Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes
Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes
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DOI：
10.1016/j.ophtha.2010.02.011
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发表时间：
2010-10-01
期刊：
影响因子：
13.7
通讯作者：
Nawrocki, Jerzy
中科院分区：
文献类型：
--
作者：
Michalewska, Zofia;Michalewski, Janusz;Nawrocki, Jerzy
目的：较大的黄斑裂孔通常会增加手术失败的风险。高达44%的大黄斑裂孔在1次手术后仍然开放。另外19%至39%的黄斑裂孔在手术后是平开的。平开性黄斑裂孔与有限的视力有关。本文介绍了一种修改的标准黄斑裂孔手术，以改善功能和解剖结果的患者与大macular hole.Design：前瞻性，随机临床试验。参与者：患者的黄斑裂孔大于400 μ m。第1组40例51眼行标准三孔式玻璃体切割术。在第2组，50眼的46例患者进行了修改的标准技术，称为倒置内界膜（ILM）flap technology.Methods：在倒置ILM皮瓣技术，而不是完全删除后，台盼蓝染色ILM，残余连接到边缘的黄斑孔留在原地。然后将该ILM残余倒置以覆盖黄斑孔。然后进行流体-空气交换。光谱光学相干断层扫描和临床检查术前和术后1周和1，3，6，12 months.Main结果测量：视力和术后黄斑裂孔closed.Results：术前平均视力为0.12，在组1和0.078，在组2。第1组中88%的患者和第2组中98%的患者观察到黄斑裂孔闭合。在第1组19%的患者和第2组2%的患者中观察到具有裸视网膜色素上皮（平开口）的平孔顶部。是说术后12个月的术后视力（或中位视力）为0.17（范围，0.1-0.6），组1和0.28（范围：0.02-0.8），第2组（P = 0.001）。结论：倒置内界膜瓣技术可防止术后平坦黄斑裂孔的开放外观，并改善直径大于400 μ m的黄斑裂孔的玻璃体切除术的功能和解剖结果。与标准手术相比，采用倒置ILM瓣技术的玻璃体切除术后的光谱光学相干断层扫描显示了中心凹解剖结构的改善。
Purpose: Large macular holes usually have an increased risk of surgical failure. Up to 44% of large macular holes remain open after 1 surgery. Another 19% to 39% of macular holes are flat-open after surgery. Flat-open macular holes are associated with limited visual acuity. This article presents a modification of the standard macular hole surgery to improve functional and anatomic outcomes in patients with large macular holes.Design: A prospective, randomized clinical trial.Participants: Patients with macular holes larger than 400 mu m were included. In group 1, 51 eyes of 40 patients underwent standard 3-port pars plana vitrectomy with air. In group 2, 50 eyes of 46 patients underwent a modification of the standard technique, called the inverted internal limiting membrane (ILM) flap technique.Methods: In the inverted ILM flap technique, instead of completely removing the ILM after trypan blue staining, a remnant attached to the margins of the macular hole was left in place. This ILM remnant was then inverted upside-down to cover the macular hole. Fluid-air exchange was then performed. Spectral optical coherence tomography and clinical examination were performed before surgery and postoperatively at 1 week and 1, 3, 6, and 12 months.Main Outcome Measures: Visual acuity and postoperative macular hole closure.Results: Preoperative mean visual acuity was 0.12 in group 1 and 0.078 in group 2. Macular hole closure was observed in 88% of patients in group 1 and in 98% of patients in group 2. A flat-hole roof with bare retinal pigment epithelium (flat-open) was observed in 19% of patients in group 1 and 2% of patients in group 2. Mean (or median) postoperative visual acuity 12 months after surgery was 0.17 (range, 0.1-0.6) in group 1 and 0.28 (range, 0.02-0.8) in group 2 (P = 0.001).Conclusions: The inverted ILM flap technique prevents the postoperative flat-open appearance of a macular hole and improves both the functional and anatomic outcomes of vitrectomy for macular holes with a diameter greater than 400 mu m. Spectral optical coherence tomography after vitrectomy with the inverted ILM flap technique suggests improved foveal anatomy compared with the standard surgery.