New perspectives on macular hole surgery at three years of follow-up

ABSTRACT Purpose: The aim of this study was to determine the functional and anatomical success rates as well as the safety of sutureless combined surgery involving vitreous base removal and internal limiting membrane peeling after Brilliant Blue G (0.5 mg/mL) staining for the management of idiopathic macular holes after three years. Methods: Forty-six eyes of 46 patients with an idiopathic macular hole were enrolled in this retrospective study. The inclusion criteria were macular holes with a minimum linear diameter below 1,500 mm, 0.05 or better decimal best-corrected visual acuity and duration of symptoms less than two years. The exclusion criteria included pregnancy, optic nerve atrophy, advanced glaucoma, and other chronic ocular diseases. The surgical procedure included internal limiting membrane peeling after Brilliant Blue G (0.5 mg/mL) staining, along with C3F8 tamponade and face-down positioning for three days postoperatively. Ophthalmologic examinations and optical coherence tomography were performed at 1 and 7 days and 1, 6, 12, 24, and 36 months postoperatively. If no anatomic closure of the macular holes occurred within the first month, the area of the internal limiting membrane peeling was enlarged in a second procedure. Multiple logistic regression and chi-squared tests were used for data analyses, and p-values of &lt;0.05 were considered significant. Results: Out of 46 eyes with a preoperative idiopathic macular hole, anatomic closure was achieved in 42 (91.3%) after one procedure and in 45 (97.8%) after an additional surgery. The median postoperative best-corrected visual acuity improvement was 0.378 (range: 0.050-0.900) decimal. None of the patients experienced macular hole reopening, surgery-related complications, or ocular complications related to the dye. Conclusion: Combined surgery including vitreous base removal and internal limiting membrane peeling after staining with Brilliant Blue G (0.5 mg/mL) for the management of idiopathic macular holes resulted in adequate staining, best-corrected visual acuity improvement, and macular hole closure with no signs of ocular toxicity at the three-year follow-up examination.摘要 目的：本研究旨在明确术后3年时，采用亮蓝G（Brilliant Blue G，0.5 mg/mL）染色后行无缝合联合手术（玻璃体基底部切除（vitreous base removal）联合内界膜（internal limiting membrane）剥除术）治疗特发性黄斑裂孔（idiopathic macular holes）的功能预后、解剖成功率及安全性。 方法：本回顾性研究纳入46例特发性黄斑裂孔患者的46只患眼。纳入标准为：黄斑裂孔线性最小直径低于1500mm、小数视力法下最佳矫正视力0.05及以上，且症状持续时间少于2年。排除标准包括妊娠、视神经萎缩、进展期青光眼及其他慢性眼部疾病。手术步骤为：采用亮蓝G（0.5 mg/mL）染色后行内界膜剥除术，联合C3F8眼内填充及术后3天俯卧位。术后1天、7天及1、6、12、24、36个月行眼科检查及光学相干断层扫描（optical coherence tomography）。若术后1个月内未实现黄斑裂孔解剖闭合，则于二次手术中扩大内界膜剥除范围。数据分析采用多因素logistic回归分析与卡方检验，以p值<0.05为差异具有统计学意义。 结果：术前确诊为特发性黄斑裂孔的46只患眼中，首次手术后42只（91.3%）实现解剖闭合，追加手术后共45只（97.8%）实现解剖闭合。术后中位最佳矫正小数视力提升量为0.378（范围：0.050~0.900）。所有患者均未出现黄斑裂孔复发、手术相关并发症或与染色剂相关的眼部并发症。 结论：采用亮蓝G（0.5 mg/mL）染色后行玻璃体基底部切除联合内界膜剥除术治疗特发性黄斑裂孔，可实现良好的染色效果，显著提升最佳矫正视力，实现黄斑裂孔闭合，且在3年随访中未观察到眼部毒性迹象。