Delayed closure of highly myopic macular holes combined with retinoschisis after inverted internal limiting membrane flap.

IF 2.4 3区医学 Q2 OPHTHALMOLOGY Graefe’s Archive for Clinical and Experimental Ophthalmology Pub Date : 2024-11-09 DOI:10.1007/s00417-024-06678-5

Matteo Mario Carlà, Carlos Mateo

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引用次数: 0

Abstract

Purpose: To assess functional and anatomical outcomes of internal limiting membrane (ILM) inverted flap in highly myopic macular holes (HMMHs) with outer-retinoschisis (O-RS).

Methods: Retrospective interventional analysis of 19 eyes with HMMH and O-RS undergoing vitrectomy and ILM inverted flap. At baseline and every follow-up visit (1, 3, 6, 12 months and the most recent) we performed best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT), collecting several parameters: minimum linear diameter (MLD), basal diameter (BD), peri-HMMH nasal and temporal retinal thickness (RT_NAS and RT_TEM), peri-HMMH nasal and temporal O-RS height (O-RS_NAS and O-RS_TEM). The ratios O-RS_NAS/ RT_NAS and O-RS_TEM/RT_TEM were defined as %O-RS_NAS and %O-RS_TEM. Postoperatively, we distinguished classic HMMH closure (n = 14) from a newly described "delayed" closure pattern (n = 5).

Results: Primary anatomical closure was obtained in 89% of eyes. Mean BCVA improved from 0.23 ± 0.17 to 0.44 ± 0.20 and 0.46 ± 0.25 at 6-months and final follow-up (p = 0.009 and p = 0.001, respectively). At every follow-up, "classic" vs. "delayed closure" did not influence BCVA (all p > 0.05). Baseline O-RS_NAS (p = 0.026), O-RS_TEM (p = 0.04), %O-RS_NAS (p = 0.04) and %O-RS_TEM (0.004), were significantly associated with the "flap closure" pattern, differently from MLD and BD. In the "delayed closure" subgroup we reported a 100% closure rate, but 65.8 ± 64.4 days after first surgery. Meantime, OCT showed an inverted ILM flap covering an area of persistent tissue loss. O-RS_NAS and O-RS_TEM progressively reduced until HMMH closure.

Conclusion: Inverted flap is useful to close HMMH with O-RS. In case of "delayed closure" pattern, watchful-waiting allows for HMMH self-sealing, without impact on BCVA.

Key messages: What is known Inverted internal limiting membrane (ILM) flap showed favorable anatomic success in cases of highly myopic macular holes (HMMH). What is new HMMHs with outer retinoschisis (class 2c of the staging system) may close following a classic or "delayed closure" pattern. In cases of delayed closure, it took a variable range of 30-179 days to seal the HMMH but no further surgery was advisable. Post-operative BCVA improvement was not impacted at any follow-ups when comparing "delayed" and "classic" closure subgroups.

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倒置内缘膜瓣术后高度近视黄斑孔合并视网膜裂孔的延迟闭合。

目的：评估高度近视黄斑孔（HMMHs）合并外视网膜裂孔（O-RS）的内限膜（ILM）倒置瓣的功能和解剖效果：对19只接受玻璃体切除术和ILM倒置瓣手术的高度近视黄斑孔（HMMH）和外视网膜裂孔（O-RS）眼进行回顾性介入分析。在基线和每次随访（1、3、6、12 个月和最近一次随访）时，我们都进行了最佳矫正视力（BCVA，Snellen）和光学相干断层扫描（OCT），收集了几个参数：最小线性直径（MLD）、基底直径（BD）、HMMH 周围鼻侧和颞侧视网膜厚度（RTNAS 和 RTTEM）、HMMH 周围鼻侧和颞侧 O-RS 高度（O-RSNAS 和 O-RSTEM）。O-RSNAS/ RTNAS 和 O-RSTEM/RTTEM 的比率被定义为 %O-RSNAS 和 %O-RSTEM。术后，我们对典型的 HMMH 闭合（n = 14）和新描述的 "延迟 "闭合模式（n = 5）进行了区分：结果：89%的眼球获得了原发性解剖闭合。6个月和最后随访时，平均BCVA从0.23 ± 0.17提高到0.44 ± 0.20和0.46 ± 0.25（分别为p = 0.009和p = 0.001）。在每次随访中，"经典 "与 "延迟闭合 "对 BCVA 均无影响（均 p > 0.05）。基线 O-RSNAS（p = 0.026）、O-RSTEM（p = 0.04）、%O-RSNAS（p = 0.04）和%O-RSTEM（0.004）与 "皮瓣闭合 "模式显著相关，与 MLD 和 BD 不同。在 "延迟闭合 "亚组中，我们报告的闭合率为 100%，但在首次手术后 65.8 ± 64.4 天。同时，OCT 显示一个倒置的 ILM 瓣覆盖了一个持续组织缺失的区域。O-RSNAS和O-RSTEM逐渐缩小，直至HMMH闭合：结论：倒置皮瓣可用于关闭伴有 O-RS 的 HMMH。在 "延迟闭合 "模式的情况下，观察等待可使 HMMH 自行闭合，而不会影响 BCVA：已知信息在高度近视黄斑孔（HMMH）病例中，倒置内缘膜（ILM）瓣显示出良好的解剖效果。新进展伴有外层视网膜裂孔（分期系统中的 2c 级）的高度近视黄斑孔可能会按照经典或 "延迟闭合 "模式闭合。在延迟闭合的病例中，HMMH 的闭合时间从 30 天到 179 天不等，但不建议进一步手术。在比较 "延迟 "和 "经典 "闭合亚组时，术后BCVA的改善对任何随访都没有影响。

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来源期刊

Graefe’s Archive for Clinical and Experimental Ophthalmology 医学-眼科学

CiteScore

5.40

自引率

7.40%

发文量

398

审稿时长

3 months

期刊介绍： Graefe''s Archive for Clinical and Experimental Ophthalmology is a distinguished international journal that presents original clinical reports and clini-cally relevant experimental studies. Founded in 1854 by Albrecht von Graefe to serve as a source of useful clinical information and a stimulus for discussion, the journal has published articles by leading ophthalmologists and vision research scientists for more than a century. With peer review by an international Editorial Board and prompt English-language publication, Graefe''s Archive provides rapid dissemination of clinical and clinically related experimental information.