| Objective: 1.To observe and analyze the influence of the internal limiting membrane(ILM)tamponade on visual outcome,macular microstructure and the closure rate after surgery in the surgical treatment of Idiopathic Macular Holes(IMH).2.Observe the characteristics of submacular choroidal thickness in eyes with IMH.Methods: A total of 27 patients(27 eyes)with IMH who were admitted to the hospital for surgical treatment from September 2018 to October 2020 were collected.High myopia,ocular trauma,and other ocular or systemic diseases that may affect eyesight were excluded.The patients with the minimum liner diameter(MLD)of 400-1000 um were prospectively grouped by random function.According to whether ILM tamponade was performed during the operation,they were divided into the ILM tamponade group and the simple ILM peeling group.There were 13 cases(13 eyes)in the ILM tamponade group and 14 cases(14 eyes)in the simple ILM peeling group.And the healthy eyes were set respectively as healthy control group 1 and healthy control group 2.All patients were asked for a detailed medical history,and undertook the best corrected visual acuity(BCVA),enhanceddepth imaging optical coherence tomography(EDI-OCT)and multifocal electroretinogram(mf ERG)etc.All casas underwent 23 G,25G vitreous surgery performed by the same surgeon.After the operation,the patients were followed up for no less than 3 months to observe and compare the clinical characteristics,closure rate,visual function recovery,and macular microstructure changes between the two groups.In the outpatient clinic,patients who did not suffer from choroidal diseases were randomly selected as healthy control group,and the difference in macular choroidal thickness between MH eye,MH healthy eye and healthy control group was compared and analyzed.Results: 1.General information: A total of 27 cases(27 eyes)were conclude in this study,including 5 male patients and 22 female patients.The male to female ratio was 1:4.4,and the age was 55 to 70 years old.The average age was 63.56±3.73 years old.The preoperative MH diameter was 419 to 845 um,the average is 590.48±111.15 um.The preoperative MH diameter of the ILM tamponade group was 448-845 um,with an average of 628.85±111.86 um,and the preoperative MH diameter of the simple ILM peeling group was 419-780 um,with an average of 554.86±101.58 um.There was no statistical difference in the preoperative data between the two groups.2.Postoperative macular hole closure: 13 cases(13 eyes)in the ILM tamponade group,13 cases of the hole were completely closed,and the IMH closure rate was 100%(13/13).In the simple ILM peeling group,14 cases,14 eyes,12 cases were completely closed,MH closure rate was 85.71%(12/14),there was no statistical difference in closure rate between the two groups.3.Visual outcome: The average log MAR BCVA of preoperative,1 month and 3 months after operation in the ILM tamponade group were 1.81±0.58,0.98±0.26,and 0.75±0.38.The average log MAR BCVA of preoperative,1 month and 3 months after operation in the ILM peeling group were 1.98±0.7,0.77±0.29,0.61±0.20.The postoperative visual acuity of the two groups were improved compared with that before the operation,and there were statistically significant difference.There was no statistical difference in visual outcome of preoperative and after operation between the two groups.4.Postoperative complications: There were no postoperative complications in both two groups.5.The outcomes of OCT: Preoperative minimum liner diameter(MLD),MH height(H),MH diameter index(DHI),tractional hole index(THI),MH index (macular hole index),MHI),hole form factor(HFF),etc..were not statistically different.During the postoperative follow-up period,the ILM tamponade group and the simple ILM peeling group with the defective diameter of external limiting membrane(ELM),photoreceptor inner-outer segment junction(IS/OS),and the cone outer segment tips(COST)line was reduced compared with that before operation,and there were statistically significant differences.Compared with the simple ILM peeling group,the recovery of ELM and IS/OS lines in the tamponade group was slightly worse,and there were statistically significant difference.6.Multifocal electroretinogram(mf ERG): The peak values of ring 1 and ring 2 of mf ERG in the preoperative tamponade group and the simple ILM peeling group were smaller than those of their control groups.The ring peaks were significantly higher than those before surgery,and there was no statistical difference between the two groups.7.Submacular choroidal thickness: The average of the submacular choroidal thickness(SFCT)of the preoperative IMH eyes,the healthy eyes and the control group were 214.08±56.85,230.0±41.23,258.24±30.60.Compared with the control group and the IMH eyes,there were statistically significant difference.And there is no statistical difference between IMH eye and the healthy eyes,and the healthy eyes and control group.There was no significant difference in the submacular choroidal thickness after surgery compared with that before surgery.Conclusion: 1.In the treatment of large IMH,vitrectomy combined with ILM tamponade is a safe and effective surgical treatment,which can improve the closure rate of large IMH.2.In the recovery of macular microstructure,the simple ILM peeling group is better than the ILM tamponade group,which may be related to the glial proliferation caused by the ILM flap in the IMH. 3.There was no significant difference between the ILM tamponade group and the simple ILM peeling group in postoperative visual acuity,mf ERG etc..mf ERG can assist in evaluating the visual function of patients with IMH before and after operation.4.The SFCT of IMH eyes was significantly less than control group,and there was no significant difference in macular choroid thickness between the tamponade group and the simple ILM peeling group before and after operation.The reduction of the submacular choroidal thickness may play a important role in the mechanism of IMH,and It needs to be given clinical attention. |
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