Managing Optic Pit. The Right Stuff!
Managing Optic Pit. The Right Stuff!
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管理光学坑。
DOI：
10.1097/iae.0000000000001218
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Z. Michalewska
中科院分区：
文献类型：
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作者：
J. Nawrocki;Karolina Bonińska;Z. Michalewska
管理光学坑。正确的东西！手术治疗视盘凹坑相关黄斑病变的目的是对视网膜内和视网膜下的液体迁移产生永久性阻断，从而提高视力。由于这种疾病的罕见性，进行随机对照临床试验极其困难。因此，使用了多种手术技术。在过去的 20 年里，治疗上述病症最流行的手术技术是玻璃体切除术，玻璃体后脱离，最终进行气体交换，有或没有激光光凝。在最近的一项多中心研究中，与不进行激光光凝的玻璃体切除术相比，未证实激光光凝玻璃体切除术显示出任何益处。黄斑区内界膜（ILM）剥离的作用也存在争议。在长期随访中，据报道，它与谱域光学相干断层扫描（OCT）中黄斑厚度的减少有关。人们提出了不同的尝试来封闭视盘凹坑：在视盘凹坑上注射自体血小板的病例报告显示出良好的效果。 Travassos 等人对三只眼睛进行了自体巩膜移植。其他人建议将 ILM 襟翼翻转到坑上方。作者之前使用过最后一种技术，但给人的印象是长期结果不稳定并且黄斑病变会再次出现。本文的目的是讨论一种新的手术方法，将倒置的 ILM 皮瓣塞入视凹。
Managing Optic Pit. The Right Stuff! The purpose of the surgical treatment of optic disc pit–associated maculopathy is to produce a permanent intraretinal and subretinal blockade of fluid migration, which should result in improved visual acuity. Because of the rarity of this disease, it is extremely difficult to conduct a randomized controlled clinical trial. Thus, a number of surgical techniques are used. Over the past 20 years, the most popular surgical technique used in the above-mentioned condition has been vitrectomy with posterior vitreous detachment, with eventual gas exchange, with or without laser photocoagulation. In a recent multicenter study, vitrectomy with laser photocoagulation was not confirmed to show any benefit when compared with vitrectomy without laser photocoagulation. The role of internal limiting membrane (ILM) peeling in the macular area is also controversial. In long-term follow-up, it was reported to be associated with reduction of macular thickness in spectral-domain optical coherence tomography (OCT). Different attempts to seal the pit have been proposed: A case report of injecting autologous platelets over the optic disc pit showed good results. Travassos et al introduced an autologous scleral transplant in three eyes. Others proposed inverting an ILM flap over the pit. The authors previously used the last technique, but had the impression that long-term results are unstable and maculopathy reappears. The aim of this article was to discuss a new surgical approach, stuffing the inverted ILM flap into the optic pit.