Incidence of Reopening and Variables That Influence Reopening After Macular Hole Surgery

Purpose: To evaluate the incidence and variables of reopening of macular holes after macular hole surgery.Methods: Our study included 467 eyes in which macular holes were successfully closed after surgery. Surgical techniques consisted of conventional methods (358 eyes) and scalping methods (109 eyes) with retinal pigment scalping of the macular hole basis added in such cases: reoperation, hole size (more than 0.4 disc diameter), duration of symptoms (more than 2 years). Long term incidence of reopening was predicted by life table method. After we compared reopened cases with non-reopened cases, the variables of gender, stage, biocular occurrence, age, duration of symptoms, hole size, preoperative visual acuity, refraction axial length ratio, and intraoperative retinal tears were used for the multiple regression.Results: Reopening was found in 20 eyes (5.6%) treated by conventional methods and in 10 eyes (9.2%) treated by scalping methods. Survival ratio was 87% for the conventional methods in 6 years and 79% for the scalping methods in 5 years. The variables influencing reopening were as follows: conventional methods: gender (r = 0.065, P =.19), biocular occurrence (r = 0.12, P =.026), and refraction axial length ratio (r = -0.11, P =.045); scalping methods: hole size (r = 0.14, P =.25).Conclusions: Incidence of reopening in scalping methods was high. The variables that influenced reopening after macular hole surgery were biocular occurrence and refraction axial length ratio in conventional methods. The shape of the eye may be related to reopening.     

黄斑裂孔术中玻璃体腔内注射吲哚青绿后的视野缺损

目的：报道一组患者发现在黄斑裂孔手术中使用吲哚青绿（ICG）辅助内界膜剥离后的视野缺损，并评估视野缺损与使用ICG间的关系。设计：回顾性、非对照性干预的一组病例。参与者：本研究中的39只眼来自38例临床诊断黄斑裂孔患者，自2001年1月1日至2002年12月31日问均接受了玻璃体切割术。     

黄斑裂孔术中玻璃体腔内注射吲哚青绿后的视野缺损

目的：报道一组患者发现在黄斑裂孔手术中使用吲哚青绿（ICG）辅助内界膜剥离后的视野缺损。并评估视野缺损与使用ICG间的关系。设计：回顾性、非对照性干预的一组病例。参与者：本研究中的39只眼来自38例临床诊断黄斑裂孔患者。自2001年1月1日至2002年12月31日间均接受了玻璃体切割术。干预：22只眼使用ICG辅助剥离内界膜：其中12只眼使用0．5％ICG溶液并暴露于视网膜3min（组1）。4只眼接受0．5％ICG溶液后立即进行冲洗（组2）。6只眼使用0．25％ICG溶液后亦立即冲洗（组3）。剩下的17只眼仅接受玻璃体切割术而未使用ICG辅助剥离内界膜（组4）。主要检测方法：采用视野、最佳矫正视力、眼底照相检查。结果：组1中的所有眼（100％）及组2的4只眼中的1只眼（25％）术后出现视野缺损。组3中所有患者均未出现视野缺损。视野缺损中鼻侧缺损10只眼（84％）。颞下缺损1只眼（8％）。1只眼（8％）则为广泛视野缺损。术后出现视野缺损的13只眼经眼底镜检查。其中8只眼（62％）发现轻至中度视盘苍白。组4中仅有1例患者出现颞下缺损。其他患者均无视野缺损。术后有或无视野缺损患者间其视力差别无统计学显着意义。结论：虽然本研究因入选病例较少而受限制。但我们的经验指出黄斑裂孔手术中使用ICG辅助剥离内界膜可导致术后视野缺损。特别是鼻侧缺损。这种视野缺损的发生率取决于ICG的浓度和（或）暴露于视网膜的时间。有待进一步研究以阐明视野缺损的病理机制。     

糖尿病黄斑水肿玻璃体腔内注射曲安耐德后视力的预测因素

目的：评价哪些因素将影响弥漫性糖尿病黄斑水肿玻璃体腔注射曲安耐德后最佳矫正视力的最大提高。     

黄斑裂孔手术中应用吲哚青绿染色内界膜对视力预后的影响

目的：确定黄斑裂孔手术中应用吲哚青绿（ICC）染色内界膜对视力预后的影响，并探讨其副作用的发生机制。     

Task Complexity and Visual Acuity in Senile Macular Degeneration

ABSTRACT The effects of choice of test object and inter-symbol spacing (contour interaction) on the measurement of low visual acuities was investigated. Visual acuities of sixteen subjects with senile macular degeneration and five age-matched normal subjects were measured using different test targets of varying complexities. Visual acuity of both groups of subjects decreased with increasing task complexity but the trend was more marked for the low vision subjects. However, within the low vision group, the complexity effect was not dependent on the level of visual acuity. This study showed that visual acuity of persons with senile macular degeneration can be measured equally well with single letters, constant contour interaction Landolt rings, or the Bailey-Lovie letter chart but the test used should be specified. Grating targets and word charts measure different visual functions from standard visual acuity tests.     

Macular Hole Surgery-Associated Peripheral Visual Field Loss

To examine in more detail the peripheral visual field loss after macular hole surgery, we reviewed a series of 38 consecutive patients (44 eyes) with idiopathic macular hole who underwent vitrectomy and fluid–gas exchange. Ten (22.7%) eyes of 9 patients developed peripheral visual field loss shortly after successful surgery. This complication was characterized by mild to moderate wedge-shaped visual field loss that predominantly affected the inferotemporal periphery. Of these 9 patients, 2 complained of peripheral visual field loss, and the 7 others remained asymptomatic. The peripheral visual field loss remained unchanged for a mean follow-up of 18.5 months, except in one case of complete recovery. The thickness of the retinal nerve fiber layer was measured postoperatively to determine whether any damage to the optic nerve head had occurred during surgery. The information obtained in this study did not provide conclusive evidence for the understanding of the pathomechanism of the macular hole surgery-associated visual field loss. Peripheral visual field defect after otherwise uneventful surgery for idiopathic macular hole is probably not uncommon. This complication is variable in its severity and is usually permanent. Whether it is caused by any surgical trauma to the optic nerve head remains to be elucidated.