玻璃体切除联合内界膜剥除治疗黄斑裂孔的疗效观察

目的 评价玻璃体切除联合内界膜剥除治疗黄斑裂孔的临床效果.方法对53例（53只眼）黄斑裂孔进行玻璃体切除联合内界膜剥除的临床资料进行回顾性分析.分析手术前后矫正远视力、黄斑裂孔的分期,术后裂孔是否闭合与术后视力预后的关系.结果相干光断层扫描观察形态恢复正常者42只眼,改善者8只眼,无改善者3只眼.12只眼术后出现一过性眼压升高.手术后裂孔闭合者视力都有不同程度提高.手术有效率94.3%,裂孔闭合率79.2%.结论使用玻璃体切除联合内界膜剥除,可以增加黄斑裂孔闭合率、提高患者术后视力.     

Phacovitrectomy with internal limiting membrane peeling for idiopathic macular hole

BACKGROUND: Progressive nuclear sclerosis is a known complication of macular hole surgery that hinders patients' recovery to their best visual acuity postoperatively. We report the visual outcome, complications and efficacy of combined phacoemulsification, intraocular lens (IOL) insertion and vitrectomy with internal limiting membrane (ILM) peeling for patients with cataract undergoing macular hole surgery. METHODS: We reviewed the records of 32 consecutive patients (36 eyes) who underwent phacoemulsification with insertion of a polymethylmethacrylate lens into the capsular bag and pars plana vitrectomy with ILM peeling in one session for repair of idiopathic macular hole. Patients were assessed between February 1998 and August 2001. RESULTS: The mean age of the patients was 70 (range 52 to 83) years, and 25 (78%) were women. The median duration of the holes before surgery was 8.3 months; in 19 eyes (53%) the duration was 6 months or less. Twenty eyes (56%) had stage 3 holes. The preoperative vision was 20/200 or worse in 29 eyes (80%). The mean grade of nuclear sclerosis was 2.4. The average length of follow-up after surgery was 11 (range 1.5 to 37) months. Primary hole closure was achieved in 28 eyes (78%). In five of the remaining eight cases the patient consented to a second procedure, which was successful in four cases, for a final closure rate of 89%. Postoperatively, the visual acuity improved by 2 lines or more in 22 eyes (61%). Of the 32 eyes with final closure, 11 (34%) attained a visual acuity of 20/40 or better, and 25 (78%) had an acuity of 20/100 or better. The most common complication was posterior capsular opacification (27 eyes [75%]), an expected complication when perfluoropropane or other gases are used for tamponade. INTERPRETATION: The results are comparable to those with standard macular hole surgery. Combined surgery is reliable and safe; the benefits support its use as a routine procedure for patients with cataract undergoing macular hole repair.     

Anatomical and visual outcome of macular hole surgery with infracyanine green-assisted peeling of the internal limiting membrane, endodrainage, and silicone oil tamponade

PURPOSE: To evaluate the anatomical and visual outcome in macular hole patients who underwent surgery with infracyanine green-assisted internal limiting membrane peeling. DESIGN: A prospective case series with 51 consecutive eyes of 49 patients with idiopathic, iatrogenic, or traumatic Stage 2, 3, or 4 macular holes. METHODS: After removing the vitreous, in all eyes infracyanine green-assisted removal of the internal limiting membrane was performed. Patients older than 65 years of age underwent a simultaneous phacoemulsification. At the end of surgery, a silicone oil tamponade was used in all cases, and all patients were asked to position face down for 24 hours. Optical coherence tomography was performed preoperatively and postoperatively to determine the macular hole stage/size and the anatomical closure rate, respectively. RESULTS: The mean follow-up time was 9.8 months (range, 6-26 months). The overall median duration between the first symptoms and the surgery was 5 months. The overall anatomical success rate after one surgery was 92% (47 eyes), while that of chronic and nonchronic ones was 72.3% and 97.5%, respectively. The median preoperative visual acuity was 20/160 (range, 20/30 to counting fingers) and increased to 20/50 (range, 20/20 to 20/400) postoperatively. The mean increase in visual acuity was 3.7 lines (range, -4 to 10 lines). Of all 51 operated-on eyes, 26 (51%) eyes had a final visual acuity of 20/50 or better. CONCLUSIONS: These findings indicate that infracyanine green-assisted removal of the retinal internal limiting membrane appears to induce a high incidence of anatomical closure, with good visual outcome.     

