VITREOUS SURGERY FOR IDIOPATHIC MACULAR HOLES - RESULTS OF A PILOT-STUDY
VITREOUS SURGERY FOR IDIOPATHIC MACULAR HOLES - RESULTS OF A PILOT-STUDY
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DOI：
10.1001/archopht.1991.01080050068031
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发表时间：
1991-05-01
影响因子：
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通讯作者：
WENDEL, RT
中科院分区：
文献类型：
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作者：
KELLY, NE;WENDEL, RT
特发性黄斑裂孔通常被认为是一种无法治愈的疾病。 我们使用现代玻璃体切除术技术来评估两个问题：（1）黄斑裂孔周围的视网膜是否可能重新附着？ (2)如果重新接上，患者的中心视力会改善吗？ 在52名患者中，有30名（58%）患者能够通过我们的外科手术成功地重新连接分离的黄斑。 在30例黄斑成功复位的患者中，有22例（73%）的视力改善了两行或更好。 在22例黄斑裂孔未复位的患者中，视力无明显改善。 因此，术后视力改善的总体成功率为42%（22/52）。 在我们早期的经验中，有8名患者（15%）观察到与手术相关的并发症，包括黄斑裂孔大小增加、视网膜色素上皮斑点和血管闭塞。 我们的临床观察表明，黄斑裂孔的玻璃体切除术治疗可能提供一些承诺，否则无法治愈的条件。 在复位成功的患者中，所使用的技术似乎允许视力的临床显著改善。 然而，在广泛使用该手术治疗黄斑裂孔之前，需要在增加手术成功率和最小化手术并发症以及进一步了解视网膜复位机制方面进行额外的工作。
Idiopathic macular holes are generally considered an untreatable condition. We used modern vitrectomy techniques to evaluate two questions: (1) Is it possible to reattach the retina around the macular hole? (2) If it is reattached, will the patient's central vision improve? In 30 (58%) of 52 patients, we were able to reattach successfully the detached macula with our surgical procedure. In 22 (73%) of the 30 patients in whom the macula was successfully reattached, there was an improvement in visual acuity of two lines or better. In the 22 patients in whom reattachment of the macular hole was not obtained, there was no significant improvement in visual acuity. Thus, the overall success rate for improved vision postoperatively was 42% (22/52). Complications related to surgery were observed in eight patients (15%) early in our experience with this procedure and included increase in the size of the macular hole, mottling of the retinal pigmented epithelium, and a vascular occlusion. Our clinical observations indicate that the treatment of macular holes by vitrectomy may offer some promise for this otherwise untreatable condition. In patients in whom reattachment was successful, the technique used appeared to allow for clinically significant improvements in visual acuity. However, additional work on increasing surgical success and minimizing surgical complications, as well as a further understanding of the mechanism of retinal reattachment, is required before widespread use of this procedure for treating macular holes.