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用于黄斑裂孔手术的无需额外皮瓣的反向内界膜瓣技术 INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLE SURGERY WITHOUT EXTRA MANIPULATION OF THE FLAP

Casini, G., Mura, M., Figus, M., et al.

期刊名称:Retina

卷期:2017年第37卷第11期

关键词:
裂孔 皮瓣 黄斑

摘要

摘要:目的:旨在确定内界膜(ILM)内侧缘瓣的手术操作步骤,如ILM整理,ILM孔内打结,ILM按压等,对修复巨大IV期特发性黄斑裂孔是否能获得满意的预后。方法:在这项介入性比较前瞻性单盲研究中,将81只眼随机分为2个治疗组。在第1组(41只眼)中,进行了典型的反向ILM皮瓣技术。在第2组(40只眼)中,使用一种改良的操作:在ILM剥离之后,不进行额外的皮瓣操作。由于流体-空气交换时的气压,黄斑孔被反向ILM瓣覆盖。结果:12个月时,第140只眼(97.6%)和第239只眼的黄斑裂孔闭合(97.5%)。两组的U型闭合率,椭球区缺损和外界界膜缺陷相似。结果显示,两组解剖和功能成功率无统计学差异。结论:改良的反向ILM技术的黄斑孔闭合率,视力提高,无并发症,提示非劣性。为了获得手术成功,可能不需要内界膜整理,打结和按压。

PURPOSE:To determine whether surgical manipulation steps of the internal limiting membrane (ILM) flap, such as ILM trimmed, ILM tuck inside the hole, ILM massage, are mandatory to obtain satisfactory outcomes for the repair of large stage IV idiopathic macular hole using the inverted ILM flap technique.METHODS:In this interventional comparative prospective single-masked study, 81 eyes were randomized into 2 treatments groups. In Group 1 (41 eyes), the classic inverted ILM flap technique was performed. In Group 2 (40 eyes), a modified procedure was used: after ILM peeling, no extra flap manipulation was performed. The macular hole was covered by the inverted ILM flap because of the air pressure at the time of the fluid-air exchange.RESULTS:At 12 months, macular hole closure was observed in 40 eyes (97.6%) in Group 1 and in 39 eyes in Group 2 (97.5%). U-shape closure rate, ellipsoid zone defects, and external limiting membrane defects were similar in both groups. The results indicate no statistical difference in anatomical and functional success between both groups.CONCLUSION:The macular hole closure rate, improved visual acuity, and no extra complications indicate noninferiority of the modified inverted ILM technique. Internal limiting membrane finishing, tucking, and massage may not be required to obtain surgical success.


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