Idiopathic macular hole surgery with low-concentration infracyanine green-assisted peeling of the internal limiting membrane

PURPOSE: To evaluate the efficacy of pars plana vitrectomy with infracyanine green (IFCG)-assisted internal limiting membrane peeling for the treatment of idiopathic macular hole. DESIGN: Prospective, noncomparative interventional case series. METHODS: Thirty-eight consecutive eyes of 35 patients with idiopathic macular hole were included in the study. Patients underwent early treatment diabetic retinopathy (ETDRS) visual acuity examination, dilated ophthalmoscopy, and optical coherence tomography before treatment and during follow-up. Fluorescein angiography was done in selected cases. Patients underwent a three-port pars plana vitrectomy with complete posterior hyaloid and epiretinal membrane removal. The internal limiting membrane (ILM) was stained with 0.5 cc of IFCG (0.5 mg/ml, 308 mOsm) and peeled up to the vascular arcades. Perfluoropropane gas (C(3)F(8)) 10% was used as tamponade. RESULTS: Mean follow-up duration was 10 +/- 5 months (range, 3 to 24 months). Six eyes had stage 2 macular hole, 15 eyes stage 3, and 16 eyes stage 4. Overall, 37 of 38 macular holes closed after a single surgery. Median visual acuity was 20/100 (range, 20/400 to 20/50) before surgery and 20/50 (range, 20/640 to 20/25) after surgery. Visual acuity after surgery was 20/50 or better in 24 of 38 (63.1%) eyes. Twenty-five (65.8%) eyes improved by 2 or more lines, nine (23.7%) eyes were stable, and four (10.5%) eyes worsened by 2 or more lines. CONCLUSIONS: This study suggests that IFCG (0.05%) effectively stains the ILM with apparent safety, and that IFCG-assisted peeling of the ILM may be useful in the treatment of idiopathic macular hole.     

Autologous platelets for macular hole surgery: the Sussex Eye Hospital experience

PURPOSE: To evaluate the anatomical and visual outcomes of patients managed by macular hole surgery with adjunctive use of autologous platelets at Sussex Eye Hospital, UK. METHODS: A retrospective non-comparative consecutive interventional case series was conducted. Standard macular hole vitrectomy surgery was combined with autologous platelets. No other adjuncts were used, nor internal limiting membrane peeling performed. The main outcome measure was anatomical closure of the macular hole. Secondary outcome measures included: visual outcome (best postoperative best corrected visual acuity [BCVA] and final BCVA), hole reopening and/or re-operation, complications, and time to and influence of cataract surgery. RESULTS: Seventy eyes of 65 patients underwent macular hole surgery with vitrectomy and autologous platelets. There were 14 stage 2 holes, 52 stage 3 holes and four stage 4 holes. Mean follow up was 29 months (range 1.5-78 months). Primary anatomical success (hole closure) was 95.7% (n = 67); however, six (8.5%) holes reopened at a mean of 12.7 months (range 3.6-36.3 months) after their initial surgery. Final surgical success was 98.5% (65/66) in those eyes of patients electing re-operation procedures. Seventy-seven per cent (n = 54) of patients obtained 2 or more lines of visual acuity improvement at final follow up with a mean improvement of 4 lines (range -3 to +12 lines). Forty per cent (n = 28) achieved final BCVA of 6/12 or better, which improved to 51% (n = 36) if best postoperative BCVA was considered. CONCLUSIONS: Adjunctive use of autologous platelets at the time of macular hole surgery yields good surgical and visual results, without significant complications, and should remain a considered option in the surgical management of macular holes. Improved macular hole closure with autologous platelets (compared with vitrectomy alone) has previously been demonstrated in a randomized controlled trial. Visual outcome benefit of platelets remains to be investigated by randomized controlled trial and any planned trials should include an autologous platelets intervention arm along with visual acuity as a primary outcome measure.     

