Curative Effect Of Air And C3F8 Filling In The Treatment Of Large Idiopathic Macular Hole

BackgroundIdiopathic macular hole(IMH)is a common macular disease,which refers to the absence of a full layer of retinal neuroepithelium in the macular area caused by no obvious primary eye disease,causing serious visual impairment.The pathogenesis of IMH is not yet clear,but all researchers reached a consensus on the plan of vitreous surgery.Especially with the application of minimally invasive vitreous surgery technology in the treatment of IMH,new treatments have emerged endlessly,and IMH has achieved good results for small aperture(<400um)IMH.However,for IMH with a large aperture(> 400um),the treatment effect is still not satisfactory,which is also the focus and difficulty in IMH treatment.The purpose of this study is to investigate whether air can replace perfluoropropane(C3F8)in the treatment of large IMH,and to evaluate the efficacy of autologous blood-assisted internal limiting membrane tamponade for the treatment of large IMH combined with air or C3F8 intraocular tamponade and to provide more options for the treatment of large IMH.Purpose and methodPurposeTo observe and compare the effect of autologous blood-assisted internal limiting membrane tamponade combined with air and C3F8 filling in the treatment of large idiopathic macular hole.MethodsRetrospective analysis of IMH patients with pore diameter greater than 400 um treated by vitrectomy combined with autologous blood-assisted internal limiting membrane tamponade in our hospital from January 2017 to October 2019 completed by the same experienced physician in our operation,excluding follow-up less than 3 months Of patients.The patients were divided into two gr oups,one group was autologous blood-assisted internal limiting membrane reversal with air tamponade,for short air group;the other group was autologous blood-assisted internal limiting membrane reversal with C3F8 tamponade,for short C3F8 group.Record the patient's preoperative frequency domain posterior segment optical scanning,fundus photography and other related examinations.The patient's best corrected visual acuity(BCVA),intraocular pressure,axial length,hole size and external membrane(ELM),ellipsoid zone(IS / OS)Defective value.The BCVA,intraocular pressure,hole closure,and ELM and IS / OS defect values at 1 week,1 month,and 3 months follow-up were recorded.SPSS24.0 software was used to analyze the data.ResultsThe results of one week postoperative review showed that 28 eyes were closed in the air group and 27 eyes were closed,with a closure rate of 96.43%.In the C3F8 group,27 eyes were closed and 26 eyes were closed,the closure rate was 96.30%.Chi-square test was used for comparison,P = 0.979 P> 0.5,showed no statistical difference.The closure of the hole at 1 month and 3 months after operation was the same as 1 week after operation.In the first month after surgery,the eyesight in the air group improved by 23 eyes,with an improvement rate of 82.14%.The eyesight in the C3F8 group improved by 21 eyes,with an improvement rate of 77.78%.Chi-square test was performed,P = 0.686,and the best corrected vision improvement rate between the two groups was not obvious.The difference(P> 0.05),3 months after operation was the same as January.The best corrected visual acuity in the air group was(0.86 ± 0.29)log MAR in 1 month after operation,and the best corrected visual acuity in the C3F8 group was(0.91 ± 0.39)log MAR,which were significantly improved compared with those before the operation.Paired t test was performed,and the P values were all less than 0.05.The difference was statistically significant.The diameter of ELM defect in the first month after operation was 610.93 ± 244.39 um in the air group,and 611.41 ± 316.99 um in the C3F8 group;the diameter of the IS / OS defect in January was 786.46 ± 272.95 um in the air group,and 746.48 ± 335.03 um in the C3F8 group The diameter of the ELM defect in the postoperative month is 437.25 ± 206.38 um in the air group and 435.26 ± 265.24 um in the C3F8 group;the IS / OS defect diameter in the postoperative month is 574.46 ± 224.81 um in the air group and 534.37 ± 283.90 in the C3F8 group um.The diameter of the ELM defect at 1 month after operation was 604.57 ± 271.61 um in the air group and 547.85 ± 266.65 um in the C3F8 group;the diameter of the IS / OS defect at 1 month after operation was 522.68 in the air group.± 267.91 um,499.56 ± 263.66 um in the C3F8 group;the diameter of the ELM defect in 3 months after surgery compared with the one-month postoperative repair value,173.68 ± 76.93 um in the air group,176.15 ± 94.07 um in the C3F8 group;The diameter of IS / OS defect compared with the one-month postoperative repair value was 212.00 ± 111.49 um in the air group and 212.11 ± 94.32 um in the C3F8 group.The t test was performed between the two groups,and the P value was greater than 0.05,and the difference was not statistically significant.In the air group,there were 2 eyes with increased intraocular pressure at a rate of 7.14%,and 2 eyes with higher intraocular pressure in the C3F8 group The rate of increase was 7.41%.The chi-square test was used between the two groups,P=0.97,the difference was not statistically significant(P> 0.05).All of them were controlled to normal after being given eye drops for lowering intraocular pressure.All patients had successfully completed the operation,and no serious complications occurred during or after the operation.conclusionThere was no significant difference in the efficacy and safety of autologous blood-assisted internal limiting membrane reversal tamponade combined with air and C3F8 tamponade in the treatment of large idiopathic macular hole.Air Can replace C3F8 in the treatment of large idiopathic macular hole and achieve satisfactory visual acuity and macular microstructure improvement.