目的：探讨内界膜(ILM)翻转覆盖术与单纯ILM剥离术治疗特发性黄斑裂孔(IMH)的疗效及其相关影响因素。

方法：本研究为回顾性队列研究。收集2023年1月至2024年11月在我科接受手术治疗的IMH患者32例35眼(所有患者同时接受超声乳化白内障摘除联合人工晶状体植入术)，根据手术方式的不同分为研究组19眼行ILM翻转覆盖术和对照组16眼行单纯ILM剥离术。观察两组患者末次随访时裂孔封闭情况、最佳矫正视力(BCVA)、黄斑区结构，并分析末次随访时BCVA和裂孔愈合类型与各参数的相关性。

结果：两组患者术前一般资料比较均无差异(均P>0.05)。末次随访时，两组患者裂孔均愈合，其中研究组U型愈合7眼，V型愈合6眼，不规则愈合6眼，对照组U型愈合13眼，V型愈合1眼，不规则愈合2眼(χ²=7.167，P=0.028)。两组患者末次随访时BCVA均优于术前(均P<0.05)，手术前后黄斑区脉络膜厚度比较无差异(P>0.05)，但研究组黄斑区视网膜厚度低于对照组(168.11±92.11 vs 235.56±92.18 μm，P=0.03)。Pearson相关性分析显示末次随访时BCVA与术前裂孔最小径呈正相关(r=0.476，P<0.05)，与术前裂孔牵拉指数呈负相关(r=-0.364，P<0.05)，与术前裂孔直径指数呈正相关(r=0.361，P<0.05)； Keendall相关性分析显示末次随访时裂孔愈合类型与裂孔基底径(τ=0.296，P=0.029)、裂孔最小径(τ=0.366，P=0.007)和末次随访时视力(τ=0.412，P=0.003)呈正相关，与黄斑裂孔指数(τ=-0.415，P=0.002)和裂孔牵拉指数(τ=-0.511，P<0.01)呈负相关。随访期间，两组患者均未发生术后并发症。

结论：ILM翻转覆盖术与单纯ILM剥离术治疗IMH均安全有效，术前黄斑裂孔基底径和最小径越小，黄斑裂孔指数和裂孔牵拉指数越大，术后黄斑裂孔U型愈合概率越大，术后裂孔越接近U型愈合，术后视力越好。

METHODS: A retrospective cohort study was conducted on totally 32 patients(35 eyes)with IMH who received surgery at our department from January 2023 to November 2024. All the patients simultaneously received phacoemulsification combined with intraocular lens implantation, and they were divided into study group(19 eyes)and control group(16 eyes), with ILM flap technique and simple ILM peeling received in the two groups, respectively. The closure situation of macular hole, best corrected vision acuity(BCVA), and macular structure were observed in the two groups of patients. Furthermore, the correlation of BCVA and healing type of macular hole at the last time of follow-up with each parameter was analyzed.

RESULTS: There was no statistical difference between the two groups of patients in preoperative general characteristics(all P>0.05). At the last time of follow-up, the macular hole was heeled in both groups, with 7 eyes of U-shaped heeling, 6 eyes of V-shaped heeling, and 6 eyes of irregular heeling in the study group, and with 13 eyes of U-shaped of heeling, 1 eye of V-shaped heeling and 2 eyes of irregular heeling in the control group(χ²=7.167, P=0.028). The postoperative BCVA was better than preoperative level(all P<0.05), there were no statistical significant differences between the two groups of patients in macular choroidal thickness before and after surgery(P>0.05), but the macular retinal thickness of the study group was thinner than that of the control group(168.11±92.11 vs 235.56±92.18 μm, P=0.03). Pearson correlation analysis indicated that BCVA at the last time of follow-up was positively correlated with the preoperative minimum diameter(r=0.476, P<0.05)and the diameter hole index(r=0.361, P<0.05), and negatively correlated with traction hole index(r=-0.364, P=0.031); Keendall correlation analysis showed that the postoperative closure types positively correlated with the basal diameter(τ=0.296, P=0.029), minimum diameter(τ=0.366, P=0.007), and visual acuity at the last time of follow-up(τ=0.412, P=0.003), while negatively correlated with macular hole index(τ=-0.415, P=0.002)and traction hole index(τ=-0.511, P<0.01). During the follow-up period, neither group of patients experienced postoperative complications.

CONCLUSION: Both ILM flap technique and simple ILM peeling are safe and effective in treating IMH. As the smaller the basal diameter and minimum diameter of the macular hole, the larger the macular hole index and traction hole index, the probability of U-shaped heeling after surgery is greater and the visual acuity is better.