The Healing Process and Functional Recovery of Neuroretina after Idiopathic Macular Hole Surgery without Internal Limiting Membrane Reversal Tamponade.

Xinlei Zhu,Haoyu Chen,Bo Huang,Jiaxing Wang,Hua Yan,Jianan Li

doi:10.1155/2020/2478943

Abstract

Purpose To investigate the healing process and functional recovery of neuroretina after idiopathic macular hole surgery, as well as analyzing the influencing factors. Methods Thirty-six eyes of 31 patients with full-thickness idiopathic macular hole (IMH) were enrolled in this retrospective study. All of them were operated using 23-gauge or 25-gauge vitrectomy with inner limiting membrane peeling and air tamponade. Spectral-domain optical coherence tomography was performed before surgery and after surgery to observe the structural changes of neuroretina. Results Twenty eyes (55.56%) had the macular hole closed at 3 to 5 days after surgery (closed group), beginning from the inner retina based on OCT. Holes of 16 eyes (44.44%) remained unclosed and progressed to larger holes at 13 to 15 days (t = −2.811, P=0.013) after surgery (unclosed group). Compared with the eyes in the closed group, the eyes in the unclosed group had significantly larger hole diameter (t = −2.882, P=0.007). Postoperative BCVA was significantly improved in the closed group (t = 2.573, P=0.019) and not improved in the unclosed group (t = 0.606, P=0.554) at the 6-month follow-up. Conclusion Full-thickness IMHs could achieve anatomic closure 3 to 5 days after surgery with first-step inner retina tissue bridging. Otherwise, they were not able to achieve hole closure and opened to larger holes about 2 weeks postoperatively. Macular hole diameter was an important factor affecting the healing of the holes. The delayed restoration of fovea detachment and ellipsoid area deficiency were responsible for poor vision outcomes after surgery.

Highlights

Idiopathic macular hole (IMH) is an eye disease which severely threatens the patient’s vision and quality of life
Closed group were eyes which achieved anatomic closure of the holes after surgery based on OCT, while the eyes with holes remained unclosed 6 months after surgery were in the unclosed group
Clinical Characteristic. irty-one full-thickness IMH patients were enrolled in our study. e mean age of patients was 66.08 years old with a range of 54 to 81 years old

Summary

Introduction

Idiopathic macular hole (IMH) is an eye disease which severely threatens the patient’s vision and quality of life. E surgical method of internal limiting membrane (ILM). Peeling was described by Eckardt et al in 1997 which improved the closure rate of idiopathic macular holes [11]. In 2010, Michalewska et al proposed inverted internal limiting membrane flap technique for the treatment of large macular holes [12], which became a general practice by most surgeons in recent years. Yamashita et al had reported that inverted ILM flap technique could improve the success rate of surgery, but the differences were not statistically significant [13, 14]. Vitrectomy combined with internal limiting membrane peeling and intraocular tamponade was an effective way to close the hole and improve the visual acuity. Vitrectomy combined with internal limiting membrane peeling and intraocular tamponade was an effective way to close the hole and improve the visual acuity. e current closure rate of Journal of Ophthalmology

Results

Discussion

Conclusion