The Surgical Treament Of Idiopathic Macular Hole

Objective:To observe the clinical effect of disinfectant air tamponade after vitrectomy for the treatment of idiopathic macular hole(IMH)and analysis the correlation between microstructures of macular and visual outcome after IMH surgery.So that to concluded whether the disinfectant air tamponade in IMH treatment is worth recommending and the microstructures of the macular have predictive value for IMH.Methods:A total of 20 eyes of 20 patients with IMH were collected.All patients were excluded from ocular trauma,high myopia,other diseases of the fundus,glaucoma and other eye diseases which may affect eyesight.All cases underwent 25-Gage pars plana vitrectomy(PPV)combined with internal limiting membrane peeling and disinfectant air tamponade.All patients undertook the best corrected visual acuity(BCVA),multifocal electroretinogram(mf-ERG),spectral-domain optical coherence tomography(SD-OCT)and Intraocular Pressure before surgery,and record the result of those auxiliary examinations after 1 wk.,1 month and 3 months of operation.Measure and record the minimum diameter(MD),bottom diameter(BD),height(H),the defective diameter of external limiting membrane(ELM)and ellipsoid zone,macular hole index(MHI=H/BD),hole diameter index(DHI=H/MD)and hole traction index(THI=MD/BD)of macular hole,and record the response density of ring 1~5 in P1 wave of mf-ERG;and analyze whether there is correlation between those indices and visual outcomes after IMH surgery.Results:1.General information: The BCVA has no correlation with the age,course of disease,BCVA(logarithm of the minimum angel of resolution,log MAR)before operation(P> 0.05).2.IMH closure rate after operation: 18 cases(90%)were completely closed(all type ? closed),2 cases failed to close,and the closure rate of macular hole with the minimum diameter of <400?m was 100%(5/5),400-700?m was 92.3%(12/13),and > 700?m was 50%(1/2).3.The best corrected visual acuity: The mean BCVA(log MAR)of preoperative and 1wk,1month,3month after surgery were 1.18±0.54,0.83±0.54,0.65±0.41,0.48±0.34,and there were statistically significant difference between preoperative and postoperative BCVA(P <0.05).4.The outcomes of OCT: The IMH closure had a significant negative correlation with MD and the defective diameter of ELM(R =-0.449,P = 0.047;R =-0.449,P = 0.47).MHI and THI were positively correlated with the closure of the hole(R = 0.474,P = 0.035,P = 0.546,p=0.013).The BCVA after 3 months of surgery was positively correlated with MD,the defective diameter of ellipsoid zone and ELM preoperative,and postoperative ellipsoidal zone defective diameter(R = 0.56,P = 0.01;R = 0.59,P = 0.006;R = 0.68,P = 0.001;R = 0.52,P = 0.019).5.The outcomes of mf-ERG: The P1 wave response density of the ring 1 and ring 2 of mf-ERG have statistically significant difference between preoperation and postoperation of IMH(P<0.05).The spearman correlation analysis showed that BCVA(log MAR)was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf-ERG(R =-0.34,P = 0.006;R =-0.16,P = 0.02).Conclusion:1.It is safe and effective with disinfectant air tamponade after vitrectomy for the treatment of idiopathic macular hole(IMH).2.The smaller the minimum diameter or the effective diameter of the ELM,or the greater the MHI and THI values,the better closure rate of IMH will get.3.The visual outcomes of IMH tended to be stable over time after surgery.4.The minimum diameter of macular hole,the defective diameter of ELM and the ellipsoidal zone of IMH were related to the visual outcomes after IMH operation.5.The response density of ring 1 and ring 2 in P1 wave of mf-ERG was significantly improved compared with preoperative,indicating that the function of the macular area was significantly improved after surgery.And BCVA(log MAR)was associated with the response density of ring 1 and ring 2 in P1 wave of mf-ERG.