiting membrane (ILM; P = 0.02), with a greater effect of ILM perihole sparing, were associated with a greater 6-month VA. Perihole epiretinal proliferation sparing was associated with a better postoperative VA by univariate analysis (P = 0.03), but this was not significant by multivariate analysis. Eight eyes (9.0%) developed a postoperative FTMH. Using Cox proportional hazard ratios [HRs], pseudophakia at baseline (HR, 0.06; 95% confidence interval [CI], 0.00-0.75; P = 0.03) and peeling of the ILM (HR, 0.05; 95% CI, 0.01-0.39; P = 0.004) were protective factors, while ellipsoid zone disruption (HR, 10.5; 95% CI, 1.04-105; P = 0.05) was associated with an increased risk of FTMH.
CONCLUSIONS: Observed eyes with LMH experienced, on average, progressive VA loss. Patients with LMH and altered vision may benefit from surgery. Internal limiting membrane peeling, with perihole ILM sparing, represents a crucial step of the surgery associated with a greater VA and a lower risk of postoperative FTMH.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.