Macular hole surgery with internal-limiting membrane peeling and intravitreous air
Macular hole surgery with internal-limiting membrane peeling and intravitreous air
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DOI：
10.1016/s0161-6420(99)00730-7
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发表时间：
1999-07-01
期刊：
影响因子：
13.7
通讯作者：
Jacobsen, J
中科院分区：
文献类型：
--
作者：
Park, DW;Sipperley, JO;Jacobsen, J
目的：观察采用玻璃体切除、内界膜剥离、玻璃体内充气治疗黄斑裂孔的效果。设计：回顾性、干预性、非对比性病例系列。患者：连续50例(58眼)全层黄斑裂孔。干预：所有患者均接受玻璃体切除内界膜剥离和玻璃体内充气，患者只需面朝下4天。主要观察指标：黄斑裂孔状况、视力、相关发现和并发症。结果：所有患者术后随访6个月或更长时间。黄斑裂孔2期8眼(14%)，黄斑裂孔3期48眼(83%)，黄斑裂孔4期2眼(3%)。只有26只眼(45%)在手术前出现黄斑视网膜前膜。58个黄斑裂孔中53个(91%)一次手术闭合，55个(95%)黄斑裂孔再次手术闭合。58只眼中5只眼(9%)的初始视力为20/50或更高，31只眼(53%)的最终视力为20/50或更高。症状持续时间<6个月的45只眼中，44只眼(98%)黄斑裂孔一次手术闭合，27只眼(60%)最终视力达20/50或以上。症状持续6个月或以上的13只眼中，9只眼(69%)黄斑裂孔一次手术闭合，4只眼(31%)最终视力达20/50或以上。手术并发症包括视网膜裂孔、视网膜脱离、术后黄斑皱褶、黄斑光毒。结论：本组手术的解剖和视觉效果良好。目前的技术与传统的黄斑裂孔手术相似，只是使用玻璃体内空气，所有眼睛的内界膜剥离，以及术后仅4天的定位。这项研究表明，剥离内界膜是成功关闭黄斑裂孔的重要辅助手段。
Objective: To examine the results of macular hole surgery using pars plana vitrectomy, internal-limiting membrane peeling, and intravitreous air in a series of consecutive patients.Design: A retrospective, interventional, noncomparative case series.Patients: Fifty consecutive patients (58 eyes) with full-thickness macular holes.Intervention: All eyes underwent a pars plana vitrectomy with internal-limiting membrane peeling and intravitreous air, and patients were asked to position face-down for only 4 days.Main Outcome Measures: Status of macular holes, visual acuity, and associated findings and complications.Results: All patients had postsurgical follow-up of 6 months or greater. Eight eyes (14%) presented with stage-2 macular holes, 48 eyes (83%) with stage-3 macular holes, and 2 eyes (3%) with stage-4 macular holes. Only 26 eyes (45%) had a macular epiretinal membrane seen before surgery. Fifty-three (91%) of the 58 macular holes were closed with 1 operation, and 55 (95%) had closure of the macular holes with subsequent operations. Five (9%) of 58 eyes had an initial visual acuity of 20/50 or better, and 31 eyes (53%) had a final visual acuity of 20/50 or better. Of the 45 eyes with symptoms of less than 6 months' duration, 44 (98%) had macular holes that were closed with 1 operation and 27 (60%) had a final visual acuity of 20/50 or better. Of the 13 eyes with symptoms of 6 months' duration or longer, 9 (69%) had macular holes that were closed with 1 operation and 4 (31%) had a final visual acuity of 20/50 or better. Complications attributed to the operation included retinal tears, retinal detachments, postoperative macular puckers, and macular light toxicity.Conclusions: The anatomic and visual results in this series are good. The current technique is similar to that of conventional macular hole surgery except for the use of intravitreous air, internal-limiting membrane peeling in all eyes, and only 4 days of postoperative positioning. This study would suggest that peeling of the internal-limiting membrane is an important adjuvant for successful closure of macular holes.