The Application Value of Intraoperative Optical Coherence Tomography(iOCT)in the Surgery of Idiopathic Macular Holes
10.3870/j.issn.1672-0741.24.10.022
- VernacularTitle:iOCT在特发性黄斑裂孔手术中的应用价值
- Author:
Fang LI
1
;
Yan LUO
1
;
Zefeng XIAO
1
Author Information
1. 武汉市第一医院眼科,武汉 430022
- Publication Type:Journal Article
- Keywords:
intraoperative optical coherence tomography;
idiopathic macular hole;
internal limiting membrane peeling;
inverted internal limiting membrane coverage;
internal limiting membrane filling
- From:
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
2025;54(1):112-116
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the application value of intraoperative optical coherence tomography(iOCT)in the treat-ment of idiopathic macular holes(IMH)using various surgical techniques.Methods A retrospective analysis was conducted on patients who underwent vitrectomy assisted by iOCT for IMH at Wuhan No.1 Hospital from January 2021 to December 2021.All the included patients were categorized based on the different surgical methods:internal limiting membrane(ILM)peel-ing,inverted ILM coverage,and ILM filling.All patients underwent iOCT examinations to assess morphological changes in the retinal layers of the macular region,the integrity of ILM peeling,the morphology of the macular hole edges,and any intraopera-tive retinal microdamage.The closure rates of macular holes,changes in best-corrected visual acuity(BCVA),and postoperative complications were compared among three surgical approaches.Results After selection,a total of 72 patients were included in the study,consisting of 23 males and 49 females,with an average age of(57.88±7.21)years and a follow-up period of 6 months.After completing ILM peeling,iOCT revealed morphological changes at the edges of the macular holes in 15 eyes,and intraoperative retinal microdamage occurred in 18 eyes(25％).Among these,12 eyes exhibited abnormalities in the nerve fiber layer,such as hemorrhage,while 6 showed mild elevation of the inner retinal structures.iOCT indicated that 8 eyes(11.1％)still had remnants of the anterior membrane after the initial peeling,suggesting incomplete peeling and a second peeling was per-formed.The remaining 64 eyes had complete peeling.BCVA significantly improved in the ILM peeling group,ILM filling group,and ILM inversion coverage group at 1 week,1 month,and 6 months post-surgery compared to preoperative values(P＜0.05).The closure rates for the macular holes in the ILM peeling group,ILM filling group,and ILM inversion coverage group were 89.7％,91.3％,and 95.0％,respectively,with no significant differences among the groups(P＞0.05).No severe complication related to the surgical procedure was observed in any of the three groups during or after surgery.Conclusion ILM peeling,ILM filling,and ILM inversion coverage are all effective surgical techniques for treating IMH.iOCT can clearly and dynamically ob-serve the morphology of the retina in the macular area in real time during the operation,especially the subtle structural changes of the macular hole.It is beneficial to improve the surgeon's understanding of the surgical area,guide the operation,optimize the surgical decision,and improve the postoperative visual acuity of patients.
