| Objective:To explore the natural pathogenesis, prognosis of visual function and anatomy after surgery on traumatic macular hole, instruct the selection of treatment between conservative therapy,also the time of operation, by the prospective observational study on traumatic macular hole.Method:Tracking the histological variation at all stages of traumatic macular hole by OCT, the response densities of wave PI of five concentric ring zone by mf-ERG were underwent conservative therapy, visual function used by Amsler grid and VA. The Follow-up detection time: at 1st,3rd,4th,6th,8th 12thmonth after injury and 1st,3rd,4th,6th months after operation respectively. The histological and visual function features at all stages of TMH and their correlation was analyzed statistically in holes closed and unclosed. Among TMH who are not self-closed followed-up 4 months after injury,,following,11 patients received surgical treatment with the principle of voluntary. The surgical treatment was pars plana vitrectomy with internal limiting membrane peeling, and air tamponade.Result:1,(1) In 9 of the 30 (30%)conservative cases, the macular hole disappeared spontaneously 1 month to 3 months(average 2.83 months) after trauma, except one case in the 6th month, the diameter of the hole is 56μm～301μm(average 250.67). The diameter of the hole non-disappeared, is 323μm～654μm(average 464.00μm).In 15 of the 21 holes non-disappeared had traumatic cataract, traumatic hyphema, vitreous hemorrhage, and Retina-Choroid rupture near the macular hole. The hole diameter is less in spontaneous closure group than in the hole non-disappeared (t=2.58, P=0.038). (2) In 7 of the 9 (77.8%) eyes had visual acuity improved(≥2 lines), the response densities of wave PI of ring 1 were higher than before,with no difference from control group after the hole closed 3 months.the VA and response densities of wave PI of the 1,2,4 rings were no longer varied and kept lower than control group throughout the follow-up time in holes nondisappeared 6 months after injury (P>0.05). The number of squares representing distortion on Amsler chart smaller in holes disappeared spontaneously(F =13.12,P=0.002), the number decreased in both group,faster (F=12.17,P=0.002)in the holes undisappeared in conservative cases. 2,In 7 of the 11 eyes (63.6%) underwent surgery the TMH was closed completely,with the diameter of the hole239μm～447μm(average 329.0),5 of the 7(71.42%) eyes visual acuity improved(≥2 lines),the number of squares representing distortion on Amsler chart decreased (P <0.05),the response densities of wave PI of ring 1 higher than before after the hole closed 4 months. In 4 of the 11 eyes (36.4%) the MH was not closed, with the diameter of the hole is 325μm～1060μm(average 731.67),visual acuity decreased in one case 3 months after the operation, all the 4 eyes had the anterior segment injury,vitreous hemorrhage,retina-Choroid rupture extensively near the macular hole.Two cases were operated one year later.the number of squares representing distortion on Amsler chart decreased.3,The hole diameter not closed gradually stabilized 6 months in operation group,and unstabilized 12 months later in conservative treatment group after injury, and the epiretinal membranes occur in five cases of the conservative group. Visual distortion of the grid decreased faster in surgical group (F=8.055,P=0.015)There were no correlations between VA and mf-ERG and the number of squares representing distortion on Amsler chart in holes nondisappeared of the conservative treatment cases 6months later.Two retina separation about 624μm between neural epithelium and pigment epithelium spontaneous recovery over the follow-up period and no case PVDConclusion:The traumatic macular hole can close spontaneously, but most with severe choroidal and other organizations hurt, affecting hole self-closing rate. The visual function improved when the hole closed postoperately or spontaneously. no obviously improved found on anatomy and visual function when the hole is too big, Retina-Choroid rupture involving the macula seriously,too long time away from injury. such as eye injury with small diameter, slight Retina-Choroid rupture far away from macular,may closed spontaneously, with visual function improved,should do conservative therapy for 2 to 3 months.or do operation.
|
PDF Full Text Request