目的：探讨玻璃体切除(par plana vitrectomy，PPV)+视网膜内界膜(inner limiting membrane，ILM)平铺覆盖+玻璃体腔消毒空气填充术与PPV+ILM剥除+玻璃体腔消毒空气填充术治疗巨大型特发性黄斑裂孔(idiopathic macular hole，IMH)和高度近视黄斑裂孔(macular hole，MH)的疗效差异。

方法：选取巨大型IMH 40眼，巨大型高度近视性MH 40眼的临床资料进行临床对照研究。20眼巨大型IMH患者行传统ILM剥除(A1组)，余20眼行ILM平铺覆盖(A2组)； 20眼巨大型高度近视性MH行传统ILM剥除(B1组)，余20眼行ILM平铺覆盖(B2组)。术后随诊6mo以上，对比分析MH的闭合率、手术前后最佳矫正视力(best corrected visual acuity， BCVA )改善情况。

结果：A组患者手术前后BCVA改善情况差异有统计学意义(F_时间=96.193，P_时间<0.01， F_组间=4.971，P_组间=0.03，F_交互=18.772，P_交互<0.01)； 对不同时间点进行两两比较，结果显示：术前和术后1、3、6mo之间，术后1mo与3、6mo，术后3mo与术后6mo之间差异均有统计学意义(P<0.05)，比较不同时间两组之间的t检验结果显示，A1和A2在术前视力差异无统计学意义(P>0.05)，术后1、3、6mo差异均有统计学意义(P<0.05)。 B组患者手术前后BCVA改善情况差异有统计学意义(F_时间=136.150，P_时间<0.01， F_组间=5.179，P_组间=0.029， F_交互=7.079，P_交互=0.001)； 对不同时间点进行两两比较，结果显示：术前和术后1、3、6mo之间，术后1mo与3、6mo，术后3mo与术后6mo之间差异均有统计学意义(P<0.05)，比较不同时间两组之间的t检验结果显示，B1和B2在术前视力差异无统计学意义(P>0.05)，术后1、3、6mo差异均有统计学意义(P<0.05)。随访6mo，A1组裂孔闭合16眼(80%)，4眼(20%)贴附，A2组裂孔闭合20眼(100%)； B1组裂孔闭合14眼(70%)，6眼(30%)贴附，B2组中裂孔闭合18眼(90%)，2眼(10%)贴附。A1组和A2组组间在黄斑裂孔闭合率上差异无统计学意义(P=0.053)，B1组和B2组组间在黄斑裂孔闭合率上差异无统计学意义(P=0.118)，视网膜内界膜剥除组裂孔闭合30眼(75%)，10眼(25%)贴附和平铺覆盖组黄斑裂孔闭合38眼(95%)，2眼(5%)贴附，差异有统计学意义(χ²=4.057，P<0.05)。

结论：对于巨大型IMH和巨大型高度近视MH患者，ILM平铺覆盖治疗组在闭合率及BCVA提高上明显优于ILM剥除组。

METHODS: The clinical data of giant IMH 40 eyes and giant high myopia MH 40 eyes were compared. Twenty patients with giant IMH underwent traditional ILM removal(Group A1), the remaining 20 underwent ILM flat transplantation(Group A2); 20 underwent traditional ILM removal(Group B1)for giant high myopic MH, and the remaining 20 underwent ILM flat transplantation(Group B2). The closure rate of MH and the improvement of best corrected visual acuity(BCVA)before and after operation were compared and analyzed.

RESULTS: There were significant differences in BCVA before and after operation in Group A(F=96.193, P<0.001), between A1 and A2(F=4.971, P=0.03), and the interaction between different time points and groups after operation(F=18.772, P<0.001). The results showed that there were significant differences of the two groups between any two time point(P<0.05). The t-test results between the two groups at different time showed that there was no difference in preoperative vision between A1 and A2(P>0.05). There were significant differences in preoperative visual acuity between the two groups at 1, 3 and 6mo after operation(P<0.05). There were significant differences in different time points before and after BCVA in Group B(F=136.150, P<0.001), B1 and B2(F=5.179, P=0.029), and the interaction between different time points and groups after BCVA(F=7.079, P=0.001). The results showed that there were significant differences of the two groups between any two time point(P<0.05). The results of t-test between the two groups at different time showed that there was no difference in preoperative visual acuity between B1 and B2(P>0.05), but there was significant difference in 1, 3 and 6mo after operation(P<0.05). After 6-month follow-up, the closure rate of Group A1 was 80%, attached rate was 20%, closure rate of Group A2 was 100%. There was no significant difference in closure rate between Group A1 and Group A2(P=0.053). The closure rate of Group B1 was 70%, attached rate was 30%, closure rate of Group B2 was 90%, attached rate was 10%. There was no significant difference in closure rate between Group B1 and Group B2(P=0.118). There was significant difference in closure rate between retinal initial membrane stripping group and plaster group(75% vs 95%, χ²=4.057, P<0.05).

CONCLUSION: For giant IMH and giant high myopia MH, there was significant difference in closure rate and BCVA improvement between ILM stripping group and covering group, on which the former is better.