Efficacy Of 23G Transconjunctival Sutureless Vitrectomy Combined With Internal Limiting Membrane Peeling And Air-filled Surgery For The Treatment Of Macular Hole

Objective:1.To observe and analysis the efficacy of 23 G transconjunctival sutureless vitrectomy in the treatment of macular hole, combined with internal limiting membrane peeling and air-filled surgy. 2. Analysis of influence factors of macular hole closure and vision.3.The probe into the feasibility of multifocal ERG and vision is based on the follow-up visit and detection of macular function.Methods : Collect the data of macular patients who consulted in the Second Hospital of Lanzhou University Eye Center and met the conditions of operative time ranging from May.2014 to Jun.2015.The patients were dived into two crowds on the basis of suffering from high myopia or not.All the patients adopted the theraphy of23 G transconjunctival sutureless vitrectomy combined with internal limiting membrane peeling and air-filled surgy. The patients were required to maintain prone position for 3-7 days after operation, and accepted follow-up visit for 6-12 months.Detect and record BCVA, OCT, 10-2 visual field and multifocal ERG before the operation and 1 、3 and 6 month after the operation respectively. Convert decimal vision into the minimum angle of resolution logarithmic(log MAR) for statistical analysis.We measured the main data with OCT including macular hole minimum diameter(a), hole bottom diameter(b), hole height(h), preoperative and postoperative ellipsoid region(photoreceptor inner and outer section connection IS /OS) and an external limiting membrane(ELM) defect diameter. The macular hole index(MHI)= h / b, macular hole stretch index(THI) = h / a, the hole diameter index(DHI) = a / b. The collected data will be analyzed via SPSS17.0 statistical software.The correlation between log MAR BCVA and hole minimum diameter, the hole bottom diameter, MHI, THI, DHI, ellipsoid region defect diameter and external limiting membrane defects diameter was detected via correlation test. The significantdifferences of BCVA, visual acuity and response densities of each ring multifocal ERG before and after surgery was detected via T-test.Results:The study included 27 eyes, of which including 22 hole closed eyes,and 5 unclosed. Hole closure rate was 81.5%, idiopathic macular hole closure rate was90%, macular hole in high myopia closure rate was 57.1%. All objects included in the study did not develop with serious irreversible complications during the follow-up period. Preoperative log MAR BCVA with hole minimum diameter, preoperative ellipsoid region defect diameter, preoperative external limiting membrane(ELM)defect diameter, preoperative densities of ring1 multifocal ERG and preoperative visual acuity fovea exists statistically correlation(P <0.05). Postoperative log MAR BCVA and preoperative log MAR BCVA, macular hole minimum diameter,postoperative ellipsoid region defect diameter, postoperative external limiting membrane(ELM) defect diameter, postoperative visual acuity, MHI, THI, and postoperative the reaction density of ring1, ring2, ring3 multifocal ERG have correlated statistically(P <0.05). Compared with preoperative log MAR BCVA(0.95 ±0.41),postoperative log MAR BCVA(0.62 ± 0.39) improved significantly(P = 0.001<0.05). The same as the multifocal ERG P1 wave response densities ring1, the postoperative(86.66 ± 30.39)was improved significantly compared with the preoperative(60.31 ± 23.08)(P = 0.000 <0.05). Preoperative and postoperative foveal visual acuity difference was not significant(P = 0.092 <0.05). All holes will close if MHI> 0.442 or THI> 1.412 or THI> 0.512.Conclusion:23G transconjunctival sutureless vitrectomy combined with internal limiting membrane peeling and air-filled macular hole surgery is safe and effective.The factors that will affect the hole closing include the minimum hole diameter, hole bottom diameter, MHI, THI, DHI and so forth. MHI, THI, DHI might be the using in the speculation of the possibility of the hole closing. Preoperative visual acuity,macular hole diameter, preoperative ellipsoid defect diameter, preoperative outside diameter membrane defects and other factors could affect postoperative vision. The multifocal ERG can detect foveal visual function precisely which could be used as a tool of examing the effect of follow-up visit.