ObjectiveTo observe the clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane (ILM) flap covering technique for complicated macular hole (MH).MethodsThis is a retrospective case series. Twenty-one eyes of 20 patients who underwent vitrectomy combined with modified inverted ILM flap covering technique were enrolled in this study. Among these eyes, 9 eyes were idiopathic MH (IMH), with the mean basal diameter of (1 188.3±155.1) μm, minimum diameter of (626.9±86.2) μm, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) of 1.1±0.3; 2 eyes were MH with high myopia, with the mean basal diameter of (696.5±232.6) μm, minimum diameter of (259.0±69.3) μm, logMAR BCVA of 1.3; 5 eyes were high myopia MH with retinal detachment (RD), with the mean BCVA of 1.5±0.1; 3 eyes were rhegmatogenous RD (RRD) with MH, with the mean logMAR BCVA of 1.6; 2 eyes were MH after vitrectomy for RRD, with the mean basal diameter of (1 606.0±69.3) μm, minimum diameter of (909.0±387.5) μm, logMAR BCVA of 1.6. All patients received 23G or 25G vitrectomy after removal of posterior vitreous cortex intraoperatively. Indocyanine green staining assisted circle-wise ILM peeling was performed. ILM of diameter 1.5 disc-diameters around fovea was residual and loosened; perfluoronoctane assisted inverting superior or temporal residual ILM covering on macular hole. C3F8, gas or silicone oil tamponade was performed at the end. BCVA and hole closure were followed up for 1-4 months. C3F8, gas or silicone oil was tamponaded at the end. BCVA and hole closure were followed up for 1-4 months.ResultsMH of 21 eyes were closed after surgery. Nine IMH were closed at typeⅠ, with U shape closure in 7 eyes, V shape closure in 2 eyes. Two eyes of MH with high myopia, 3 eyes of RRD with MH, 2 eyes of MH after vitrectomy for RRD were closed at typeⅠ of U shape. Five eyes of high myopia MHRD including MH closure at typeⅠof U shape 3 eyes, typeⅡ of W shape 2 eyes. The mean logMAR BCVA of IMH, MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes were 0.8±0.3, 0.9±0.2, 1.4±0.1, 0.7±0.3, 0.9±0.2, respectively. The mean postoperative logMAR BCVA in IMH eyes was improved compared preoperative one (P=0.02). There was no obvious change of pre-and postoperative logMAR BCVA in MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes (P=0.18, 0.10, 0.11, 0.18).ConclusionVitrectomy combined with inverted ILM flap covering technique for complicated MH is an effective method to improve the success rate of MH closure and the visual function.
Objective To observe the efficacy of lamellar hole-associated epiretinal proliferation (LHEP) flap insertion and autologous blood for degenerative type lamellar macular hole (LMH). Methods Retrospective case review. Twenty-eight eyes of 28 patients with LMH were enrolled in this study. There were 2 males (2 eyes) and 26 females (26 eyes). Best corrected visual acuity (BCVA), medical optometry, slit-lamp biomicroscop, indirect ophthalmoscope, spectral domain optical coherence tomography, b-scan ultrasonography and axial length detection were performed on all patients. Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. There were 10 eyes (35.7%) with degenerative type LMH (flap insertion group) and LHEP. There were 18 eyes (64.3%) with tractional type LMH (general group). The differences of BCVA, AL, horizontal hole diameter from retina and lens state between two groups were not significant (P＞0.05). The differences of horizontal hole diameter of internal limiting membrane (ILM), central foveal thickness (CFT) and integrity of ellipsoidal zone between two groups were significant (P＜0.05). LHEP flap insertion and autologous blood without ILM peeling were used in eyes of flap insertion group. Vitrectomy combined ILM peeling were used in eyes of general group. The follow-up was ranged from 3 to 14 months. The changes of CFT, central foveal form and logMAR BCVA were observed. Results At latest follow-up, the BCVA of flap insertion group and general group were 0.34±0.27, 0.31±0.29; which significantly better than the preoperative BCVA (Z=−3.519, −4.945; P＜0.001). The CFT of flap insertion group and general group were (200.10±58.78), (226.61±70.49) μm. There was no difference between pre- and post-operative CFT in eyes of general group (Z=−1.455, P=0.146). There was significant difference between pre- and post-operative CFT in eyes of flap insertion group (Z=−2.798, P=0.005). In flap insertion group, regular recovery of the foveal contour occurred in 9 eyes (90.0%), improvement in 1 eyes (10.0%). In general group, regular recovery of the foveal contour occurred in 10 eyes (55.6%), improvement in 8 eyes (44.4%). The closure rate of LMH were 100% both in two groups. Conclusion LHEP flap insertion and autologous blood is an effective treatment of degenerative type LMH.