Clinical Analysis Of Three Surgical Methods For Refractory Macular Holes

Objective:To evaluate and compare the curative effects between autologous transplantation of the internal limiting membrane(ILM),internal limiting membrane flap and internal limiting membrane peeling(ILMP)with autologous serum during vitrectomy for idiopathic macular hole(IMIH)with MHCI≥1.0 or MHC<1.0,and provide an alternative basis for IMH.Method:Retrospective analysis.Totally 47 eyes in 44 patients with IMH who had undergone operations were divided into three groups.18 eyes who underwent vitrectomy with autologous transplantation of the ILM technique and air tamponade were represented as group A;14 eyes who underwent vitrectomy with internal limiting membrane flap technique and air tamponade were represented as group B;15 eyes who underwent vitrectomy and internal limiting membrane peeling with autologous serum and air tamponade were represented as group C.General information were collected and examinations such as best-corrected.visual acuity(BCVA),intraocular pressure(IOP),slit lamp microscope,binocular indirect ophthalmoscope,the defect length of the ellipsoid zone(EZ)and external limiting membrane(ELM),the choroidal thickness at 3 points:the fovea,and 1 mm,nasal to and temporal to the fovea were measure by EDI SD-OCT were performed.In order to evaluate security and effect of surgery,all the patients are followed up for 3 months after surgery.We retrospectively analyzed and compared the BCVA,postoperative macular hole closure rate.And the defect length of the EZ and ELM,and the choroidal thicknes of 3 points when MHCI≥1.0 or MHCI<1.0 of three groups.Results:1.Analysis of clinical characteristics:No significant difference was observed among the above 3 groups in terms of age,axial length,BCVA and disease duration(P>0.05).2.Data about surgeries:(1).The BCVA(IogMAR)of 1-month-follow-up were 0.920±0.259,0.900±0.141 and 1.100土0.294 in group A,B,and C.The BCVA of group A and B were significantly improved compared with preoperative(p<0.05).There was no significant difference between them(t=0.2025 p>0.05),but there was no significant improvement in the BCVA of group C compared with preoperative(p>0.05).The BCVA of 3-month-follow-up was 0.87610.130,0.845±0.132,and 0.937±0.123.The BCVA of the three groups were all significantly improved compared with 1-month-follow-up(p<0.05).There was no significant difference between group A and B(t=0.199,p>0.05),but both better than group C(p<0.05).(2).No significant difference was observed among three groups about postoperative macular hole closure rate(The group A and B were 100%while the group C was 93.33%,p>0.05).(3).At 3 months after surgery when MHCI was>1.0,the defect length of the EZ and ELM among three groups were significantly smaller compared with preoperative(pA,B,C<O.05).There was no significant difference between them(p>0.05).No significant difference was observed among three groups about the choroidal thicknes of 3 points compared with preoperative(PA.B.c>0.05).When MHCI<1.0,the defect length of the EZ and ELM among three groups were significantly smaller compared with preoperative(pA,B,C<0.05).There was no significant difference between group A and B(p>0.05),but both better than group C(p<0.05).No significant difference was observed among three groups about the choroidal thicknes of 3 points compared with preoperative(PA,B,C>0.05).Conclusion:The autologous transplantation of ILM,internal limiting membrane flap and ILMP with autologous serum are all an effective way in the treatment of IMH.When MHCI was>1.0,the defect length of the EZ and ELM among three groups were significantly smaller compared with preoperative but was no significant difference between them.No significant difference was observed among three groups about the choroidal thicknes of 3 points compared with preoperative.When MHCI<1.0,the defect length of the EZ and ELM among three groups were significantly smaller compared with preoperative.There was no significant difference between autologous transplantation of ILM,and internal limiting membrane flap,but both better than ILMP with autologous serum.No significant difference was observed among three groups about the choroidal thicknes of 3 points compared with preoperative.