Authors: Hao Yuhua, Xi Ruijie, Han You, Tian Xiaoyu, Dai Li, Shi Junfang
Giant idiopathic macular hole (IMH) severely affects visual acuity and increases operative difficulty during the surgery, so modifying or optimizing the operation method is helpful for improving the prognosis.
This study aimed to evaluate the efficacy and safty of vitrectomy combined with free internal limiting membrane transplantation for large IMH.
A prospective serial cases-observational study was carried out under the informed consent of each patient.Forty-two eyes of consecutive 42 patients with IMH of mean diameter (814.31±112.95)μm were included in the Second Hospital of Hebei Medical University from January 2013 to November 2015.All the eyes received vitrectomy combined with free internal limiting membrane transplantation and 12% C3F8 filling.The best corrected visual acuity (BCVA) (LogMAR), inner segment/outer segment (IS/OS) defect range, external limiting membrane defect range, retinal thickness at macular fovea were measured with slit lamp microscope, indirect ophthalmoscope and spectral-domain optical coherence tomography (SD-OCT) before surgery and 1, 3, 6 and 12 months after surgery.
IMH complete closure in 97.6% eyes (41/44) at 12 months after surgery.BCVA was improved after operation and showed a significant difference among various time points (F=28.032, P<0.001). The IS/OS defect range was (1 112.00±45.44), (859.00±84.55), (649.00±52.47), (486.00±46.88) and (320.00±45.13)μm before surgery and 1, 3, 6 and 12 months after surgery, showing a significant difference among different time points (F=38.761, P<0.001), and the IS/OS defect range was gradually shrinked after operation compared with that before operation (all at P<0.05). The mean defect range of external limiting membrane was (1 038.00±39.63), (748.00±64.12), (585.00±48.88), (438.00±42.84) and (265.00±28.97)μm before surgery and 1, 3, 6 and 12 months after surgery, with a significant difference among various time points (F=36.459, P<0.001), and the mean defect range of external limiting membrane was evidently reduced (all at P<0.05). The foveal retinal thickness value was increased at 3, 6 and 12 months after surgery, which was significantly higher than that 1 month after surgery (all at P<0.05). The high reflect signal was faded away at 3 months after operation, indicating that implanted internal limiting membrane was decomposed and metabolized.
Vitrectomy combined with autologous internal limiting membrane transplantation seems to be safe and effective for large IMH.