Clinical Study Of Vitrectomy Combined With Internal Limiting Membrane Peeling Or Internal Limiting Membrane Insertion For Idiopathic Macular Hole

Part ?: Clinical study of the safety and efficacy of vitrectomy combined with internal limiting membrane peeling or internal limiting membrane insertion for idiopathic macular holeObjective: To compare the safety and efficacy of vitrectomy combined with limiting membrane(ILM)peeling or ILM insertion in the treatment of idiopathic macular hole(IMH),and explore the related factors that affect postoperative vision of IMH.Methods: Retrospective case control study.From August 2016 to August 2018,44 eyes of 43 patients who primarily underwent pars plana vitrectomy in the Department of Ophthalmology,Subei Peoples' Hospital Affiliated to Yangzhou University for the first time due to IMH were included.There were 7 males(7 eyes)and 36 females(37 eyes).According to the operation methods,the patients were divided into two groups: ILM peeling group and ILM insertion group.Preoperative and postoperative visual acuity,retinal microstructural parameters were collected,postoperative visual acuity,macular closure rate and macular microstructural parameters were compared between the two groups,and the related factors that affect the postoperative visual prognosis were analyzed.Results:(1)The best corrected visual acuity(BCVA): The mean BCVA(Log MAR)of preoperative and postoperative were(1.23±0.55),(0.68±0.35)in ILM peeling group(t=5.61,P=0.00).The mean BCVA(Log MAR)of preoperative and postoperative were(1.53±0.61),(0.85±0.46)in ILM insertion group(t=5.28,P=0.00).There was no statistically significant difference in preoperative and postoperative BCVA(Log MAR)between two groups(t=-1.69,-1.41;P=0.09,0.16).(2)Closure rate and closure type of IMH:The IMH closing rate was 90% in ILM peeling group,and 91.67% in ILM insertion group,there was no statistically significant difference(Fisher Test P=1.00).The rate with type ? was 88.89% in ILM peeling group,while 86.36% in ILM insertion group,there was no statistically significant difference(Fisher Test P=1.00).(3)Changes of ellipsoid defect diameter: The mean ellipsoid defect diameter of preoperative and postoperative were(968.05±225.01)?m,(634.80±434.31)?m in ILM peeling group(t=4.02,P=0.00).The mean ellipsoid defect diameter of preoperative and postoperative were(1094.04±223.37)?m,(988.50±470.13)?m in ILM insertion group(t=1.15,P=0.26).There was statistically significant difference in postoperation ellipsoid defect diameter between two groups(t=-2.57,P=0.01).(4)Changes of inner retinal complex(IRC)thickness: There was no statistically significant difference in both nasal and temporal regions of postoperative IRC thickness between two groups(t=-0.91,-0.67;P=0.37,0.50),but the postoperative IRC thickness showed thinning on both sides than preoperative(t=4.29,8.50,2.42,5.22;P=0.00,0.00,0.02,0.00),and the thickness of temporal region decreased more than that in the nasal region [the IRC decreased in thickness after surgery in both nasal and temporal regions in two groups was(12.40±12.92)?m,(24.85±13.07)?m,(9.46±12.45)?m,and(20.92±16.49)?m respectively].(5)Predict indexs: The postoperative BCVA(Log MAR)was positive related to preoperative BCVA(Log MAR),ellipsoid defect diameter,ELM defect diameter and base diameter of macular holes in ILM peeling group(rs=0.49,0.047,0.61,0.59;P=0.03,0.03,0.00,0.01),negative related to preoperative IRC thickness in the nasal region(rs=-0.54,P=0.01),there were no relationship between the postoperative BCVA(Log MAR)and other parameters.The postoperative BCVA(Log MAR)was positive related to preoperative BCVA(Log MAR)in ILM insertion group(rs=0.32,P=0.04),there were no relationship between the postoperative BCVA(Log MAR)and other parameters.Conclusion:(1)The postoperative visual acuity of patients with IMH treated by ILM peeling or ILM insertion is significantly improved compared with preoperative.There is no significant difference in the postoperative BCVA,closure rate and closure type.(2)The postoperative ellipsoid defect diameter in ILM peeling group is smaller than that in ILM insertion group,which indicated that the disturbance to the microstructure of the outer retinal layer in ILM insertion group is severer than that in ILM peeling group.(3)Vitrectomy combined with ILM peeling and vitrectomy combined with ILM insertion are both safe and effective in the treatment of IMH,but the disturbance to the microstructure of the outer retinal layer in ILM peeling group is slighter than that in ILM insertion group.Part ?: Fluid-air exchange with single syringe for the treatment of persistent macular hole after vitrectomyObjective: To observe the efficiency and safety of treatment of postvitrectomy persistent idiopathic macular hole(IMH)with single syringe fluid-air exchange(SSFAE).Methods: Retrospective case series study.The data of 10 cases(11 eyes)with postvitrectomy persistent IMH from January 2015 to August 2018 were collected.The MH morphology changes were observed using optical coherence tomography(OCT)and the best-corrected vision acuity(BCVA)was measured.Results: The mean minimum MH diameter was(545.36±161.65)?m at pre-vitrectomy,and(535.91±182.19)?m at postvitrectomy(t=0.14;P=0.89).The mean Log MAR BCVA was(1.25±0.55)at pre-vitrectomy and significantly improved to(0.68±0.26)(t=3.54;P=0.01).Macular hole closed with type ? in 7 eyes(63.63%;7/11)following the first SSFAE,8 eyes(72.72%;8/11)following the second SSFAE and 9 eyes(81.81%;9/11)following the third SSFAE.Conclusions: SSFAE is a simple,safe and efficient method to manage the postvitrectomy persistent IMH and it can be seen as the first choice.