Macular hole surgery with and without internal limiting membrane peeling
Macular hole surgery with and without internal limiting membrane peeling
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DOI：
10.1016/s0161-6420(00)00331-6
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发表时间：
2000-10-01
期刊：
影响因子：
13.7
通讯作者：
Brooks, HL
中科院分区：
文献类型：
--
作者：
Brooks, HL
目的：比较连续 5 年期间一系列患有或不伴有内界膜 (ILM) 剥离的特发性黄斑裂孔患者的手术结果。设计：一项回顾性、非随机、与同期对照组的比较试验。参与者：将 44 只患有黄斑裂孔且病程小于或等于 6 个月但未进行 ILM 剥离的眼睛与 116 只患有 ILM 剥离且裂孔持续时间相同的眼睛进行比较。还对第三组 65 只患有 ILM 剥离且持续时间超过 6 个月的眼睛进行了评估。 干预：所有眼睛均接受平坦部玻璃体切除术，伴或不伴 ILM 剥离、玻璃体内气体和面朝下定位。任何组均未使用辅助治疗。 主要结果指标：比较伴有和不伴有 ILM 剥离的黄斑裂孔的闭合和/或再开放率、预后、视力和并发症。 结果：所有患者均进行了 18 个月或更长时间的术后随访。 ILM剥脱术使初次闭合得到显着改善，116只眼中的116只眼（100%）显示没有重新张开，而44个孔中的36只（82%）主要闭合，其中9只（25%）在小于或等于6个月的孔中重新张开而没有ILM剥离（P < 0.00001）。手术成功的 27 只未进行 ILM 剥离的眼的平均术后视力为 20/40，与 ILM 剥离成功的眼相同（P = 0.6）。52 只进行 ILM 剥离的 II 期眼的平均术后视力为 20/30，52 只眼中的 48 只（92%）为 20/40 或更好。未进行 ILM 剥离的 III 期眼睛（大于 400 μm 的孔）预后较差，25 只眼睛中有 6 只 (24%) 初次手术失败，25 只眼睛中有 4 只 (16%) 重新睁开。在没有 ILM 剥离的情况下，小于 300 μm 的孔只有 1 个重新打开，而大于或等于 300 μm 的孔在 17 个主要失效和/或重新打开的孔中有 16 个 (94%) (P < 0.001)。所有重新打开和/或主要失效的 12 个孔均通过 ILM 剥离修复，具有良好的视觉恢复效果。持续时间大于 6 个月的黄斑裂孔采用 ILM 剥离治疗，65 个孔中的 63 个 (97%) 得到了初步闭合，65% 的视力增加了两条或更多 Snellen 线。结论：ILM 剥离显着改善了近期和慢性黄斑裂孔以及重新开放和失败的孔的所有阶段的视觉和解剖成功率，同时消除了大于 300 μm 的孔的重新开放。眼科 2000；107：1939-1949 (C) 2000 年，美国眼科学会。
Objective: To compare results of surgery for idiopathic macular hole with and without internal limiting membrane (ILM) peeling in a series of consecutive patients over a 5-year period.Design: A retrospective, nonrandomized, comparative trial with concurrent control group.Participants: Forty-four eyes with macular holes of less than or equal to 6 months duration without ILM peeling were compared to 116 eyes with ILM peeling and the same hole duration. A third group of 65 eyes with ILM peeling and duration greater than 6 months was also evaluated.Intervention: All eyes underwent pars plana vitrectomy with or without ILM peeling, intravitreous gas, and positioning face down. No adjunctive therapies were used in any group.Main Outcome Measures: Comparing the closure and/or reopening rate, prognosis, visual acuity, and complications for macular holes with and without ILM peeling.Results: All patients had postsurgical follow-up of 18 months or greater. Primary closure was significantly improved with ILM peeling with 116 of 116 eyes (100%) showing no reopenings versus 36 of 44 holes (82%) primarily closed, 9 of which (25%) reopened without ILM peeling (P < 0.00001) in holes less than or equal to 6 months. The 27 eyes without ILM peeling that had successful surgery displayed a mean postoperative vision of 20/40, which is the same as the successful eyes with ILM peeling (P = 0.6), The 52 stage II eyes with ILM peeling had a mean postoperative vision of 20/30, and 48 of the 52 eyes (92%) were 20/40 or better. Stage III eyes (greater than 400-mu m holes) without ILM peeling had a poor prognosis, with 6 of the 25 eyes (24%) having initial surgery fail and an additional 4 of 25 eyes (16%) reopening. Without ILM peeling, holes less than 300 mu m had only one reopen, whereas holes greater than or equal to 300 mu m had 16 of the 17 (94%) primary failures and/or reopenings (P < 0.001), All 12 holes that reopened and/or primarily failed were repaired with ILM peeling with excellent visual recovery. Macular holes with a duration greater than 6 months were treated with ILM peeling, and 63 of 65 holes (97%) were closed primarily and 65% had an increase in vision by two or more Snellen lines.Conclusions: ILM peeling significantly improves visual and anatomic success in all stages of recent and chronic macular holes and reopened and failed holes, while eliminating reopening for holes greater than 300 mu m. Ophthalmology 2000;107:1939-1949 (C) 2000 by the American Academy of Ophthalmology.