Clinical Analysis Of Internal Limiting Membrane Fragment Transplantation Combined With Temporal Inverted Flap Technique And Air Tamponade For Refractory Macular Holes

Background:Macular hole(MH)refers to the perforation of the whole layer of retinal neurosensory layer in foveola.which is divided into idiopathic macular hole(IMH)and nonspecific macular hole according to the pathogeny.MH is difficult to cure and has a poor prognosis of vision,especially in the refractory MH.At present,surgery is still the main treatment of refractory MH.Objective:This study aimed at investigating clinical significance and application of internal limiting membrane(ILM)fragment transplantation combined with temporal inverted ILM flap technique for refractory MHs.Analyse the closure rate of MH and the changes of visual function before and after this MH surgery,compared with traditional ILM fragment transplantation.Methods:Totally 25 eyes in 25 patients with MH who had undergone operations at Qilu Hospital from January 2016 to December 2016 were selected.All surgical operations were accomplished successfully by the same surgeon.General information were collected and examinations such as best-corrected visual acuity(BCVA).intraocular pressure(IOP).slit lamp microscope,binocular indirect ophthalmoscope and optical coherence tomography(OCT)were performed.We divided these patients into two groups randomly.11 eyes who underwent vitrectomy with ILM fragment transplantation combined with temporal inverted ILM flap technique and air tamponade were represented as experimental group,and 50%hypertonic glucose was used to inverte the ILM flap creatively;14 eyes who were treated with vitrectomy and traditional ILM fragment transplantation with silicone oil tamponade were represented as control group.All the patients are followed up for 3 months after surgery.We retrospectively analyzed and compared the BCVA and postoperative macular hole closure rate of two groups to evaluate security and effect of surgery.Results1.Analysis of clinical characteristics:No significant difference was observed among the above 2 groups in terms of age,hole diameter,BCVA and disease duration(P>0.05).2.Data about surgeries:(1)The BCVA(logMAR)were 0.95±0.29 and 0.92±0.36 in the experimental group and control group respectively.There was no significant difference between them(P=0.844).(2)No significant difference was observed among two groups about postoperative macular hole closure rate(The experimental group was 100%while the control group was 92.9%,P=0.366).Conclusions:1.ILM fragment transplantation combined with temporal inverted ILM flap technique and air tamponade is an effective way in the treatment of refractory MH.2.The temporal inverted ILM flap in this technique can protect the ILM fragment from displacement and improve the closure rate of refractory MH.3.The ILM fragment transplanted in the operation can act as a scaffold for Muller cell proliferation and promote the close of MH.4.The 50%hypertonic glucose can make it easier in the temporal inverted ILM flap technique.It can prevent the displacement of inverted ILM flap and reduce the chance of reoperation.