| Objectives:To compare the anatomy and short-term visual effects of standard internal limiting membrane stripping,internal limiting flap turnover and internal limiting membrane transplantation combined with autologous whole blood coverage in the treatment of large idiopathic macular holes(minimum diameter of the hole?400?m)Anatomical changes in the microstructure of the central fovea of the macula to explore the effectiveness and safety of the three surgical methods for the treatment of large idiopathic macular holes,and propose a method based on evidence-based medicine to select the best and most practical for the individual treatment plan.Methods:Retrospective analysis.From September 2017 to September 2019,61 patients(63 eyes)diagnosed as idiopathic macular hole in the Second People's Hospital of Yunnan Province with a minimum diameter range of?400?m and ?800?mwere included in the study.According to different surgical methods,it is divided into three groups:A,B and C.Among them,23 eyes(38.1%)in group A underwent 25G standard three-channel vitrectomy combined with internal limiting membrane stripping+disinfected air filling;group B had 20 eyes(31.7%)underwent 25G standard three-channel vitrectomy combined with Boundary flap turnover+disinfected air filling;18 cases(19 eyes)(30.2%)in group C underwent 25G standard three-channel vitrectomy combined with internal limiting membrane transplantation+autologous whole blood coverage+disinfected air filling.At the same time,all the above patients underwent cataract phacoemulsification and intraocular lens implantation.Before the operation,the binocular vision,intraocular pressure,examination of the anterior and posterior segment of the eye under the slit lamp,B-ultrasound of the posterior segment,and fundus photography were improved.The SD-OCT was used to measure the minimum diameter of the hole(the narrowest part of the neuroepithelial layer defect in the OCT scan image),the horizontal defect diameter of the ellipsoid zone(EZ)and the external membrane(ELM)layer.All patients were instructed to maintain the face-down prone position for 1 week and were closely followed up for at least 6 months,which were 1 week,1 month,3 months,and 6 months after surgery,respectively.During the follow-up to January and June,the best corrected visual acuity(BCVA),hole closure rate and closed form of the three groups of patients were recorded;after the follow-up to June,the changes of EZ and ELM defect diameters of the three groups of patients have recorded Complications and statistical analysis.Results:1.Clinical data:The age,course of the disease,intraocular pressure,axial length,preoperatively corrected visual acuity and minimum hole diameter of the three groups of patients all conform to the normal distribution.The results of the analysis of variance showed that there was no statistical difference between the three groups The significance of learning(p>0.05)can be compared among the three groups.2.Macular hole closure:the closure rate in group A was 87.5%,the closure rate in group B was 95%,and the closure rate in group C was 94.7%.The rate of hole closure in groups B and C was slightly higher than that in group A,but there was no statistically significant difference between the three groups(p=0.942).Types of postoperative closure:19 eyes(90.5%)with type 1 closure in group A,and 2 eyes(9.5%)with type 2 closure;19 eyes(100%)with type 1 closure in group B;no type 2 closure;group 1 with 16 closures Eyes(88.9%),type2 closed 2 eyes(11.1%).Postoperative morphology of hiatus closure:two groups A and C were mainly U-shaped and V-shaped,and group B was mainly U-shaped.3.Postoperative BCVA was converted to Logarithm of Minimal of Resolution(LogMAR)for comparison.At 1 month after surgery,the BCVA of the three groups A,B,and C were significantly higher than that before the operation,and the difference was statistically significant(pA,B,C?0.05).The difference was statistically significant(p?0.05),but the difference between A and C groups was not statistically significant(p?0.05).At 6 months after surgery,the BCVA of the three groups were significantly improved compared with 1 month after surgery,the difference was statistically significant(PA.B,C?0.05),and the visual acuity improvement in group B was more significant than that in groups A and C.Academic significance(p?0.05),but the difference between the two groups A and C was not statistically significant(p?0.05).4.Changes in EZ level defect diameter before and after surgery:At 6 months after surgery,the EZ level defect diameters in the three groups A,B,and C were significantly reduced compared with those before surgery(pA,B,C?0.05).Significance(f=2.411,P?0.102).In group A,EZ recovered completely in 1 eye,in group B,EZ recovered completely in 3 eyes,and in group C,EZ recovered completely.5.Changes in the diameter of ELM level defects before and after surgery:At 6 months after operation,the diameters of ELM level defects in groups A,B,and C were significantly reduced compared with those before surgery(pA,B,C?0.05),and there was no statistical difference between the three groups Significance(f=0.308,p?0.736).In group A,4 eyes of ELM recovered completely,in group B,7 eyes of ELM recovered completely,and in group C,no ELM recovered completely.6.Complications:All patients were followed up to 6 months after the operation.No serious complications such as endophthalmitis,vitreous hemorrhage,and retinal detachment were found.Transient intraocular pressure occurred in all three groups of patients(group A,2 cases 1 case in group B and 3 cases in group C),the intraocular pressure returned to normal after the local IOP lowering treatment.Conclusions:25G standard three-channel vitrectomy combined with standard internal limiting membrane exfoliation,internal limiting flap reversal surgery,internal limiting membrane transplantation combined with autologous whole blood coverage for the treatment of large idiopathic macular hole Good vision improvement and few postoperative complications are safe and effective procedures.But the internal limiting flap reversal surgery has more significant visual acuity improvement than the other two surgical methods.The three surgical methods can effectively reduce the diameter of EZ and ELM defects,and the anatomy of the macular area is restored,but there is no statistically significant difference between the three groups. |
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