One year clinical results of different surgical methods in the treatment of idiopathic macular hole_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Yuyan , Wang Ying , Chu Yanhua , Wang Hongyan ,  Han Quanhong

Tianjin Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Institute of Ophthalmology, Tianjin 300020, China;

Corresponding author：

Han Quanhong, Email: hanquanhong126@126.com

Keywords：

Retinal perforation; Vitrectomy; Tomography, optical coherence

DOI：

10.3760/cma.j.issn.1005-1015.2019.06.010

Video：

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Objective To observe the effect of 25G pars plana vitrectomy (PPV) combined with or without internal limiting membrane (ILM) flap and sterile air or perfluoropropane (C₃F₈) tamponade in the treatment of idiopathic macular hole (IMH).Methods A retrospective case analysis. From December 2015 to December 2016 in Tianjin Eye Hospital, 101 eyes of 98 consecutive IMH patients who underwent 25G PPV combined with or without ILM flap and sterile air or C₃F₈ tamponade, were included in this study. All patients underwent BCVA and OCT examination. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The patients were divided into three groups according to preoperative minimum liner diameter of Hole (MLD) and surgical methods: MLD＜400 μm for the group A, 41 eyes of 39 patients, MLD more than 400 μm without ILM flap surgery as the group B, 39 eyes of 38 patients, including 16 eyes tamponaded with air and 23 eyes tamponaded with C₃F₈, MLD more than 400 μm with ILM flap as the group C, a total of 21 patients of 21 eyes, including 7 eyes tamponaded with air and 14 eyes tamponaded with C₃F₈. The logMAR BCVA of group A, B and C were 0.82±0.39, 1.11±0.42, 1.25±0.50, respectively. The follow-up times were 1 week, 1 month, 3 month, 6 month and 1 year post operation, BCVA and OCT were performed at each follow-up time. The hole closure rate and BCVA improvement were observed.Results The postoperative BCVA of group A, B and C was improved obviously, the differences were statistically significant (t=−11.66, −7.52, −4.99; P＜0.01). There was no significant difference in improvement of visual acuity between the three groups (A and B, A and C, B and C group: t=0.77, −0.41, 0.28; P=0.44, 0.72, 0.76). 96.94% macular hole closure occurred in 7 days post operation. The postoperative visual acuity improved significantly in 3 mouth after operation,Conclusions The macular hole closure occurred mainly in 1 week after operation, postoperative visual acuity increased mostly in the 3rd month post operation. There is no advantage of ILM flap in improve postoperative visual acuity of IMH patients with MLD more than 400 μm.

Citation： Liu Yuyan, Wang Ying, Chu Yanhua, Wang Hongyan, Han Quanhong. One year clinical results of different surgical methods in the treatment of idiopathic macular hole. Chinese Journal of Ocular Fundus Diseases, 2019, 35(6): 571-575. doi: 10.3760/cma.j.issn.1005-1015.2019.06.010 Copy

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2.	Kase S, Saito W, Mori S, et al. Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique[J]. Clin Ophthalmol, 2016, 16(11): 9-14. DOI: 10.2147/OPTH.S119762.
3.	Salter AB, Folgar FA, Weissbrot J, et al. Macular hole surgery prognostic success rates based on macular hole size[J]. Ophthalmic Surg Lasers Imaging, 2012, 43(3): 184-189. DOI: 10.3928/15428877-20120102-05.
4.	Michalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes[J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/j.ophtha.2010.02.011.
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9.	Spiteri Cornish K, Lois N, Scott N, et al. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH)[J/CD]. Cochrane Database Syst Rev, 2013, 5(6): CD009306. DOI: 10.1002/14651858.CD009306.pub2.
10.	吕林. 认识特发性黄斑裂孔分类及治疗新趋势提升特发性黄斑裂孔诊断治疗水平[J]. 中华眼底病杂志, 2017, 33(4): 333-335. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.002.Lyu L. Understanding the classification and new treatment trend of idiopathic macular hole to improve its diagnosis and treatment outcome[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 333-335. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.002.
11.	Forsaa VA, Krohn J. Air tamponde combined with nonsupine positoning in macular hole surgery for pseudophakic eyes[J]. Retina, 2017, 37(9): 1750-1756. DOI: 10.1097/IAE.0000000000001413.
12.	Yu Y, Liang X, Wang Z, et al. Internal limiting membrane peeling and air tamponade for stage Ⅲ and Ⅳ idiopathic macular hole[J/OL]. Retina, 2018, 2018: E1[2018-10-03]. https://insights.ovid.com/crossref?an=00006982-900000000-96326. DOI: 10.1097/IAE.0000000000002340. [published online ahead of print].
13.	鲁静, 马志中. 玻璃体切割手术联合空气或C₃F₈填充治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.Lu J, Ma ZZ. Clinical outcomes of C₃F₈ and air tamponade after vitrectomy for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.
14.	Tirelli F, Sasso P, Scupola A. Idiopathic macular hole: post-operative morpho-functional assessment and prognostic factors for recovery of visual acuity[J]. Ann Ist Super Sanita, 2013, 49(3): 313-316. DOI: 10.4415/ANN_13_03_14.
15.	曹维, 韩泉洪. 内界膜翻瓣手术治疗黄斑裂孔的应用[J]. 中华眼底病杂志, 2016, 32(5): 561-563. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.031.Cao W, Han QH. The application of inverted internal limiting membrane flap technique in macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 561-563. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.031.
16.	Kannan NB, Kohli P, Parida H, et al. Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial[J]. BMC Ophthalmol, 2018, 18(1): 177. DOI: 10.1186/s12886-018-0826-y.

