Effect Of Internal Limiting Membrane Tamponade On The Closure Of Idiopathic Macular Hole

OBJECTIVE:analyze the effect of pars plana vitrectomy and retinal inner membrane tamponade on the closure of the hole and compare it with the efficacy of simple internal liniting membrane peeling.In order to provide a basis for clinically more effective treatment of macular holes.METHODS:Thirty patients(30eyes)with idiopathic macular hole from August 2017 to January 2019 were grouped at admission.All patients excluded other diseases that may affect vision.Performing internal membrane filling 1 7cases,17eyes(referred to as the filling group).The inner limiting membrane peeling without filling 13 cases,14 eyes(referred to as the non-filled group).All patients underwent preoperative and postoperative best corrected visual acuity(BCVA),spectral-domain optical coherence tomography(SD-OCT)and other auxiliary examinations.Postoperative visual acuity,external membrane continuity recovery and hiatus closure The rate and incidence of surgical complications were comparcd.RESULTS:1.General information:5 male patients and 25 female Patienls,the male to female ratio was 1:5,the average age was 62.87±6.60,the average intraocular pressure before surgery was 16.03±2.50mmHg,and the average hole diameter was 588.27±213.51 ?m.The hole size of the filling group was 582.94±254.56?m,and the peeling group was 595.23±159.23?m.There was no significant difference between the two groups(P>0.05).2.IMH closure rate:There were 17 patients in the filling group,17 eyes,all the holes were closed after operation,and the rate of hole closure was 100%.13 patients in the peeling group,13 eyes,2 cases did not heal after surgery,the rate of hole closure was 85%.One of the cases was operated again,and the inner limiting membrane was removed,the silicone oil was filled and the hole was closed,and the other case was lost.3.BCVA:The BCVA(logMAR)in the Filling group at 1 and 3 months after operation:0.69±0.25,0.56±0.23.The BCVA(logMAR)was 0.78±0.32 and 0.67±0.35 at 1 and 3 months after operation.There was statistical difference between postoperative visual acuity and preoperative visual acuity.There was no significant difference in visual acuity between preoperative and postoperative groups between the two groups.4.The results of OCT:The diameter of the ELM defect in the Filling group and peeling group 1 week after qperation were 239.23±136.40?m?337.23±23?m.The ELM of the patients in the Filling group recovered their continuity at 6 months after operation.One patient in the unfilled group did not recovery continuity.The data were no statistical difference.5.The resultx of mf-ERG:In the two groups,the post-operative first-order function 1 ring,2 ring P1 wave reaction density was significantly improved compared with preoperative.However,there was no statistical difference between the two groups.Conclusion:1.Pars plana vitrectomy combined with internal limiting peeling and internal limiting membrane filling for the treatment of large-aperture macular holes has a certain advantage in the rate of hole closure.2.For macular hole with large diameters,recurring holes and long course disease,combined with inner-membrane filling has obvious advantages in promoting the closure of the holes.3.The statistical results of the first-order function PI wave of mf-ERG showed that there was no significant difference in the recovery of visual function compared with the internal liliting membrane peeling during the observation period.4.Combined with internal membrane filling,there was no significant difference in the complete and continuous recovery of anatomical structures such as external limiting membrane and IS/OS.5.There was no postoperative complications in both methods.Therefore,two surgical methods are both safe and effective for the treatment of IMH.