Vitrectomy combined with extended internal limiting membrane peeling and vitreous cutter perimacular hole massage for large macular hole
Objective To evaluate the outcome and safety of vitrectomy combined with extended internal limiting membrane peeling and vitreous cutter perimacular hole massage in the treatment of large macular hole.Methods Thirty-five patients(35 eyes)with large macular hole were diagnosed and treated in the First People's Hospital of Luoyang from March 2017 to January 2024.All patients underwent vitrectomy combined with extended internal limiting membrane peeling,and were performed vitrectomy cutter perimacular hole massage to assist macular hole closure.The best corrected visual acuity(BCVA)was assessed before surgery,one week after surgery,and one month after surgery,and was converted to logarithm of minimal angle of resolution(BCVA logMAR).The macular hole diameter was measured before surgery and the closure of macular hole was observed after surgery using optical coherence tomography.The macular hole diameter before surgery was compared between U-shaped(type Ⅰ)closure and V-shaped(type Ⅱ)closure eyes.The incidence of complications as increased intraocular pressure and cataract,and recurrence of macular hole were observed one month after surgery.Results The BCVA logMAR decreased gradually before surgery,one week after surgery,and one month after surgery(1.33±0.50,1.08±0.43,0.72±0.25)(F=20.193,P＜0.001).The macular hole diameter before surgery was(564.20±161.82)μm.One week after surgery,the macular hole was closed in 32 eyes(91.4％),with type Ⅰ closure in 28 eyes,type Ⅱ closure in 3,and type Ⅲ closure in 1.There was no significant difference in presurgical hole diameter between type Ⅰ closure eyes[(544.54±150.86)μm]and type Ⅱclosure eyes[(534.67±117.99)μm](t=0.134,P=0.903).One month after surgery,the outer retinal layers recovered well in 32 eyes with macular hole closure,and external limiting membrane and ellipsoid zone were recovered compared with those before surgery,with transient intraocular hypertension in 3 eyes and mild cataract in 2.There was no recurrence of macular hole.Conclusion Vitrectomy combined with extended internal limiting membrane peeling and vitrectomy cutter perimacular hole massage is effective and safe in the treatment of large macular hole,which can promote the repair of retinal tissue structure in macular area and restore good visual function.
large macular holeextended internal limiting membrane peelingvitrectomyretina
NETL
NSTL
万方数据
