目的：探讨玻璃体切除术(PPV)联合内界膜(ILM)翻转覆盖术或填塞术治疗底径大于1 000μm特发性黄斑裂孔(IMH)的有效性及安全性。

方法：回顾性临床研究。选取2018-01/2020-12在汕头国际眼科中心就诊的IMH底径大于1 000μm的56例患者57眼作为研究对象，根据手术方式的不同分为2组，其中PPV联合ILM翻转覆盖组30例30眼(组1)，PPV联合ILM填塞组26例27眼(组2)。分析两组患者术后1wk，1mo时最佳矫正视力(BCVA)、裂孔闭合情况、中心凹神经上皮层厚度及并发症，并探讨术后BCVA与术前参数的相关性。

结果：两组患者性别、年龄、眼别、病程、术前BCVA、裂孔分期、术前裂孔底径及眼轴长度均无差异(P>0.05)。组1患者裂孔闭合率为97%，其中1型闭合为80%； 组2患者裂孔闭合率为100%，其中1型闭合为78%，两组患者裂孔闭合率的比较无差异(P=0.99)，1型闭合率也无差异(χ²=0.04，P=0.84)。两组患者术后1wk，1mo BCVA均优于术前(均P<0.01)，术后1mo组1的BCVA优于组2(t=-2.20，P=0.03)。术后1mo两组中心凹神经上皮层厚度比较无差异(t=0.407，P=0.69)。术后1mo患者的BCVA与裂孔底径及术前BCVA呈正相关(r=0.435，P=0.004； r=0.440，P=0.001)。两组患者在术中及术后均未出现视网膜脱离及视网膜裂孔等并发症。

结论：PPV联合ILM翻转覆盖术及ILM填塞术治疗大底径IMH裂孔闭合率高，PPV联合ILM翻转覆盖术后BCVA可能优于ILM填塞组； 术后BCVA与术前裂孔底径及术前BCVA呈正相关，术前裂孔底径可作为临床判断预后的依据之一。

AIM:To investigate the efficacy and safety of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane(ILM)flap and PPV combined with ILM tamping in the treatment of large basal diameter idiopathic macular hole(IMH), and to analyze the correlation between postoperative visual acuity and preoperative parameters.

METHODS:This study is a retrospective clinical study. Totally 56 patients(57 eyes)with macular hole bottom diameter greater than 1 000μm, who treated in Joint Shantou International Eye Center from January 2018 to December 2020, were enrolled in this study. Thirty eyes were involved in PPV combined with inverted ILM flap(Group 1)and 27 eyes were involved in PPV combined with ILM tamping(Group 2). The best corrected visual acuity(BCVA), the closure of the macular hole, thickness of foveal neurosensory layer and complications were compared between the two groups at 1wk and 1mo after the surgery. Person correlation analysis was used to explore the correlation between preoperative parameters and BCVA at 1mo after operation.

RESULTS: There was no significant difference in gender, age, eye type, course of disease, preoperative BCVA, postoperative macular hole healing classification, preoperative hole bottom diameter and eye axis between the two groups(P>0.05). The closure rate of macular hole in Group 1 was 97%, of which type 1 closure was 80%. The closure rate of macular hole in Group 2 was 100%, of which type 1 closure was 78%, and there was no significant difference in the closure rate(P=0.99). The postoperative follow-up BCVA of patients in both groups was better than that before operation(all P<0.01). The BCVA of Group 1 was better than Group 2 at 1mo after operation, and the difference was statistically significant(t= -2.20, P=0.03). There was no significant difference in the thickness of foveal neurosensory layer between two groups at 1mo after operation(t=0.407, P=0.69). The BCVA at 1mo after operation was positively correlated with the hole diameter and preoperative BCVA(r=0.435, P=0.004; r=0.440, P=0.001). There was no complication in both groups during and after operation.

CONCLUSION:PPV combined with inverted ILM flap and PPV combined with ILM tamping can improve the closure rate of the hole. The long-term visual acuity of PPV combined with inverted ILM flap is better than that of PPV combined with ILM tamping. There is a significant positive correlation between postoperative BCVA and the bottom diameter of the hole and preoperative BCVA. Preoperative bottom diameter can be used as one of the basis for clinical prognosis.

汕头市科技计划医疗卫生类别项目(No.190629115260313)