AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5...AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 µm who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure.RESULTSMean age was 63.2±8.4y with all 5 subjects being females. Mean duration of symptoms was 11±14mo with a mean postoperative follow up of 13.2±13mo. The mean base diameter of the macular holes was 1420±84.8 µm (1280-1480 µm). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen’s equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen’s equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted.CONCLUSIONThe inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.展开更多
Background：Inverted internal limiting membrane （ILM） flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes （MHs） wit...Background：Inverted internal limiting membrane （ILM） flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes （MHs） with fair MH closure rates as well as gains in visual acuity.In the current study,longitudinal changes in multi-focal electroretinogram （mfERG） responses,best-corrected visual acuity （BCVA） and spectral-domain optical coherence tomography （SD-OCT） were evaluated in eyes with large MHs managed by this technique.Methods：A prospective noncontrolled interventional study of eight patients （eight eyes） with large MHs （minimum diameter 〉400 μm） was conducted.All MHs were treated with pars plana vitrectomy and indocyanine green-assisted inverted ILM flap technique.SD-OCT images were used to assess the anatomical outcomes of surgery while BCVA and mfERG were used to evaluate the functional outcomes during a 3-month follow-up.Results：All patients underwent successful intended manipulation and translocation of the ILM flap without flap dislocation and achieved complete anatomical closure.Partial microstructural reconstruction,demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone,was observed in all cases as early as 1 month after surgery.Functionally,as compared to baseline,all patients showed improvements in BCVA and all but one in mfERG response during follow-up.However,Pearson＇s test revealed no significant correlations between BCVA and mfERG responses of the fovea and of the macular area at each evaluation time point.Conclusions：Inverted ILM flap technique appeares to be a safe and effective approach for the management of large idiopathic MHs with favorable short-term anatomical and functional results.Postoperative reconstruction of the microstructure generally shows good consistency with improvements in both BCVA and mfERG response,of which the latter might be a supplement for the former in postoperative functional follow-up.展开更多
目的比较经睫状体平坦部玻璃体切割术(PPV)联合内界膜翻转覆盖术与PPV联合游离内界膜移植术治疗大直径黄斑裂孔(MH)的临床疗效和安全性。方法将40例(40只眼)大直径MH(最小直径>400μm)患者按随机数字表法分为翻转组(n=20,20只眼)和...目的比较经睫状体平坦部玻璃体切割术(PPV)联合内界膜翻转覆盖术与PPV联合游离内界膜移植术治疗大直径黄斑裂孔(MH)的临床疗效和安全性。方法将40例(40只眼)大直径MH(最小直径>400μm)患者按随机数字表法分为翻转组(n=20,20只眼)和移植组(n=20,20只眼)。翻转组采用PPV联合内界膜翻转覆盖术治疗,移植组采用PPV联合游离内界膜移植术治疗。观察2组术后2周裂孔闭合率,术前和术后2周和术后1、3、6个月最小视角对数视力表最佳矫正视力(log MAR BCVA)、眼压的水平及术后手术相关并发症、随访6个月的裂孔复发情况。频域光学相干断层成像(SD-OCT)的图像观察MH直径(测量MH最小直径及基底部最大直径)及MH是否闭合。结果术后2周翻转组裂孔闭合率为100.0%,移植组为95.0%。2组术后2周裂孔闭合率比较差异无统计学意义(P>0.05)。log MAR BCVA:翻转组术前为1.01±0.24,术后2周为0.82±0.32和术后1个月为0.72±0.45、术后3个月为0.52±0.25、术后6个月为0.53±0.42;移植组术前为1.09±0.32,术后2周为0.95±0.45和术后1个月为0.93±0.14、术后3个月为0.81±0.24、术后6个月为0.70±0.23。2组术后log MAR BCVA均较术前明显提高,差异有统计学意义(P<0.05);翻转组术后2周和术后1、3、6个月log MAR BCVA均较移植组明显提高,差异有统计学意义(P<0.05)。2组术后2周和术后1、3、6个月眼压与术前比较差异无统计学意义(P>0.05);2组术后均未出现手术相关并发症;2组均随访6个月,均无裂孔复发。结论PPV联合内界膜翻转覆盖术治疗大直径MH效果与PPV联合游离内界膜移植术治疗相当,但翻转组术后log MAR BCVA优于移植组。展开更多
文摘AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 µm who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure.RESULTSMean age was 63.2±8.4y with all 5 subjects being females. Mean duration of symptoms was 11±14mo with a mean postoperative follow up of 13.2±13mo. The mean base diameter of the macular holes was 1420±84.8 µm (1280-1480 µm). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen’s equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen’s equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted.CONCLUSIONThe inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.
