Objective To evaluate and compare the curative effects between extensive and standard internal limited membrane peeling (ILMP) during vitrectomy for idiopathic macular hole (IMH) with closed index＜0.7 and provide an alternative basis for IMH.Methods The clinical data of ninety-six eyes of 96 patients of IMH with closed index ＜0.7 who received vitrectomy with extensive (48 eyes) or standard ILMP (4-8 eyes) procedures from May 2012 to May 2016 in the Second Affiliated Hospital of Nanchang University under the informed consent of patients were retrospectively analyzed.Best corrected visual acuity (BCVA),central vision,direct ophthalmoscope examination,slit lamp microscope with preset lens,optical coherence tomography (OCT),intraocular pressure,Amsler grid table and fundus photography inspection were performed before surgery and 1 month,6 and 12 months after surgery.The healing rate of IMH and the correction rate of Amsler grid table were also observed.Based on the OCT image,U-like closure was thought to be normal fovea,V-like closure was steep fovea and W-like closure exhibited the defect of sensory layer.Three types were considered as hole closure.Results OCT showed that retinal nurosensory layer was defect at macular area in both extensive ILMP group and standard ILMP group before surgery.At 12 months after operation,43 cases had U type closure,1 case had V type closure and 1 case had W type closure in the extensive ILMP group,while 33 cases had U type closure,1 case had V type closure and 3 cases had W type closure in standard ILMP group.The BCVA was significantly better in the extensive ILMP group than that in the standard ILMP group in postoperative 1 month,6 months and 12 months (all at P＜0.05).Compared with preoperation BCVA,the number of eyes with central and paracentral scotomas was decreased in both extensive ILMP group and standard ILMP group at the end of the following up (central scotoma:x2 =80.98,56.99,both at P＜0.05;paracentral scotoma:x2 =88.21,80.98,both at P＜0.05),and the number of eyes with central scotoma in the extensive ILMP group was significantly less than that in the standard ILMP group (3 vs.11) (x2 =4.10,P＜0.05).The closure rate of IMH was 93.75％ in the extensive ILMP group and 77.08％ in the standard ILMP group,showing a significant difference between the two groups (x2 =4.10,P＜0.05).The corrected rate of Amsler grid abnormality was 93.75％ in the extensive ILMP group,which was evidently higher than 75.00％ in the standard ILMP group,with a significant difference between the two groups (x2 =5.06,P＜0.05).Conclusions Both extensive ILMP and standard ILMP during vitrectomy for IMH with MCHI＜0.7 are effective,and vitrectomy combined with extensive ILMP has a better outcome in comparison to vitrectomy combined with standard ILMP.%目的 观察和对比玻璃体切割术中行扩大内界膜剥离术与标准内界膜剥离术治疗黄斑裂孔闭合指数(MCHI)＜0.7的特发性黄斑裂孔(IMH)的疗效,为MCHI＜0.7 IMH的手术方式选择提供临床依据.方法 对2012年5月至2016年5月在南昌大学第二附属医院采用不同手术方式治疗MCHI＜0.7的IMH 96例96眼的临床资料进行回顾性分析.所有术眼手术前及术后1、6及12个月均行最佳矫正视力(BCVA)、直接检眼镜、裂隙灯显微镜、光相干断层扫描(OCT)和Amsler方格表检查,并行眼压测量和眼底照相.选择的患眼中48眼行扩大内界膜剥离术,另48眼行标准内界膜剥离术,IMH术后闭合按照OCT闭合形态分为U型(正常黄斑中心凹)、V型(中心凹陡峭)和W型(中心凹感觉神经层缺损),U型、V型和W型闭合者视为裂孔闭合.比较2种不同术式的疗效和视网膜功能恢复情况. 结果 OCT检查显示,术前2个组患眼黄斑区视网膜神经感觉层全层缺失,术后12个月扩大内界膜剥离术组U型闭合43例,V型闭合1例,W型闭合1例;术后12个月标准内界膜剥离术组U型闭合33例,V型闭合1例,W型闭合3例.术后1、6和12个月扩大内界膜剥离术组患眼BCVA较常规内界膜剥离术组提高,差异均有统计学意义(均P＜0.05).与术前比较,术后2个组术眼有中心暗点眼数均减少,差异均有统计学意义(x2=80.98、56.99,均P＜0.05);术后旁中心暗点眼数均减少,差异均有统计学意义(x2=88.21、80.98,均P＜0.05).扩大内界膜剥离术组和标准内界膜剥离术组随访末期有中心暗点者分别为3眼和11眼,扩大内界膜剥除组有中心暗点眼数少于标准内界膜剥除组,差异有统计学意义(x2 =4.10,P＜0.05).扩大内界膜剥离术组IMH闭合率为93.75％,明显高于标准内界膜剥离术组的77.08％,差异有统计学意义(x2=4.10,P＜0.05).术后扩大内界膜剥离术组术眼视野改善率为93.75％,标准内界膜剥离术组为75.00％,差异有统计学意义(x2=5.06,P＜0.05).结论 扩大内界膜剥离术和标准内界膜剥离术治疗MCHI＜0.7的IMH均有效,前者疗效更好.
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