| Objective:It aims to assess the efficacy and security of inverted internal limiting(ILM)membrane flap in operating retinal detachment with macular hole in high myopia,and to compare it with the efficacy of ILM peeling.Methods:Forty patients(40 eyes)of retinal detachment with macular hole in high myopia who were examined and diagnosed in our hospital from February 2020 to December2020 were selected for the study.The patients were randomly divided into two groups:flap group(n = 20)and peeling group(n = 20).Vitrectomy combined with internal limiting membrane flap was performed in the flap group,and vitrectomy combined with ILM peeling was performed in the peeling group.All patients underwent the best corrected visual acuity(BCVA),intraocular pressure(IOP),fundus examination,macular OCT and axial length measurement.The patients were followed up for 6months,and the BCVA,recovery outcomes of macular hole and retinal reattachment were compared and analyzed with the two groups.Results:1.There was no significant difference in average age,course of disease,IOP,ocular axis length,preoperative BCVA and preoperative narrowest diameter of the hole between the two groups(P > 0.05).2.Comparison of BCVA at each follow-up period of postoperative between the two groups: there was no statistical difference in BCVA between the two groups in 1week,1 month,3 months and 6 months after operation.(P = 0.620 > 0.05,P= 0.678 >0.05,P = 0.306 > 0.05,P = 0.517 > 0.05).3.The BCVA of the two groups were compared with those before operation at each follow-up period: there was no distinct difference in the BCVA in 1 week after operation compared with before operation in the two groups(P = 0.231 > 0.05,P =0.149 > 0.05).In the flap group,the BCVA in 1 month,3 months and 6 months after operation were better than those before operation(P = 0.006 < 0.05,P = 0.000 < 0.05,P = 0.000 < 0.05).Meantime,the BCVA in 1 month,3 months and 6 months after operation in the peeling group were also better than those before operation(P = 0.043< 0.05,P = 0.000 < 0.05,P = 0.000 < 0.05).4.Comparison of the changes of BCVA of postoperative between the two groups at each follow-up period: there was no significant difference between the two groups.There was no significant difference between the two groups in that the average p is greater than 0.05 in 1 week,1 month,3 months and 6 months after operation.5.Comparison of the MH closure rate between the two groups in 6 months after operation: Observing the MH closure of the two groups in 6 months after operation,it was found that the MH closure rate of the overlay group was 100%(20 cases),of which type I closure accounted for 90%(18 cases),and type II closure accounted for10%(2 cases),while the removal group MH closure rate was 80%(16 cases),of which type I closure accounted for 40%(8 cases),and type II closure accounted for40%(8 cases).Six months after operation,the MH closure rates between groups were compared.In terms of statistics,the type I closure rate,type II closure rate and unclosed rate in the flap group were better than those in the peeling group(P = 0.01,< 0.05,P = 0.028,< 0.05,P = 0.035,< 0.05).6.Comparison of the retinal detachment reduction rate between the two groups in 6 months after operation: RD was restored in both groups after the first operation,and no retinal detachment was found in both groups after operation.7.No ocular and systemic complications such as secondary glaucoma,endophthalmitis,intraocular hemorrhage,and recurrence of retinal detachment etc.were found in this study.Conclusion:1.Compared with ILM peeling,ILM flap is more efficient in improving the closure rate of macular hole,but the improvement of BCVA is not distinct.2.With the improvement of surgical methods,inverted internal limiting membrane flap may become the standard treatment for MHRD patients in high myopia in the future. |
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