Idiopathic Macular Hole Pathogenesis Research And The Clinical Efficacy Of Inner Limiting Membrane Peeling

Idiopathic macular hole pathogenesis research and the clinical efficacy of inner limiting membrane peelingObjective(1) To investigate the pathogenesis of idiopathic macular hole (IMH),based on the characteristics of optical coherence tomography (OCT) images; (2) To investigate the clinical efficacy of par plana vitrectomy (PPV) combine with inner limiting membrane peeling(ILMP) in the treatment of IMH; (3)To observe the staining efficacy of triamcinolone acetonide(TA) and indocyanine green(ICG) in the treatment of IMH.MethodsPart 1:The OCT images of IMH in 39 cases 43 eye's were collected and were put into different stages according to the standard of Gass. The images of 17 eyes (all were stage 2-4) taken PPV combined with ILMP were also included. The OCT images feature of different stages were analysed and speculated the pathogenesis of IMH. Part 2:The holes closure rate, best corrected visual acuity(BCVA) before and after surgery were studied of 28 cases (30 eyes) with TA, ICG double staining assisted PPV combined and ILMP, The staining effect, complications were also observed.Results1. In sage 1 IMH,4/5 eyes (80.0%) were found the traction from posterior vitreous detachment(PVD) at fovea. In stage 2,10/13 eyes (76.95%) were found the traction from PVD at fovea. In stage 3 and 4, were found vitreous have separated from fovea. In stage 3 and 4,11/16 eyes (68.7%), and 7/9 eyes (77.8%) were found that the thickness and glisten of internal limiting membrane(ILM) were increased. In stage 2-4, cystic lesion can be found on the hole's edge in every image, curl up like "fish mouth", and almost all the holes'shapes were round,but all the cystic lesion and curl up like "fish mouth" completely disappeared in the images taken PPV combined with ILMP.2. Posterior vitreous cortex and ILM in all the 30 eyes were stained well and dissected successfully. TA and ICG staining greatly facilitated surgeons ability to visualize. After following up for average 5.00±1.62 months,27 eyes (90%) got anatomical restoration of the macular holes,22 eyes (73.33%) got improvement of visual acuity at least two lines.Conclusions1. In stage 1 of IMH, the main pathogenesis is the fore-and-aft traction of PVD at fovea; in stage 3 and 4, the main pathogenesis are the centrifugal tension from joint action of ILM and retina surface's proliferation membrane; in stage 2, traction of PVD at fovea combine with the centrifugal tension of ILM are existed.2. PPV combined with ILMP appears to be a safe and effective method for IMH repair.3. TA and ICG staining assisted PPV combined with ILMP can reduce the difficulty and increase the safety of the operation...