The Clinical Effect Of Vitrectomy With Internal Limiting Membrane Peeling And Air Tamponade For The Idiopathic Macular Hole

Objective:To observed the therapeutic effect of vitrectomy associated with internal limiting membrane peeling and air tamponade for the patients of idiopathic macular hole (IMH).Methods:In this research,69cases of IMH were accepted from Tianjin Medical University Eye Hospital since July2010to December2013. All the patients were undertaken vitrectomy combined with internal limiting membrane peeling surgery.All the study subjects were divided into two groups (Group A and Group B) randomly. The patients in Group A were tamponaded with inert gases(SF6)(30eyes), while in Group B were tamponaded with sterile air tamponade (39eyes). The closure rate and morphology of macular hole, the thickness of macular, the post-operation visual acuity, the progress of cataract and the gas absorption time were compared and statistical analysed in these two groups. All the patients were reexamined after the surgery in one week, one month, two months and six months, respectively.Results:1. Post-operation visual acuity:In Group A, vision was improved in18eyes, unchanged in6eyes and decreased in6eyes; In Group B, vision was improved in23eyes, unchanged in10eyes and decreased in6eyes. There is no statistically significant difference compared the two groups (x2=0.443, p<0.801).2. The thickness of macular: In Group A, the macular thickness of pre-operation was317.23±61.04μm, the macular thickness of post-operation was280.83±31.42μm; In Group B, the macular thickness of pre-operation was303.30±62.18μm, the macular thickness of post-operation was253.05±36.63μm. Compared with the Group A, Group B showed higher change of macular thickness after the operation.3. Intraocular pressure (IOP):In Group A, pre-operation and post-operation IOP were14.92±3.41mmHg and15.01±3.68mmHg. In group B, the results were14.67±3.16 mmHg and13.25±2.57mmHg, respectively. Compared with the Group A, Group B showed lower decreased IOP after the operation. There is no difference between pre-operation IOP and post-operation IOP in Group A (t=-0.112, p>0.05). Compared with the pre-operation, post-operation showed decreased IOP in Group B (t=7.142, p<0.05).4. Gas absorption time: the time of gas completely absorption time in group A was31.10±3.20days, and8.54±1.74days in group B. The gas absorption time in group B was significantly shorter than that in group A. The difference was statistically significant (p<0.01).5. the closing rate of the hole:the closing rate of the hole in the group A was90%(27/30),and89.74%(35/39) in the group B. The closing rate of the hole between the two groups had no significant (x2=0.001, P>0.972).6. Closed form: in the group A, U-shaped closing was19cases, V-shaped closing was6cases, and W-shaped closing was2cases, the difference was not statistically significant (x2=5.256, p>0.05). In group B, U-shaped closing was25cases, V-shaped closing was7cases, and W-shaped closing was3cases, the difference was statistically significant (x2=8.328, p<0.05).7. Cataract progress: the surgery rate of cataract in the group A was76.92%(10/13) within six months,and the group B was19.23%(5/26).Compared to the group A, the surgery rate of cataract was significantly reduced in the group B, the difference was statistically significant(x2=12.188, P＜0.01).conclusion:Compared to the group of inert gas (SF6) filling, filling the disinfected air can also obtain higher closing rate, good closing form of the hole and satisfactory visual acuity. And filling the disinfected air during the operation can also remarkablely improve the life quality of the patients and relieve the discomfort peri operative period.