| Objective: To explore the efficacy of simple internal limiting membrane peeling versus internal limiting membrane tamponade in the treatment of larger idiopathic macular hole.Methods: A total of 21 patients(21 pairs of eyes)with larger idiopathic macular hole(diameter > 400 um)were enrolled at the Ophthalmology Department of the First Affiliated Hospital of Hainan Medical College from August 2020 to October 2021.The patients were divided into two groups using the randomized number table method.Ten patients(10 pairs of eyes)who received vitrectomy with limiting membrane peeling were assigned to group A,while the other 11 patients(11 pairs of eyes)who received vitrectomy with limiting membrane tamponade were assigned to group B.All of them received 23 G pars plana vitrectomy by the same surgeon.Before and after surgery,the patients underwent Snellen Table Visual Acuity Examination,Corrected Visual Acuity,Optical Coherence Tomography(OCT),and Optical Coherence Tomography Angiography(OCTA)were used to obtain the best corrected visual acuity(BCVA),IOP,central macular thickness(CMT),central macular foveal avascular zone area(FAZ),retinal vessel densities of the superficial capillary plexus(VSCP),and retinal perfusion densities of the superficial capillary plexus(PSCP)in the retinal.Then,according to the with OCT,the postoperative closure types were categorized as no closure type,irregular type,V type,and U type.Moreover,all patients were followed up for at least 3 months to observe and compare the clinical characteristics,closure rate,recovery of visual function,and macular microstructural changes between the two surgical groups.Results: 1.General clinical data: A total of 21 cases(21 pairs of eyes),five male patients and 16 female patients with a male to female ratio of 1:3,were recruited for this study.Patients aged 53-69 years,with a mean age of 61.14±5.37 years.The mean MLD(Minimum liner diameter)of group A was 686.60±132.68 um,while that of group B MLD was 684.70±127.34 um before operation.The preoperative data of the two groups were not statistically different(P > 0.05).2.Prognosis of visual acuity: The postoperative BCVAs were improved in both groups at 1 month and 3 months compared with the preoperative values,and the comparison was statistically significant(P < 0.05)within group,but the difference between the two groups was not statistically significant(P > 0.05).3.Macular fissure closure rate: In the group A,9 patients had a complete closure of hole after surgery,with a MH closure rate of 90%(9/10),while in group B,11 patients had a complete closure of hole after surgery,with a MH closure rate of 100%(11/11).There was no statistical difference in the closure rate between two groups.4.The results of OCT: The preoperative MLD,macular hole height(Height,H),tractional hole index(THI),Diameter hole index(DHI)and macular hole index(MHI)were not statistically different between the two groups(P > 0.05).The difference between the two groups was statistically significant(P < 0.05)for the thinner CMT at1 month and 3 months after surgery compared to the preoperative CMT,and there was no statistically significant difference in the preoperative and postoperative CMT between groups A and B.5.The results of OCTA: The FAZ area decreased at 1 month and 3 months after surgery compared with that before surgery in both groups,and the difference was statistically significant(P < 0.05),however,there was no significant difference when compared with the decreased values between two groups.There was no significant difference in the preoperative and postoperative temporal,superior,nasal,and inferior VSCP comparisons within group and between two groups.In group A,the nasal PSCP increased at 1 month and 3 months after surgery compared with that before surgery(P < 0.05),while the rest of the quadrants were not statistically significant different;However,in group B,the temporal PSCP decreased at 1 month and 3months after surgery compared with that before surgery(P < 0.05),while the rest of the quadrants were not statistically significant;The difference in postoperative PSCP between the two groups was not statistically different(P > 0.05).6.Correlation analysis of postoperative closure type: Group A showed a negative correlation between postoperative healing type and preoperative PSCP(r =-0.711,P= 0.021).In group B,the type of postoperative healing was positively correlated with the 1 month postoperative PSCP(r = 0.737,P = 0.015),and the 3 months postoperative PSCP(r = 0.696,P = 0.025).7.Postoperative complications: There was no postoperative complication observed in group A,while one case of postoperative IOP was observed in group B and returned to normal after treatment with IOP lowering.Conclusion: Both internal membrane limiting peeling and internal limiting membrane tamponade are safe and effective surgical procedures,and internal limiting membrane tamponade can improve the closure rate of macular hole to some extent.In addition,this study suggests that PSCP is related to the type of postoperative hole healing and can be used as a reference indicator to evaluate the type of hole healing. |
