Efficacy Of Vitrectomy And Internal Limiting Membrane Peeling Combined With Air Filling In The Treatment Of Macular Hole

Objective:The most common surgical procedure for macular foramen is vitrectomy combined with retinal detachment.The postoperative complications of inert gas are relatively high and the compliance of special position is poor.Therefore,more scholars try to use short-acting gas for intraocular filling.This study compare the efficacy of vitrectomy combined with air filling and C3F8 filling in the treatment of macular hole and analyz the influencing factors of macular hole healing.Methods:Retrospective and prospective case-control studies.Data of patients admitted to the eye center of taihe hospital of shiyan city affiliated to hubei university of medicine for macular hole from February 2014 to November 2018 were collected.Causes include idiopathic macular hole,high myopia macular hole.All the 40 patients with macular hole underwent 23 G minimally invasive vitrectomy and internal limiting membrane peeling combined with sterilized air filling or inert gas(C3F8)filling,including 20 cases(20 eyes)in the air filling group and 20 cases(20 eyes)in the C3F8 filling group.The patients were followed up for at least 3 months.The patients were examined preoperatively with detailed anterior segment and posterior segment,and their basic data were recorded in detail.BCVA,OCT,intraocular pressure,prone position time and postoperative complications were examined preoperatively and 3 months after surgery.The fractional vision was converted into the log MAR for statistical analysis.OCT was used to measure the MD,BD,H and the actual distance between the departure of the photoreceptor from the starting point and the broken end of the external limiting membrane on both sides of the crack(M?N)values of macular hole,and calculate MHI,THI,DHI and MHCI.The collected data were collated and input into Excel form,and SPSS22.0 statistical software was used for analysis.Results:1.Baseline data of preoperative air filling group and C3F8 filling group: gender,age,course of disease,intraocular pressure,log MAR-BCVA,MD,BD,H,M,N,MHCI,MHI,THI,DHI and etiology(idiopathic macular hole,high myopic macular hole)were not statistically significant.2.The overall hole closure rate of air group and C3F8 group was 85% and 90%respectively 3 months after surgery.The closure rates of the two groups of IMH patients were 93.6% and 94.1%,respectively.The closure rates of patients with high myopia were 50% and 66.7%,respectively,and the differences were not statistically significant(P=1.000).The improvement rates of log MAR-BCVA in the two groups were 70% and75% respectively(P=1.000).Postoperative log MAR-BCVA and intraocular pressure showed no significant difference between the two groups(P=0.146,P=0.146).The postoperative time of prone position in the two groups was 3.55 1.39 and 11.75 2.51,respectively,and the difference was statistically significant(P=0.032).The groups were grouped according to MD value,and the difference in MD value between the groups was statistically significant,but the difference in hole closure rate between the groups was not statistically significant.The difference of log MAR-BCVA between the two groups before and after surgery was statistically significant(P<0.001).3.Postoperative complications: 1 patient in the air group developed complicated cataract,and the opacity gradually decreased.High intraocular pressure occurred in 1eye of C3F8 group after operation.Cataract was found in 1 patient,who underwent cataract surgery 1.5 months after surgery.4.Related factors affecting the closure of macular hole: the smallest diameter of the hole,MHCI and the cause of disease have statistically significant differences in the closure rate of macular hole(P=0.040,P=0.018,P=0.030).MHCI is an independent factor affecting macular hole closure.Conclusion:1.Compared with C3F8 inert gas group,sterilized air can achieve the same effect in the treatment of IMH closure rate and the closure rate of high myopia MH as well as the improvement of visual function of patients.The incidence of postoperative complications was low and mild.Air stays in the eye for a short time,which solves the problem that most patients cannot tolerate prone position for a long time,and it provides faster visual recovery,and patients can achieve normal daily life in a short time.2.The MHCI are expected to be reliable factors for predicting macular healing,and MHCI shows more significant predictive ability than other parameters.3.The prognosis of high myopia macular hole is worse than that of idiopathic macular hole.