Clinical findings in macular hole surgery with indocyanine green-assisted peeling of the internal limiting membrane

PURPOSE: Indocyanine green (ICG) staining of the internal limiting membrane has facilitated ILM peeling in macular hole surgery. However, it has been reported that ICG-assisted peeling of the ILM may result in retinal damage and unfavorable functional outcome. Therefore, we analyzed our visual and anatomical results of ICG assisted macular hole surgery. METHODS: In a retrospective study the records of a consecutive series of 37 patients with full-thickness idiopathic macular holes operated with ICG-assisted ILM peeling by a single surgeon were analyzed. All patients underwent a standard three-port vitrectomy with surgically induced posterior vitreous detachment, staining of the ILM with ICG, peeling of the ILM in a circular manner around the fovea, and SF6 20% endotamponade. RESULTS: A total of 37 patients (37 eyes) were included in the study. The mean age was 69+/-7 years (range 52-81 years), and there were 26 women and 11 men. The follow-up ranged from 6 to 30 months (mean 18+/-6 months). At baseline visual acuity ranged from 20/400 to 20/40. Anatomically, 13 eyes had stage 2 holes, 21 eyes (57%) stage 3 holes, and three eyes stage 4 holes. At the postoperative visit (8-12 weeks after surgery) anatomical closure of the macular hole was achieved in 36 eyes. Visual acuity ranged between 20/400 and 20/20. At the last follow-up after initial surgery the macular hole was closed in all eyes. Visual acuity ranged from 20/200 to 20/20. CONCLUSION: In our retrospective series anatomical and functional results of macular hole surgery with ICG-assisted peeling of the ILM are satisfactory. Primary hole closure was achieved in 97% of eyes and visual acuity increased in 62% of eyes in our series.     

Outcome results in macular hole surgery with internal limiting membrane removal

PURPOSE: To determine the visual outcome and anatomic closure rate of macular hole surgery using pars plana vitrectomy with internal limiting membrane (ILM) peeling. MATERIAL AND METHODS: Fifty three eyes of 52 consecutive patients with a full-thickness idiopathic macular holes (stage 3 or 4). All eyes underwent a pars plana vitrectomy including separation of the posterior hyaloid, ILM peeling with trypan blue (TB) or indocyanine green (ICG) and gas endo-tamponade with instructions to the patient, to be face down for 4-5 days. Postoperative anatomic results, visual acuity (VA), and complications were recorded. The follow-up was 3 to 22 months. RESULTS: VA improved postoperatively in 45 eyes (84.9%), at least two lines on the Snellen chart in 24 eyes (45.3%). It remained unchanged in 6 eyes (11.3%) and deteriorated in 2 eyes (3.80%). The mean preoperative VA was 0.1 +/- 0.04 and does not differ significantly between stage 3 and 4. The improvement of postoperative VA was statistically significantly better in stage 3, in comparison to stage 4. The anatomical success rate (flat/closed) was 88.7% (47 eyes). There were no differences in VA improvement between TB- or ICG-stained eyes. CONCLUSIONS: 1. Vitrectomy with ILM removal in macular holes provides with meaning improvement in visual acuity. 2. Patients with macular hole in stage 3 have a better prognosis for visual rehabilitation. 3. A kind of dye and preoperative VA do not influence postoperative visual function improvement.     

