Objective To observe the changes of visual acuity、multifocal electroretinogram (mfERG) and optical coherence tomogram（OCT）before and after successful idiopathic macular hole (IMH) surgery, and evaluate the efficiency of the IMH surgery. Methods A total of 28 eyes of 28 patients with IMH who underwent vitrectomy during February 2001 and May 2002 in our hospital were collected. visual acuity, mfERG, and OCT were examined preoperatively and 1, 3, 6, and 12 months postoperatively, respectively. The results were analyzed statistically compared with 33 eyes in control group. Results (1) OCT showed that 27 eyes (96.43%) had anatomic closure of the macular hole 1 month after the surgery without recurrence in 12 months. Just 1 eye (3.57%) failed in the closure within 1 year. (2) The visual acuity was much higher in the eyes 1 year after surgery, especially within 6 months postoperatively, than that before the vitrectomy（P＜0.01）. (3) Before the operation, the mfERG topographies of IMH eyes seem like volcanoes becase the response densities of wave P1 of ring 1 and ring 2 were lower than control group while the other three rings kept in normal. The central peaks of mfERG topographies reappeared little by little during 1 year after the surgery, and the response densities of wave P1 of ring 1 and ring 2 were higher than before, which was still lower than the control group（P＜0.05）. (4) The thickness of neuroepithelial layer (NEL) of fovea measured by OCT of 27 eyes with anatomic closure was no longer varied and kept lower than control group throughout the follow-up time （P＜0.05）. (5) One year after the operation, there were positive correlations among visual acuity, mfERG and NEL（P＜0.05）. Conclusions Vitrectomy is useful for IMH, which could be evaluated by visual acuity mfERG and OCT efficiently. The three factors had consistency. (Chin J Ocul Fundus Dis，2004，20：221-225)
Purpose To evaluate the surgical effect of idiopathic macular hole (IMH)，with optical coherence tomography (OCT)． Methods To measure the diameter of holes and hole halos，the thickness of hole in edge，the changes of hole pattern in 19 cases (19 eyes) with IMH using OCT． Results By quantitatively measuring，OCT showed that after surgery the mean hole diameter lessened from （570．95plusmn;264．59 ）mu;m to （337．05plusmn;335．95）mu;m．The mean diameter of hole halo lessened from （1043．53plusmn;278．80）mu;m to （695．00plusmn;483．00）mu;m and the mean thickness of the hole edge thinned from （389．78plusmn;60．58）mu;m to （298．78plusmn;109．80）mu;m．In 17 eyes the holes become closed or reduced in size or the hole halo，and thinned in hole edge．The anatomic successful rate of the surgery is 89%． Conclusion OCT can objectively，accurately and effectively judge the anatomic effect of IMH surgery． (Chin J Ocul Fundus Dis，2000，16：71-138)
ObjectiveTo analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. MethodsThe clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. ResultsTraumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9)μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z=-2.40, P < 0.05). The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30, 5.06;P < 0.05).These data suggests that the macular function was recovered well. In the surgery group, the mean diameter of macular hole was(643.3±125.0)μm and statistically larger than that of the observation group (t=-4.76, P < 0.05). At the last follow-up, visual acuity were not improved significantly (Z=-1.79, P > 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P > 0.05).These data suggests that the macular function was recovered slightly only in a few patients. ConclusionsA part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant.
Objective To investigate the clinical characteristics of retinal degeneration (RD) with retinal holes and the therapeutic effect of argon laser therapy. Methods The data of argon laser therapy in 210 RD patients (224 eyes) with retinal holes who underwent the treatment in our department were retrospectively analyzed, which was compared with the data of argon laser therapy in 173 RD patients (198 eyes) without retinal holes. Results In RD patients with retinal holes, 89.7% of the patients were less than 60 years old (53.3% males and 46.7% females). Grid-like degeneration was found in 65.6% of the patients in whom 87.5% had the range of degeneration less than 1 quardrant. There were oval-shaped holes in 60.7% of the patients and accompanied with limited rhegmatogenous retinal detachment (LRRD) in 23.7%. Compared with RD patients without retinal holes, the ratio of patients with the age ofge;35 years, cystic degeneration, retinal lengthways small plica, and subjective symptoms was higher in RD patients with retinal holes; while the therapeutic effect of argon laser therapy on patients with LRRD was obviously less than whom without retinal holes (Plt;0.01 ). Conclusions RD with retinal holes often occurs in youth, most of whom have grid-like degeneration with the range of le;1 qua drant. The major types of retinal holes are oval-shaped degeneration without retinal detachment. There was no sex difference in RD patients with retinal holes and most of the patients have no subjective symptoms. The therapeutic effect of prophylactic argon laser therapy on RD patients with retinal holes but no retinal detachment is satisfying. (Chin J Ocul Fundus Dis, 2006, 22: 39-41)
Macular hole is a retinal hole locates in macular fovea, and can be idiopathic, traumatic and high myopic. Although its etiology, disease course, treatment and prognosis varied from case to case, enforcing macularhole closure and retinal reattachment are challenges to all cases. Completely removal of premacular vitreous cortex is the key to successful repair, and inner limiting membrane (ILM) staining and peeling can greatly help the removal of those cortexes. Selections and usages of different dyes, methods of ILM peeling, and strategies to promote macular retinachoroidal adhesion warrant further study to improve treatment and prognosis of macular holes.
ObjectiveTo investigate the course of the idiopathic macular hole (IMH) clinically diagnosed as at stage Ⅰ-Ⅳ by optical coherence tomography (OCT), and analyze the relationship between the posterior vitreous detachment (PVD) and the course of IMH. MethodsHadn′t undergone any operation, periodical OCT were performed on 72 eyes of 58 patients with IMH at stage Ⅰ-Ⅳ confirmed by Gass standard and the features of OCT images.ResultsThe longest follow-up period was 43 months (average 13.4 months), and the examine times of OCT on each eye were between twice to 10 times (average 4.7 times). During the followup period, 23 eyes were in stage I in which 9 (39.1%) developed to stage II and 2 had recovered normal curve of fovea after PVD; 19 were in stage II in which 13 (68.4%) developed to Ⅲ-Ⅳ and 1 had closed hole after PVD; 11 were in stage III in which 5 (45.5%) developed to stage IV and 1 had partly closed hole 12 months later. The images of OCT showed that the process of macular hole was consistent with the course that vitreous depart from retina from the circumference of fovea till entire posterior detachment.Fifteen affected eyes in this series of patients had undcrygong surgical treatment due to serious progression of IMH in follow-up period. ConclusionsThere is a close relationship between the formation and development of macular hole and the occurrence of PVD. OCT can show the progress of the macular hole directly and offer an important technique in diagnosis, classification and surgical treatment of IMH. (Chin J Ocul Fundus Dis, 2005,21:79-82)