Clinical outcomes of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole

Q4 Medicine

中华眼底病杂志 Pub Date : 2019-11-25 DOI:10.3760/CMA.J.ISSN.1005-1015.2019.06.009

Shuxia Xu, Guanfang Su

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The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index(THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery. \n \n \nResults \nClosure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, - 6.151; P<0.01,<0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf- ERG (r=-0.34, -0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM(r=-0.449, -0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation. \n \n \nConclusions \nVitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA. \n \n \nKey words: \nRetinal perforations/surgery; Vitreoretinal surgery; Air; Treatment outcome; Influence factors","PeriodicalId":10103,"journal":{"name":"中华眼底病杂志","volume":"35 1","pages":"564-570"},"PeriodicalIF":0.0000,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"中华眼底病杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3760/CMA.J.ISSN.1005-1015.2019.06.009","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 1

Abstract

Objective To observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH). Methods A prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index(THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery. Results Closure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, - 6.151; P<0.01,<0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf- ERG (r=-0.34, -0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM(r=-0.449, -0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation. Conclusions Vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA. Key words: Retinal perforations/surgery; Vitreoretinal surgery; Air; Treatment outcome; Influence factors

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玻璃体切除术联合内限制膜剥离和空气填塞治疗特发性黄斑裂孔的临床效果

目的观察玻璃体切除术联合内限定膜剥离和空气填塞治疗特发性黄斑裂孔的临床效果。方法采用前瞻性、非随机对照病例队列研究。选取2016年9月至2017年1月在吉林大学第二医院眼科就诊的20例IMH患者的20只眼作为研究对象。男性4例(4眼)，女性16例(16眼)，平均年龄60.60±9.50岁，平均病程9.55±15.5个月。黄斑孔分期为Ⅱ~Ⅳ。所有患者均行BCVA、眼压、光谱域OCT (SD-OCT)和多焦ERG检查。BCVA检查采用国际标准视力表，视力表转换为logMAR视力。采用SD-OCT(德国海德堡)测量黄斑孔的最小直径(MIN)、底直径(BD)、高度(H)、椭球区缺陷直径、外限制膜缺陷直径(ELM)。计算黄斑孔洞指数(MHI=H/BD)、孔洞牵引力指数(THI=MD/BD)和孔洞直径指数(DHI=H/MD)。用mf-ERG检测P1波的响应密度。logMAR BCVA为1.18±0.54。MIN小于400 μm者5眼，MIN 400-700 μm者13眼，MIN大于700 μm者2眼。所有患者均行玻璃体切除术并内限制膜剥离和空气填塞。根据术后SD-OCT图像特征，将IMH闭合分为Ⅰ闭合型、Ⅱ闭合型和未闭合型。随访时间等于或大于3个月。观察IMH、BCVA的闭合率及黄斑区微结构参数的变化。采用Spearman相关分析分析术前P1波响应密度与IMH术后疗效的BCVA相关性。结果IMH闭合率:18只眼(90.0%)完全闭上(均为Ⅰ闭上型)。MIN小于400 μm的黄斑孔闭合率为100.0% (5/5)，400 ~ 700 μm的为92.3%(12/13)，大于700 μm的为50%(1/2)。BCVA:术后1周、1个月、3个月的平均logMAR BCVA分别为0.83±0.54、0.65±0.41、0.48±0.34，术前、术后BCVA差异有统计学意义(t=3.382、4.459、5.250;P=0.003, 0.007, 0.004)。术后3个月SD-OCT检查结果:18眼(90.0%)眼外膜完整。椭球区缺损直径为260.34±272.08 μm，手术前后差异有统计学意义(t=13.545, P=0.002)。f- erg结果:术后环1、环2 P1波响应密度较术前增高(t=-16.748， - 6.151;P < 0.01, < 0.01)。Spearman相关分析结果:术后BCVA与术前MIN、椭球区缺损直径、ELM、术后椭球区缺损直径呈正相关(r=0.56、0.59、0.68、0.52;P=0.010, 0.006, 0.001, 0.019)。术后BCVA与mf- ERG环1、环2 P1波响应密度呈负相关(r=-0.34， -0.16;P = 0.006, 0.020)。IMH闭合度与MIN、ELM缺损直径呈显著负相关(r=-0.449， -0.449;P = 0.047, 0.047)。MHI、THI与井眼闭合度呈正相关(r=0.474、0.546;P = 0.035, 0.013)。随访期间2眼眼压升高，经降压药治疗后1周内恢复正常。手术中、术后均无并发症发生。结论玻璃体切除术联合内限定膜剥离和空气填塞治疗内腔粘连是安全有效的。MIN、MHI THI与IMH术后疗效显著相关，可作为预测和评价疗效的指标。mf-ERG P1波环1、环2响应密度较术前显著提高，且与BCVA呈负相关。关键词:视网膜穿孔/手术;手术适应症;空气;治疗效果;影响因素

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来源期刊

中华眼底病杂志 Medicine-Ophthalmology

CiteScore

0.40

自引率

0.00%

发文量

5383

期刊介绍： Chinese Journal of Ocular Fundus Diseases is the only scientific journal in my country that focuses on reporting fundus diseases. Its purpose is to combine clinical and basic research, and to give equal importance to improvement and popularization. It comprehensively reflects the leading clinical and basic research results of fundus disease disciplines in my country; cultivates professional talents in fundus disease, promotes the development of fundus disease disciplines in my country; and promotes academic exchanges on fundus disease at home and abroad. The coverage includes clinical and basic research results of posterior segment diseases such as retina, uveal tract, vitreous body, visual pathway, and internal eye diseases related to systemic diseases. The readers are medical workers and researchers related to clinical and basic research of fundus diseases. According to the journal retrieval report of the Chinese Institute of Scientific and Technological Information, the comprehensive ranking impact factor and total citation frequency of the Chinese Journal of Ocular Fundus Diseases have been among the best in the disciplines of ophthalmology, otolaryngology, and ophthalmology in my country for many years. The papers published have been included in many important databases at home and abroad, such as Scopus, Peking University Core, and China Science Citation Database (CSCD).