玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术治疗大孔径特发性黄斑裂孔

目的　探讨玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术治疗大孔径特发性黄斑裂孔的疗效。方法　回顾性分析2017年3月至2019年12月在我院行玻璃体切割术治疗的大孔径（最小直径＞400 μm）特发性黄斑裂孔患者68例，其中40例联合内界膜翻转填塞治疗（传统术式组），28例联合玻璃酸钠凝胶辅助内界膜翻转填塞治疗（改良术式组）。比较两组患者术前及术后最佳矫正视力及裂孔闭合率。结果　传统术式组术后6个月视力（0.842±0.340）logMAR较术前（1.160±0.310）logMAR明显改善（P<0.05）,改良术式组术后6个月视力（0.825±0.288)logMAR较术前（1.204±0.334）logMAR也明显改善（P<0.05），但两组患者术后视力改善程度差异无统计学意义（P>0.05）。改良术式组术后裂孔闭合率（100.00%）高于传统术式组（77.50%），差异有统计学意义（P<0.05），且随着裂孔直径的增大，传统术式组术后裂孔闭合率逐渐降低。超大孔径特发性黄斑裂孔（裂孔直径>700 μm）分组中，传统术式组和改良术式组患者术后裂孔闭合率分别为61.53%、100.00%,差异也有统计学意义（P<0.05）。结论　玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术是一种安全有效的手术方式，不仅在一定程度改善大孔径黄斑裂孔患者术后视力，还可大幅提高大孔径特发性黄斑裂孔闭合率，尤其是超大孔径黄斑裂孔的闭合率。

Effect of vitrectomy combined with sodium hyaluronate gel assisted inverted internal limiting membrane flap technique to treat large idiopathic macular hole

Objective　To investigate the effect and security of vitrectomy combined with sodium hyaluronate gel assisted inverted internal limiting membrane (ILM) flap technique to treat large idiopathic macular hole (LIMH).Methods　A retrospective study was performed in 68 patients with large idiopathic macular hole (minimum diameter＞400 μm) undergoing vitrectomy surgery in our hospital from Mar. 2017 to Dec. 2019, of whom 40 patients combined with inverted ILM flap technique (traditional surgical group), and 28 combined with sodium hyaluronate gel assisted ILM flap technique (modified surgical group). All patients were followed up for 3 and 6 months to compare their preoperative and postoperative the best corrected visual acuity (BCVA) and macular hole closure rate. Results　In traditional surgical group, compared with preoperative BCVA ［(1.160±0.310) logMAR］,6 months postoperative BCVA ［(0.842±0.340) logMAR］ was significantly improved (P＜0.05), and it was true of the modified surgical group ［(1.204±0.334) logMAR vs. (0.825±0.288) logMAR］ (P＜0.05). There is no statistically significant difference in BCVA improvement for both groups (P＞0.05). For macular hole closure rate, the modified surgical group (100.00%) was higher than the traditional surgical group (77.50%), and the difference was statistically significant (P<0.05). With the increase of the hole diameter, the traditional surgical hole closure rate gradually decreased. In patients with super-large idiopathic macular hole (macular hole diameter >700 μm), the difference in postoperative macular hole closure rate between the traditional surgical group and the modified surgical group was statistically significant (61.53% vs. 100.00%, P<0.05).Conclusion　Vitrectomy combined with sodium hyaluronate gel assisted inverted ILM technique is a safe and effective surgical method, which can not only improve the visual acuity of LIMH, but also greatly improve the closure rate of LIMH, especially for patients with super-large idiopathic macular hole.