Visual outcomes following ICG assisted ILM peel for Macular Hole

PURPOSE: To evaluate the anatomical and visual outcome of indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling for macular hole surgery. A literature search identified potential factors that may affect the functional success of the procedure. METHODS: Retrospective case note review of 14 consecutive patients undergoing phaco-vitrectomy, gas and ICG-assisted ILM peeling for macular hole from July 2001 to July 2002. A 0.5% ICG solution (osmolarity 270 mOsm) was left in contact with the retina for 1-3 min. The outcome measures were hole closure, change in visual acuity, and macular pigmentary changes. RESULTS: Anatomical hole closure was achieved in 13 of 14 eyes (92.8%). The mean logMAR Snellen acuities were 0.80 (range 0.60-1.30) preoperatively and 0.77 (0.48-1.30) postoperatively. Seven eyes (50%) developed retinal pigmentary changes in the macular area. CONCLUSIONS: ICG-assisted ILM peeling for macular hole surgery achieves high rates of anatomical hole closure, but functional results are less encouraging. Previous studies suggest toxicity of the ICG to the retina, at the level of the RPE or inner retina. The results may be optimized by using a lower concentration, iso-osmolar, viscous solution, and by minimizing contact time of the solution and intensity, and duration of illumination.     

Natural history of foveolar lucencies observed by optical coherence tomography after macular hole surgery

PURPOSE: To describe the incidence, course, and anatomic and functional outcomes of foveolar lucencies observed by optical coherence tomography after macular hole surgery. METHODS: Retrospective chart review of all idiopathic macular hole surgeries performed between February 2002 and August 2003. Available data involving eyes with foveolar lucencies after macular hole surgery were collected regarding best-corrected visual acuity, lens status, slit-lamp biomicroscopy, and optical coherence tomography before and at follow-up visits ranging from 1 week to 27 months after macular hole surgery. RESULTS: Thirty-five eyes of 35 patients were identified. Foveolar lucencies were detected by optical coherence tomography in 9 of the 35 eyes (26%). Operative procedures included creation of a posterior vitreous detachment in 8 eyes and indocyanine green-assisted internal limiting membrane peeling in 5 eyes. Intraocular tamponade consisted of 30% sulfur hexafluoride gas in 6 eyes and 20% perfluoropropane gas in 3 eyes with at least 1 week of face-down positioning. Postoperative visual acuity showed gradual improvement coinciding with decreasing size and eventual disappearance (3 to 11 months) of the foveolar lucency. CONCLUSION: Foveolar lucencies observed by optical coherence tomography are a common finding after macular hole surgery (26%). They occur with and without indocyanine green-assisted internal limiting membrane peeling. Earlier disappearance of the foveolar lucency does not correlate with the type of gas used for tamponade. They gradually decrease and eventually resolve with time without additional surgical intervention and with further improvement of visual acuity.     

黄斑裂孔第3、4期視網膜内界膜染色舆剥除的前瞻性研究

目的 爲了確定用吲哚青綠介導特發性黄斑裂孔第3、4期視網膜内界膜剥除手術的解剖和視覺效果.方法連績研究3～4期特發性黄斑裂孔病人28例28祗眼.所有眼都施行平部玻璃體次全切除術,必要時清除後部玻璃體及任何可見的視網膜前膜.將濃度爲每毫升0.25mg至1.25mg的ICG溶液緩慢地注入到黄斑,待浸漬時停止.内界膜被染色,距黄斑裂孔邊緣1～2個視盤直徑環行剥除内界膜.手術結束時使用12%Perfluoropropane(C3F8)氣體.術後病人需要保持面朝下2周.結果 隨訪時間爲6～14個月,平均9.5個月.14祗眼(50%)為黄斑裂孔第4期,另14祗眼(50%)爲黄斑裂孔第3期.11祗眼(39.3%)爲1年以上的慢性黄斑裂孔.最後隨訪時25祗眼(89.3%)解剖復位,黄斑裂孔閉合.其中21祗眼(75%)黄斑裂孔封閉,另4眼(14.3%)黄斑裂孔變平.18祗眼(64.3%)視力提高兩行或兩行以上.視力平均提高2.6行(範圍2～7行).非慢性裂孔和慢性裂孔分别提高3.4行和1.4行.經統計學處理,兩組間具有顯著性差异(P=0.031).結論 ICG介導視網膜内界膜剥除在封閉特發性黄斑裂孔第3～4期中是很有幫助的.     

