Perfluoro-n-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Macular Hole Surgery
Perfluoro-n-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Macular Hole Surgery
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DOI：
10.1097/iae.0000000000000339
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发表时间：
2014-09-01
影响因子：
3.3
通讯作者：
Lee, Ji Eun
中科院分区：
文献类型：
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作者：
Shin, Min Kyu;Park, Keun Heung;Lee, Ji Eun
结果一名外科医生连续对12例患者实施了该技术。表1总结了所有病例。术中及术后未见与倒瓣技术相关的并发症。在12只眼中，10只（83%）在使用单层逆行ILM瓣技术进行初次手术后显示初始黄斑孔闭合。1例（病例6；图4、A和B）术后光学相干断层扫描显示黄斑裂孔开放，边缘升高，被单层ILM瓣覆盖。在这种情况下，ILM没有被移除。在此病例后，该技术进行了改进，将黄斑内的ILM去除至3至4个椎间盘直径大小，除了ILM瓣。另一例在光学相干断层扫描中显示ILM皮瓣迁移（病例9；图4、C和D）。术后保持面朝下体位1天的患者无移位现象。在上述两种情况下，第二次手术后将ILM移至4盘直径大小，并使用14% C3F8气体作为填塞物，关闭黄斑孔。平均视力从基线时的最小分辨角（log-MAR）的对数0.9±0.21提高到6个月时的0.48±0.19 （P= 0.004）。3眼（25%）视力达到20/40或以上。代表性病例（病例1和8；图4，E-H）手术闭合后中央凹形态正常。5例（42%）在中央凹凹陷处发现ILM瓣。5只眼在术后3个月和6个月观察到内、外节交界处信号恢复（图4H）。在任何情况下均未发现残留的PFO。
ResultsOne surgeon performed this technique in 12 consecutive patients. All cases are summarized in Table 1. No intraoperative or postoperative complications related to the inverted flap technique were noted. Of the 12 eyes, 10 (83%) showed initial macular hole closure after primary surgery using a single-layered inverted ILM flap technique. One case (Case 6; Figure 4, A and B) showed an open macular hole, which had an elevated margin covered by the single-layered ILM flap in the postoperative optical coherence tomography. The ILM had not been removed in this case. After this case, the technique was modified to remove the ILM in the macula to 3 to 4 disk diameter size except the ILM flap. The other case showed migration of the ILM flap in optical coherence tomography (Case 9; Figure 4, C and D). Migration was not noted in patients who kept a postoperative facedown position for 1 day. In both cases mentioned above, the macular hole was closed after second operation in which the ILM was removed to 4 disk diameter size and 14% C3F8 gas was used as a tamponade. The mean visual acuity improved significantly from logarithm of the minimum angle of resolution (log-MAR) 0.9±0.21 at baseline to 0.48±0.19 at 6 months (P= 0.004). Visual acuity of 20/40 or better was achieved in 3 eyes (25%). Representative cases (Cases 1 and 8; Figure 4, E–H) had a normal foveal configuration after surgical closure. The ILM flap was noted over the foveal depression in 5 cases (42%). Restoration of the inner and outer segment junction signal was noted in 5 eyes at 3 months and 6 months postoperatively (Figure 4H). Residual PFO was not found in any case.