| Objective:To observed the therapeutic effect of vitrectomy associated with no-touch fluid-air exchange technology for the patients of idiopathic macular hole(IMH).Methods:Randomized double blind prospective study: In this research,40 cases of idiopathic macular hole were included from Eye Hospital of Tianjin Medical University since December 2015 to April 2017.All the patients were undertaken vitrectomy associated with no-touch fluid-air exchange technology and internal limiting membrane peeling surgery.All the study subjects were divided into two groups randomly.The experimental group patients don't touch the macular hole area in the process of air-liquid exchange and don't absorb liquid in macular hole area,namely as no-touch fluid-air exchange technology,while the control group patients touch the macular hole area in the process of air-liquid exchange and absorb liquid in macular hole area.The morphology of macular hole and closure rate of macular hole and,vision acuity the thickness of macular,vision field,electroretinogram were contrasted and statistical analyzed in experimental group and control group.We examine all the patients after our vitrectomy surgery in one,two and six months,relatively.Results:21 patients were collected ultimately.There were 12 cases in the experimental group and 9 cases in the control group.1.The closing rate of macular hole:the closing rate of the hole in experimental group was 92%(11/12),and 88.8%(8/9)in control group.The closing rate of macular hole between the experimental group and the control group had no significant difference(c2=0.046,P=0.686).2.Postoperation visual acuity: ? Post-operation visual acuity of one month: In control group,post-operation best corrected visual acuity 0.56 ± 0.28 log MAR respectively.In the experimental group,post-operation best corrected visual acuity were(0.49 ± 0.19)log MAR.Compared with the pre-operation,the experimental group and control group showed better BCVA after the operation and the difference was statistically significant(p<0.05).There is no difference in BCVA between the two group after the operation(p>0.1).? Postoperation visual acuity of two mouthIn the control group,post-operation best corrected visual acuity0.40 ± 0.20 log MAR respectively.In the experimental group,post-operation best corrected visual acuity were 0.25 ± 0.15 log MAR.The experimental group have a abvious vision improvement trend than the control group;?Postoperation visual acuity of six mouth:In the control group,post-operation best corrected visual acuity 0.42 ± 0.30 log MAR respectively.In the experimental group,post-operation best corrected visual acuity were 0.25 ± 0.30 log MAR.The experimental group have a abvious vision improvement trend than the control group.3.The thickness of macular :?In the control group,the macular thickness of pre-operation was 286.98 ± 22.83?m,the postoperation macular thickness of one month and two month was 270.07 ± 27.70?m and 271.99 ± 16.93?m.In the experimental group,the macular thickness of pre-operation was 282.22 ± 45.48?m,the postoperation macular thickness of one month and two month was 267.97 ±46.96 ?m and 271.99 ± 16.93?m.The experimental group showed 1ighter change of macular thickness compared with the control group after our vitrectomy operation.4.Anatomical outcomes of the macular hole:In the experimental group,good healing was 9 cases,poor healing was 2 cases.In the control group,good healing was 6 cases,poor healing was 2 cases.The anatomical outcomes of the macular hole between experimental group and control group had no significant difference(c2=0.72,p=0.574).5?Central visual field: ?Pre-operation central visual field: In the experimental group,the mean defect was 5.46 ± 3.56 d B.In the control group,the mean defect was 4.27± 2.88 d B;? Post-operation central visual field of two month: In the experimental group,post-operation central visual field of two month was 3.94 ± 3.09 d B.Compared with the pre-operation,the experimental group showed lower mean defect after the operation and the difference was statistically significant(t=4.78 p=0.001).In the control group,post-operation central visual field of two month was 3.94 ± 3.09 d B.The preoperation and postoperation intraocular pressure were no difference between in our control group(t=1.70 p=0.14>0.05).6 ? Light-adapted 3.0 electroretinogram : ?Pre-operation light-adapted 3.0 electroretinogram:There was one case of a severe decline in cone cell reaction and Bwave amplitude in the experimental group.There was one case of a severe decline in cone cell reaction and B wave amplitude in the control group.?Post-operation light-adapted 3.0 electroretinogram: There was one case of a severe decline in cone cell reaction and B wave amplitude in the experimental group.There was two case of a severe decline in cone cell reaction and B wave amplitude in the control group.Conclusion No-contact gas-liquid exchange technology was applied to operation of idiopathic macular hole in our clinical observational study.The experimental group patients don't touch the macular hole area in the process of air-liquid exchange and don't absorb liquid in macular hole area.Compared to the control group,the experimental group also obtain higher closing rate,anatomical outcomes of the hole and satisfactory visual acuity.The no-contact gas-liquid exchange technology reduce the operation steps and have better central visual field.And the experimental group also significancely improve the patients quality of life. |
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