1. Khodani M, Bansal P, Narayanan R, et al. Inverted internal limiting membrane flap technique for very large macular hole[J]. Int J Ophthalmol, 2016, 9(8): 1230-1232. DOI: 10.18240/ijo.2016.08.22.
2. Kase S, Saito W, Mori S, et al. Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique[J]. Clin Ophthalmol, 2016, 16(11): 9-14. DOI: 10.2147/OPTH.S119762.
3. Salter AB, Folgar FA, Weissbrot J, et al. Macular hole surgery prognostic success rates based on macular hole size[J]. Ophthalmic Surg Lasers Imaging, 2012, 43(3): 184-189. DOI: 10.3928/15428877-20120102-05.
4. Michalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes[J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/j.ophtha.2010.02.011.
5. Essex RW, Kingston ZS, Moreno-Betancur M, et al. The Effect of postoperative face-down positioning and of long- versus short-acting gas in macular hole surgery: results of a registry- based study[J]. Ophthalmology, 2016, 123(5): 1129-1136. DOI: 10.1016/j.ophtha.2015.12.039.
6. Holladay JT. Visual acuity measurements[J]. J Cataract Refract Surg, 2004, 30(2): 287-290. DOI: 10.1016/j.jcrs.2004.01.014.
7. Mester V, Kuhn F. Internal limiting membrane removal in the management of full-thickness macular holes[J]. Am J Ophthalmol, 2000, 129(6): 769-777. DOI: 10.1016/s0002-9394(00)00358-5.
8. Gelman R, Stevenson W, Prospero Ponce C, et al. Retinal damage induced by internal limiting membrane removal[J]. J Ophthalmol, 2015, 2015: 939748 [2015-09-03]. http://dx.doi.org/10.1155/2015/939748. DOI: 10.1155/2015/939748.
9. Spiteri Cornish K, Lois N, Scott N, et al. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH)[J/CD]. Cochrane Database Syst Rev, 2013, 5(6): CD009306. DOI: 10.1002/14651858.CD009306.pub2.
10. 吕林. 认识特发性黄斑裂孔分类及治疗新趋势提升特发性黄斑裂孔诊断治疗水平[J]. 中华眼底病杂志, 2017, 33(4): 333-335. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.002.Lyu L. Understanding the classification and new treatment trend of idiopathic macular hole to improve its diagnosis and treatment outcome[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 333-335. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.002.
11. Forsaa VA, Krohn J. Air tamponde combined with nonsupine positoning in macular hole surgery for pseudophakic eyes[J]. Retina, 2017, 37(9): 1750-1756. DOI: 10.1097/IAE.0000000000001413.
12. Yu Y, Liang X, Wang Z, et al. Internal limiting membrane peeling and air tamponade for stage Ⅲ and Ⅳ idiopathic macular hole[J/OL]. Retina, 2018, 2018: E1[2018-10-03]. https://insights.ovid.com/crossref?an=00006982-900000000-96326. DOI: 10.1097/IAE.0000000000002340. [published online ahead of print].
13. 鲁静, 马志中. 玻璃体切割手术联合空气或C₃F₈填充治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.Lu J, Ma ZZ. Clinical outcomes of C₃F₈ and air tamponade after vitrectomy for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.
14. Tirelli F, Sasso P, Scupola A. Idiopathic macular hole: post-operative morpho-functional assessment and prognostic factors for recovery of visual acuity[J]. Ann Ist Super Sanita, 2013, 49(3): 313-316. DOI: 10.4415/ANN_13_03_14.
15. 曹维, 韩泉洪. 内界膜翻瓣手术治疗黄斑裂孔的应用[J]. 中华眼底病杂志, 2016, 32(5): 561-563. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.031.Cao W, Han QH. The application of inverted internal limiting membrane flap technique in macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 561-563. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.031.
16. Kannan NB, Kohli P, Parida H, et al. Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial[J]. BMC Ophthalmol, 2018, 18(1): 177. DOI: 10.1186/s12886-018-0826-y.

Chinese Journal of Ocular Fundus Diseases

One year clinical results of different surgical methods in the treatment of idiopathic macular hole

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