| Macular hole was first proposed and described by Knapp in 1869.After a long period of time,the disease has no effective treatment.Until 1991,Kelly and Wen-del first reported vitrectomy for the treatment of macular hole and macular hole closure rate reached 58%.Today,with the surgical technique of improvement,macular hole surgical closure rate has reached more than 90%.The idea of macular hole surgery is benefited from the understanding and improvement of the pathological basis of macular hole formation.By exploring vitreous body and macula lutea,Gass considered that the constitute of idiopathic macular hole is mainly a comprehensive result of tangential tractive force generated by vitreous cortical shrinkage in the central concave part of macular region and various biological forces from the circle,front and back directions.This point has been confirmed by relevant researches.The main surgery procedures of macular hole mainly include vitrectomy inducing posterior vitreous cortex detachment,peeling epimacular membrane,peeling macula lutea internallimiting membrane,vitreous intracavity tamponade and face-down position.Vitrectomy combining with internal limiting membrane peeling intraocular filling materials,and the intraocular filling materials mainly include SF6,C3F8,C2F6,gas and silicone oil,etc.There are many reports about long-acting expansion gas.The side effects of silicone oil and the risk of secondary operation have limited its clinical application while there are rare relevant literatures and reports about gas tamponade.Based on previous operations,we explored the value of vitrectomy combining with internal limiting membrane peeling and gas tamponade in treatment of idiopathic macular hole.Objective and MethodsObjective to observe the curative effect of vitrectomy combining with internal limiting membrane peeling treating idiopathic macular hole(IMH),with gas tamponade during the operation.Methods A etrospective analysis was made on 106 IMH patients that had been treated in our hospital from September 2014 to October 2016;there were 31 male cases and 75 female cases after excluding cases that cannot be followed up.All patients underwent vitrectomy combining with internal limiting membrane peeling and received gas tamponade in vitreous cavity during the operation.All operations were operated by one skillful physician.Before operation,all patients received regular pre-operative examinations,including best corrected visual acuity,intraocular pressure,OCT,hole size,closure condition,etc.After operation,all patients kept the face-down position.OCT examination was carried out when retina at the site of macular hole can been seen after gas absorption.All patients were followed up at the 2nd week,1st month and 3rd month.They were divided into four groups according to minimum diameter of preoperative holes: group a: diameter ≤250μm,group b: 250 ~400μm,group c: 400 ~ 600μm,group d: diameter≥600μm.The best corrected visual acuity,hole closure time,hole closure rate,complete gas absorption time,exposure time of retina at the site of macular hole,face-down time and surgery complications.Statistical analysisData were analyzed using SPSS21.0 statistical software;chi-square test was used for comparing two rates of enumeration data;paired t test for comparing mean values of measurement data two samples;Speaman rank correlation analysis for correlation analysis of two factors.P<0.05 indicates that the difference has statistical significance.ResultsOne-week after operation: for the postoperative hole closure time: group a(1.56±0.39)days,group b(1.57±0.53)days,group c(1.619±0.34)days,group d(1.74±0.46)days.Hole closure rate: group a 100%,group b 100%,group c 97.56%,group d 95%;all groups were compared using chi-square test,P>0.05,and the difference had no statistical significance.Gas complete absorption time in 2 weeks after operation: group a(8.18±0.21)days,group b(8.10±0.35)days,group c(8.15±0.27)days,group d(8.23±0.41)days;comparing two different groups,P>0.05,and the difference had no statistical significance.One week after operation,at the 1st day after gas tamponade,the retina at the site of macular hole of 7 eyes was exposed,at the 2nd day after operation,the retina of 43 eyes was exposed and at the 3rd day after operation,the retina of 62 eyes was exposed.The face-down time of patients in 2 weeks after operation: 2 days for 6 patients,3 days for 11 patients,4 days for 37 patients,and 5 days for 52 patients.OCT examination was carried out after retina exposure at the site of macular hole;if the results showed that hole was closed,patient changed to nasal side lying position.One week after gas tamponade,the eye pressure of 6 patients increased(higher than 21 mmHg,lower than 45mmHg),accounting for 4.35% of all eyes;they were controlled to normal after being given ocular pressure-lowering agents in 4d.One week after operation,the holes of two patients were not closed,both because these two patients did not strictly keep the face-down position;no serious complication occurred to other patients.Follow-up visit condition at the 1st month and the 3rd month after operation: the hole and closure rates of all groups were the same as that at the 1st week.After operation,the best corrected visual acuity after operation of all groups was evidently higher than that before operation and the difference had statistical significance;there was no new complication.With the increase of hole diameter of IMH groups,the improvement of the best corrected visual acuity after operation presented a decreasing trend.By using Speaman grade relevant analysis,the postoperative best corrected visual acuity was negatively related to various groups.Conclusion1.For IMH patients,the hole closure rate can reach 98% by using vitrectomy combining with internal limiting membrane peeling and gas tamponade.2.The gas absorption time is shorter compared with long-acting gas and it has reduced the face-down time of patients.3.The vision of most patients’ affected eyes is improved after operation. |
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