采用或不用内界膜剥除的黄斑裂孔手术

目的:在用或不用吲哚氰绿内界膜染色剥膜的情况下,比较特发性黄斑裂孔术后的解剖及视力结果。方法:对连续采用单纯注气术进行眼内填充的40眼特发性黄斑裂孔进行回顾性分析,所有手术均由一位医生完成。所有的患眼术后至少经过了6月的随访。40眼中的前22眼采用保留内界膜手术(非内界膜剥除组),后18眼采用吲哚氰绿对内界膜染色并进行内界膜剥除手术(内界膜剥除组)。结果:内界膜剥除组和非内界膜剥除组特发性黄斑裂孔解剖复位率分别为88.9%和59.1%,统计结果有显著性差异(Fisher’检验,P =0.038)。内界膜剥除组视力提高较非内界膜剥除组更为明显,平均分别提高了3.46和1.3行(t检验,P =0.0356)。多数病例术后视力提高2行或更多,在内界膜剥除组为66.7%,非内界膜剥除组为31.8%(χ2检验,P = 0.028)。然而在2组之间最终的术后logMAR BC-VA没有明显的差异(t检验,P =0.0073)。结论:根据以上研究,通过吲哚氰绿内界膜染色剥除内界膜可促进特发性黄斑裂孔解剖复位及视力的提高。在此方面进一步的研究是必要的。     

Macular hole surgery: experience with autologous platelet concentrate and indocyanine green-assisted internal limiting membrane peeling

BACKGROUND: To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery. PATIENTS AND METHODS: Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 +/- 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 +/- 0,1 x 10(8) thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients. RESULTS: After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed. CONCLUSION: Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling     

Indocyanine green assisted retinal internal limiting membrane removal in stage 3 or 4 macular hole surgery

AIMS: To determine surgical outcome in primary idiopathic stage 3 or 4 macular holes with indocyanine green (ICG) assisted retinal internal limiting membrane (ILM) peeling. METHODS: A prospective, consecutive, interventional case series with 41 eyes of 40 patients was included. No patient defaulted follow up. Besides a standard macular hole surgery, all eyes received ICG assisted ILM removal of 3-4 disc diameters around macular holes. At the end of the surgery, 12% perfluoropropane gas was used. A face down posture for 2 weeks was required postoperatively. RESULTS: The mean follow up period was 15.1 months (range 6-24 months). Twenty (48.8%) eyes had stage 3 macular holes and 21 (51.2%) had stage 4 macular holes. The overall median duration of holes was 11 months. 19 (46.3%) were chronic macular holes of more than 12 months' duration. The anatomical success rates after one surgery was 87.8% (36 eyes), while that of chronic and non-chronic ones was 78.9% and 95.5%, respectively. The median preoperative and postoperative visual acuity was 20/200 (range 20/60 to counting fingers) and 20/100 (range 20/20 to 20/400), respectively. 24 (58.5%) eyes had improvement of two or more Snellen lines. The mean was 3.2 lines (range two to nine lines), with 3.6 lines and 2.7 lines for non-chronic and chronic holes, respectively. For all the 41 eyes, 16 (39%) eyes had a final visual acuity of 20/50 or better. CONCLUSION: ICG assisted retinal ILM removal, in idiopathic primary chronic and non-chronic stage 3 or 4 macular hole surgery, appears to give a promising anatomical closure rate without compromising the visual result.     

Does intravitreal triamcinolone acetonide-assisted peeling of the internal limiting membrane effect the outcome of macular hole surgery?

Purpose To evaluate functional and anatomical outcome of triamcinolone acetonide assisted internal limiting membrane (ILM) peeling in patients with macular hole.Methods Fifteen eyes of 15 consecutive patients were identified with stage 3 and 4 idiopathic macular holes, these undergoing triamcinolone acetonide assisted ILM peeling for macular holes. These were matched retrospectively with 15 eyes of 15 patients with stage 3 and 4 idiopathic macular holes of less than six months duration, who underwent macular hole surgery with ILM peel augmented with indocyanine green (ICG). Functional and anatomical outcomes were compared between two groups.Results There were no significant differences between the two groups with reference to demographic features of age, sex, staging of the macular holes and the proportion subsequently undergoing cataract surgery. The mean follow-up period was 6.4 months in the triamcinolone acetonide group and 7.2 months in the ICG group. The hole closure rate was 100% in both group at primary operation. The mean Snellen line change was +1.24 in the intravitreal triamcinolone group and +1.1 in the ICG group. There was a significant improvement in Snellen and Logmar visual acuity in both groups. These differences in visual outcome between the groups were not statistically significant.Conclusions Our data showed similar outcomes for patients with macular hole where ICG has been used when compared to patients where triamcinolone acetonide has been used for ILM peeling. Further study with longer follow-up and large series is warranted to assess the safety of the triamcinolone acetonide assisted ILM peeling in macular hole surgery.The authors have no commercial interest in the material used in this work.     

Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling

Background: To compare the anatomical and visual outcome in primary idiopathic macular hole surgery with or without indocyanine green (ICG) stained internal limiting membrane (ILM) peeling. Methods: The medical records of the last 40 consecutive eyes receiving primary idiopathic macular hole surgery with gas as internal tamponade performed by a single surgeon were retrospectively reviewed and analysed. All eyes had a follow‐up period of at least 6 months. In the initial 22 consecutive eyes, no ILM peeling was performed (non‐ILM peeling group). The subsequent 18 eyes underwent surgery with ICG‐stained ILM peeling (ILM peeling group). Results: The primary anatomical closure rates were 88.9% and 59.1% in the ILM peeling group and non‐ILM peeling group, respectively. The difference was statistically significant (Fisher's exact test, P = 0.038). Improvement in visual acuity was more marked in the ILM peeling group than in the non‐ILM peeling group, with a mean improvement of 3.6 and 1.3 lines, respectively (two‐tailed t‐test, P = 0.036). There were significantly more cases with improvement of two or more lines of visual acuity after surgery, with 66.7% in the ILM peeling group and 31.8% non‐ILM peeling group (Chi‐square test P = 0.028). However, there was no significant difference in the final postoperative logMAR best‐corrected visual acuity between the two groups (two‐tailed t‐test, P = 0.073). Conclusions: Based on this study, ICG‐stained ILM peeling seems to improve the anatomical and visual outcome in primary idiopathic macular hole surgery. Further studies in this aspect are warranted.     

Internal limiting membrane peeling in macular hole surgery

PURPOSE: To evaluate prospectively the ability to peel epiretinal membranes and to correlate the degree of membrane peeling to anatomic success rates. DESIGN: Consecutive, noncomparative, interventional case series. PARTICIPANTS: One hundred ninety-three patients. METHODS: The extent of membrane peeling and other intraoperative features were correlated to endpoints. MAIN OUTCOME MEASURES: Anatomic success (inducing hole closure), visual acuity of 20/50 or better, and visual improvement of two or more Snellen lines. RESULTS: One hundred ninety-three eyes were eligible for the study by virtue of having a minimum follow-up interval of 6 weeks. The overall anatomic success rate was 93% in these cases. There was a two-line or more improvement in 72%; 56% attained 20/50 or better visual acuity. The internal limiting membrane was peeled completely in 23%, partially in 43%, and not at all in 34%. The degree of internal limiting membrane peeling was not correlated with the duration of the hole or rate of two-line visual improvement, but was inversely correlated with the rate of anatomic success (P = 0.045). Final visual acuity was correlated with a better preoperative visual acuity, shorter preoperative duration of macular hole, and more complete internal limiting membrane peeling. CONCLUSIONS: Peeling of the internal limiting membrane is not essential for anatomic or visual success in macular hole surgery, but it may be a means to standardize inducement of the proper degree of gliosis. Excessive, unsuccessful attempts at internal limiting membrane peeling may decrease visual success. Techniques delivering a more reproducible, complete, atraumatic peeling of the internal limiting membrane should be studied.     

Vitrectomy for stage 1 macular holes identified by optical coherence tomography.

