Efficacy Of Pars Plana Vitrectomy Combined With Internal Limiting Membrane Peeling And Mouse Nerve Growth Factor Injection For The Treatment Of Macular Hole In High Myopia

Objectives:To observe the efficacy and safety of Pars Plana Vitrectomy（PPV）combined with Internal Limiting Membrane（ILM）peeling and vitreous injection of mouse Never Growth Factor（m NGF）in the High Myopia Macular Hole（HMMH）and compare with PPV combined with ILM peeling.Methods:A prospective study.A total of 31 patients（33 eyes）of HMMH diagnosed in the Affiliated Eye Hospital of Nanchang University from August 2020 and February2021 were selected.Before surgery,all included patients were subjected to a complete ophthalmologic evaluation including Best Corrected Visual Acuity（BCVA）,Optical Coherence Tomography（OCT）,Microperimeter and Axis Length（AL）.The included subjects were accepted the treatment of PPV combined with ILM peeling or PPV combined with ILM peeling and vitreous injection m NGF.BCVA,OCT and Microperimeter ware examined at 1week and 1,3,6months after operation using the same equipment and methond as before operation.The closure rate of MH,the integrity of External Limiting Membrane（ELM）and Ellipsoid Zone（EZ）of photoreceptor,Visual Acuity（VA）of macular,BCVA and the changes of BCVA（ΔBCVA）were compared and observed.The BCVA,VA,the deficient lengths of ELM and EZ at different time points were compared by independent-samples t-test between two groups and analysis of variance was used to compare the repeated measurement data of each group.Fisher test was performed for comparison of count data.Results:1、Comparison of preoperative general data between groups:A total of 31patients（33 eyes）including 16 cases（17 eyes）in the simple group and 15 cases（16eyes）in the combined group were followed up completely and performed statistical analysis.Before surgery,there was no statistically significant difference in gender,categories of eye,age,course of disease,BCVA,IOP,MH size,AL,VA,the loss of ELM and EZ between the two groups（P>0.05）.There was no significant difference in silicone oil emulsification rate between the two groups when silicone oil was taken（P>0.05）.However,the time of silicone oil extraction in the combined group was earlier than that in the simple group（P=0.0003）,and the difference was statistically significant.2、Comparison of the clouse rates of MH and macular structure recovery between groups:At the last follow-up,there was no significant difference in MH closure rate between the two groups（P=0.523）.Compared with the simple group,the recovery of ELM was more obvious in the combined group at 3 months（t=2.282,P=0165）and 6 months（t=3.101,P=0.0027）.The loss length of EZ in the combined group was more shorter than that in the simple group at 1,3,6 months（t₁=1.815,P=0.0422;t₃=2.302,P=0.0176;t₆=2.784,P=0.006）,and the difference was statistically significant.3、Comparison of macular structure recovery within the group:Compared with pre-operation,the recovery of EZ in the combined group was statistically significant（P<0.05）at all follow-up time points,while the resumption of EZ at 1,3 and 6months after surgery was statistically significant in the simple group（P<0.05）.The restoration of ELM in the two groups was statistically significant（P<0.05）during the follow-up.4、Comparison of macular function between groups:At each time point of follow-up,ΔBCVA and BCVA in the combined group were significantly higher than those in the simple group with statistical significance（P<0.05）.The VA of macular in the combined group was significantly higher than that in the simple group.There was a significant difference in the two group at 3 and 6 months postoperatively（t₃=1.897,P=0.038;t₆=2.250,P=0.019）.5、Comparison of macular function within the group:BCVA in the simple group was significantly improved 1 and 6 months（P₁=0.030;P₆=0.031）after surgery compared with that before surgery,while it was statistically significant in the combined group at all postoperative follow-up time points（P<0.05）.Compared with pre-operation,VA in the combined group increased with time and there was significant difference at 3 and 6 months after surgery（P<0.05）.In the simple group,it decreased at all follow-up time points and there was statistically difference at1week,3 and 6 months after surgery（P<0.05）.6、No intra-ocular complications such as endophthalmitis,hypopyon,high intraocular pressure,retinal detachment,proliferative vitroretinopathy,corneal endothelial decompensation and systemic complications were found during the follow-up.Conclusions:PPV combined with ILM peeling and vitreous injection m NGF is more effective than PPV with ILM peeling for HMMH with improving both anatomical and functional outcomes.