玻璃体切割联合改良倒置内界膜瓣覆盖及自体血封闭术治疗难治性黄斑裂孔

目的　观察玻璃体切割（PPV）联合改良倒置内界膜（ILM）瓣覆盖及自体血封闭术治疗难治性黄斑裂孔（MH）患者的临床疗效。方法　回顾性病例研究。选取2019年1月至2020年6月在南京医科大学眼科医院确诊并行PPV联合改良倒置ILM瓣覆盖及自体血封闭术治疗的难治性MH患者14例14眼纳入研究。所有入组患者均接受经睫状体扁平部三通道23G PPV联合改良倒置ILM瓣覆盖及自体血封闭术。术后至少随访6个月，观察MH闭合情况，计算裂孔闭合率，对比分析最佳矫正视力(BCVA)、微视野检查结果（黄斑10°平均视网膜光敏感度、固视稳定性）等，记录术中及术后并发症。结果　14例14眼难治性MH患者中，术前最小裂孔直径为264～785 μm，基底径为451～1630 μm。术后MH闭合率为100.0%，且随访期间均未见复发。患者术前BCVA为(1.25±0.30) logMAR,术后6个月随访时BCVA为(0.86±0.35) logMAR，差异有统计学意义(P=0.004);术后BCVA 提高12眼，2眼无提高，无视力下降者。患者黄斑10°视网膜平均光敏感度术前、术后6个月分别为（17.64±4.40）dB和（21.87±5.86） dB，差异有统计学意义 (P=0.040)。术前固视不稳定14眼,术后6个月固视稳定11眼（78.6%），相对稳定2眼（14.3%），不稳定1眼（7.1%）。术中及随访期间均未见严重并发症发生。结论　PPV联合改良倒置ILM瓣覆盖及自体血封闭术治疗难治性MH安全有效,可提高难治性MH的手术成功率及裂孔闭合率，促进视功能的恢复。

Pars plana vitrectomy combined with modified inverted internal limiting membrane flap covering technique and autologous blood for refractory macular holes

Objective　To observe the effect of pars plana vitrectomy (PPV) combined with modified inverted internal limiting membrane (ILM) flap covering technique and autologous blood for refractory macular hole (MH).Methods　This was a retrospective clinical study which included 14 patients of 14 eyes with refractory MH diagnosed in the Affiliated Eye Hospital of Nanjing Medical University and treated with PPV combined with modified inverted ILM flap covering and autologous blood sealing from January 2019 to June 2020. All patients underwent three-channel 23G PPV through the flat part of the ciliary body combined with modified ILM flap covering technique and autologous blood sealing. The follow-up was at least 6 months after surgery, followed by observing the closure of MH, calculating the rate of closure of the hole, and analyzing the best corrected visual acuity (BCVA) and microperimetry tests (mean retinal light sensitivity at 10° of the macula, fixation stability), and finally, intraoperative and postoperative complications were recorded.Results　In the 14 patients (14 eyes) with refractory MH, the minimum diameter of MH before operation was 264-785 μm, and the basal diameter was 451-1630 μm. The closing rate of MH after operation was 100.0%, and no recurrence was found during the follow-up period. The BCVA was (1.25±0.30) logMAR before operation and (0.86±0.35) logMAR after operation 6 months follow-up, and the difference was statistically significant (P=0.004). BCVA was improved in 12 eyes after operation, but there was no improvement in 2 eyes and no patients with visual deterioration. The mean retinal sensitivity within 10° was (17.64±4.40) dB before operation and (21.87±5.86)dB 6 months after operation, respectively, with statistical significance (P=0.040). The fixation was unstable in 14 eyes before operation, while 6 months after operation, there were 11 eyes (78.6%) with stable fixation, 2 eyes (14.3%) with relatively unstable fixation, and unstable fixation in 1 eye (7.1%). No serious complications occurred during operation and follow-up.Conclusion　PPV combined with modified ILM flap covering technique and autologous blood is safe and effective in the treatment of refractory MH, and the procedures can raise the success rate of operation, MH closure rate and improve patients’ visual function.