BACKGROUND AND OBJECTIVE: To describe a series of patients with decreased vision secondary to stage 1 macular hole confirmed by optical coherence tomography (OCT) that failed to spontaneously resolve with observation. To determine whether current surgical techniques can prevent progression to a full-thickness macular hole and lead to improved visual acuity. PATIENTS AND METHODS: Retrospective, comparative case series presenting patient demographics, duration of symptoms, timing of surgery, preoperative and postoperative vision, and clinical outcome based on examination and OCT. RESULTS: Five eyes of five patients with stage 1 macular holes identified on OCT required surgical repair. All eyes showed anatomic closure and lack of progression to a full-thickness hole confirmed by OCT after one procedure. Mean preoperative visual acuity was 20/102 (range, 20/50 to 20/200) and mean postoperative visual acuity was 20/52 (range, 20/25 to 20/200). Average improvement for all five eyes was 3 Snellen lines, with four of the five (80%) improving 5 lines each. CONCLUSION: In symptomatic eyes with stage 1 macular holes that fail to spontaneously resolve with observation, vitrectomy with intraocular gas tamponade may prevent progression to a full-thickness hole and lead to improved visual acuity.     

玻璃体切除术治疗外伤性黄斑孔的疗效分析

目的 对玻璃体切除术治疗外伤性黄斑孔的疗效进行同顾性分析.方法 回顾性分析2000年至2008年期间接受玻璃体切除治疗的外伤性黄斑孔病例共95例95只眼.均接受标准的扁平部玻璃体切割、气体填充联合或不联合内界膜( ILM)剥除及血小板封孔术.比较手术前后孔的闭合情况及视力的恢复情况.结果 术前平均病程为(9.8±21.8)个月,平均孔径为(644.2±270.5)μm,平均最佳矫正视力(BCVA)为0.12±0.1( 1.1±0.45 )logMAR.术后平均随访(96± 131)d,患者视力提高69只眼(72.6％)、不变19只眼(20％)、下降7只眼(7.4％).术后BCVA平均为0.22±0.19(0.83±0.40)logMAR,比术前显著提高.术后BCVA达0.2以上者46只眼(48.4％).单次手术后孔闭合率为100％.结论 玻璃体切除术治疗外伤性黄斑孔能有效促进裂孔闭合,提高视力.     

玻璃体切除术联合内界膜剥除治疗特发性黄斑裂孔

目的:探讨玻璃体切除术联合内界膜剥除治疗特发性黄斑裂孔的疗效。方法:对93例93眼特发性黄斑裂孔患者行玻璃体切除联合内界膜剥除,气液交换,眼内填充C3F8。术后观察术眼视力及OCT了解黄斑裂孔变化。结果:特发性黄斑裂孔患者93例中裂孔完全愈合89例(96%),4例裂孔未闭,患者拒绝再次手术。绝大多数患者术后视力提高。结论:玻璃体切除联合内界膜剥除是治疗特发性黄斑裂孔的有效方法,能使绝大多数患者的裂孔得到解剖愈合,视力提高。     

玻璃体切除联合内界膜剥除治疗外伤性黄斑孔

目的回顾性分析对外伤性黄斑孔行玻璃体切除联合内界膜剥除治疗的结果。方法分析本院2004年7月～2005年5月期间收治外伤性黄斑孔病人8例8眼,均进行闭合式玻璃体切除、吲哚青绿辅助下的视网膜内界膜剥除及过氟化碳眼内填充术。观察黄斑孔愈合和视功能恢复情况。结果8例均为全层黄斑孔。术前视力范围CF/30cm～0.2,低于0.01者3眼,0.01～0.1者3眼,0.1以上者2眼。挫伤直接造成黄斑孔3眼,陈旧伤、伴随黄斑前膜等改变者5例5眼。8例均顺利剥除内界膜。随访3m～6m,1眼因发生增殖性视网膜病变而再次手术,其余7眼(87.5%)黄斑孔闭合。术后视力范围眼前数指～0.5。视力<0.01者1眼,0.01～0.1者2眼,0.1～0.3者1眼,0.3以上者4眼,较术前明显提高(P<0.01)。结论玻璃体切除联合内界膜剥除及气体填充能有效促进外伤性黄斑孔闭合、提高视力。