文摘Background：Inverted internal limiting membrane （ILM） flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes （MHs） with fair MH closure rates as well as gains in visual acuity.In the current study,longitudinal changes in multi-focal electroretinogram （mfERG） responses,best-corrected visual acuity （BCVA） and spectral-domain optical coherence tomography （SD-OCT） were evaluated in eyes with large MHs managed by this technique.Methods：A prospective noncontrolled interventional study of eight patients （eight eyes） with large MHs （minimum diameter 〉400 μm） was conducted.All MHs were treated with pars plana vitrectomy and indocyanine green-assisted inverted ILM flap technique.SD-OCT images were used to assess the anatomical outcomes of surgery while BCVA and mfERG were used to evaluate the functional outcomes during a 3-month follow-up.Results：All patients underwent successful intended manipulation and translocation of the ILM flap without flap dislocation and achieved complete anatomical closure.Partial microstructural reconstruction,demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone,was observed in all cases as early as 1 month after surgery.Functionally,as compared to baseline,all patients showed improvements in BCVA and all but one in mfERG response during follow-up.However,Pearson＇s test revealed no significant correlations between BCVA and mfERG responses of the fovea and of the macular area at each evaluation time point.Conclusions：Inverted ILM flap technique appeares to be a safe and effective approach for the management of large idiopathic MHs with favorable short-term anatomical and functional results.Postoperative reconstruction of the microstructure generally shows good consistency with improvements in both BCVA and mfERG response,of which the latter might be a supplement for the former in postoperative functional follow-up.
文摘目的比较经睫状体平坦部玻璃体切割术(PPV)联合内界膜翻转覆盖术与PPV联合游离内界膜移植术治疗大直径黄斑裂孔(MH)的临床疗效和安全性。方法将40例(40只眼)大直径MH(最小直径>400μm)患者按随机数字表法分为翻转组(n=20,20只眼)和移植组(n=20,20只眼)。翻转组采用PPV联合内界膜翻转覆盖术治疗,移植组采用PPV联合游离内界膜移植术治疗。观察2组术后2周裂孔闭合率,术前和术后2周和术后1、3、6个月最小视角对数视力表最佳矫正视力(log MAR BCVA)、眼压的水平及术后手术相关并发症、随访6个月的裂孔复发情况。频域光学相干断层成像(SD-OCT)的图像观察MH直径(测量MH最小直径及基底部最大直径)及MH是否闭合。结果术后2周翻转组裂孔闭合率为100.0%,移植组为95.0%。2组术后2周裂孔闭合率比较差异无统计学意义(P>0.05)。log MAR BCVA:翻转组术前为1.01±0.24,术后2周为0.82±0.32和术后1个月为0.72±0.45、术后3个月为0.52±0.25、术后6个月为0.53±0.42;移植组术前为1.09±0.32,术后2周为0.95±0.45和术后1个月为0.93±0.14、术后3个月为0.81±0.24、术后6个月为0.70±0.23。2组术后log MAR BCVA均较术前明显提高,差异有统计学意义(P<0.05);翻转组术后2周和术后1、3、6个月log MAR BCVA均较移植组明显提高,差异有统计学意义(P<0.05)。2组术后2周和术后1、3、6个月眼压与术前比较差异无统计学意义(P>0.05);2组术后均未出现手术相关并发症;2组均随访6个月,均无裂孔复发。结论PPV联合内界膜翻转覆盖术治疗大直径MH效果与PPV联合游离内界膜移植术治疗相当,但翻转组术后log MAR BCVA优于移植组。
