Changes In Retinal Morphology And Function In The Short Term After Idiopathic Macular Hole With Internal Limiting Membrane Peeling

Objective: To study the changes of retinal morphology and function in the short term after idiopathic macular hole(IMH)inner limiting membrane ablation.Method:This study is a retrospective study,collecting 20 eyes of 20 patients who were diagnosed with idiopathic macular hole in 2018-2019 and successfully operated by experienced clinician operation in the Second Hospital of Hebei Medical University(all patients had cataract phacoemulsification + intraocular lens implantation + vitrectomy + internal limiting membrane peeling + sterile air filling),including 17 female patients(17 eyes)and 3 male patients(3 eyes).The control group was the healthy eyes of the patients.In the before and after 3 months follow-up of operation,the spectral domain optical coherence tomography(OCT)combined with the Microperimetry-3 was used to measure the BCVA,macular hole diameter,and mean macular sensitivity(MMS)?mentral macular sensitivity(CMS)before and after 3 months,and the percentage of fixation points in the range of 2 ° and 4 °,as well as the 4 quadrants of the peeling area(supranasal,infranasal,supratemporal,infratemporal)retinal sensitivity and ganglion cell complex(GCC)thickness,The post-operative image of the top layer of the RNFL layer to the bottom layer of the IPL was displayed by En-face OCT to show DONFL,and its number,total area and average area were calculated,postoperative macular foveal thickness,IS / OS layer structural integrity.Results:In the control group,there was no statistical difference in GCC thickness between 0.05 levels(all P> 0.05).In the experimental group,the thickness of GCC in each quadrant was significantly different at the 0.05 level(P = 0.000),and the difference was statistically significant.In the experimental group,we compared the thickness of GCC in the four quadrants in pairs.The results showed differences in the infratemporal-infranasal,infratemporal-supranasal,supratemporal-supranasal,and supratemporal-infranasal(P=0.000<0.05),the difference is statistically significant.However,there were no significant differences in the infratemporal-supratemporal and infranasal-supranasal groups(all P>0.05).The GCC thickness comparison between the experimental group and the control group showed that the GCC thickness in the eyes with the supranasal and infranasal quadrants was thicker than that of healthy eyes at 3 months after surgery(all P<0.05),and the difference was statistically significant.The GCC thickness in the patients with infratemporal quadrant was thinner than that in healthy eyes(P<0.05),and the difference was statistically significant.There was no significant difference between the two groups in the supratemporal quadrant(P>0.05).The MMS,CMS,and the percentage of fixation points in the range of 2 °and 4 ° before and after surgery were statistically different(P<0.05).There was no significant difference in the average retinal sensitivity of the four quadrants before and after the operation(all P>0.05).However,the infratemporal quadrant has a tendency to decrease further as the thickness of the retinal GCC becomes thinner.There was no correlation between GCC thickness changes in four quadrants and postoperative retinal sensitivity(all P> 0.05).The average area of DONFL has a negative correlation with the percentage of fixation points in the range of 2 °(correlation coefficient is-0.553 P = 0.04 <0.05),and the average area of DONFL has no correlation with CMS,MMS,and the percentage of fixation points within 4 °(P> 0.05),the number and total area of DONFL had no correlation with CMS,MMS,and the percentage of fixation points in the range of 2 ° and 4 °(all P> 0.05).There was no statistical difference in MMS,CMS,and the percentage of fixation points in the range of 2 ° and 4 °in the continuous and discontinued IS / OS layers in the two groups(all P> 0.05).There was a statistical difference in postoperative BCVA between the two groups(P<0.05).Preoperative CMS and MMS had good correlation with postoperative CMS and MMS(all P<0.05).Postoperative BCVA had a good correlation with preoperative BCVA and preoperative macular hole diameter(all P<0.05).There was a correlation between the preoperative hole diameter and postoperative MMS and CMS(all P<0.05).There was no significant correlation between postoperative macular foveal thickness and postoperative BCVA,postoperative MMS,and postoperative CMS(all P> 0.05).Conclusions:1.IMH patients underwent vitrectomy combined with internal limiting membrane peeling for 3 months after the thickness of GCC increased in the nasal quadrant and the thickness of GCC in the infratemporal quadrant became thinner;2.The CMS and MMS of the postoperative patients were significantly improved compared with the preoperative ones.The average retinal sensitivity of the four quadrants after the operation was not significantly changed compared with the preoperative ones,and the fixation point stability decreased in the short term after operation;3.Changes in GCC thickness in the four quadrants of postoperative patients did not cause a decrease in mean postoperative retinal sensitivity;4.DONFL appearing after exfoliation has no significant effect on retinal sensitivity in the macular area;5.Preoperative CMS and MMS can be used as predictors of postoperative visual recovery in patients with IMH.