全層黄斑円孔に対する内境界膜反転フラップ術の10年追跡調査

To evaluate the 10-year anatomical and functional outcomes after vitrectomy with the inverted internal limiting membrane (ILM) flap technique for full-thickness macular hole (FTMH) and assess the incidence of long-term postoperative complications.

Retrospective consecutive case series.

From 295 patients (323 eyes), who had pars plana vitrectomy with inverted ILM flap technique for idiopathic FTMH in our clinic in the years 2007- 2014 in our clinic, 89 patients (99 eyes) completed a 10-year follow-up.

Medical records were reviewed retrospectively. Patients, who had pars plana vitrectomy with the inverted ILM flap technique for idiopathic FTMH in the years 2007- 2014, were invited for a 10-year follow-up. Preoperative and postoperative parameters were analyzed, including age, sex, visual acuity, initial hole size, SS-OCT parameters, surgical technique, and postoperative complications.

Primary outcomes were long-term anatomical closure at 10 years and BCVA. Secondary outcomes included OCT-based macular morphology (ellipsoid zone [EZ], interdigitation zone [IZ], foveal contour) and complication rates (e.g., epiretinal membrane, gliosis, secondary glaucoma, retinal detachment, and AMD progression).

The initial closure rate in 323 eyes was 93.5%; final closure rate after reoperation was 100%. 20/40 vision was achieved in 44.5% of eyes one year after surgery and in 70.7% of eyes followed until the 10^th year. The number of eyes with >20/25 vision improved from 12% to 42.4% during that time. Patients achieving final BCVA better than 20/25 had a continuous IZ and EZ line until the hole margin before surgery (p=0.03), and a continuous IZ and EZ line one year after surgery (p=0.01). Foveal contour improved gradually over time. No FTMH reopenings were observed. Epiretinal gliosis developed in 7% of cases, associated with larger baseline hole size and preoperative ERM, but did not significantly impact final visual acuity. Retinal detachment incidence was 0.85% per patient/year.

The inverted ILM flap technique provides sustained anatomical and functional success in idiopathic FTMH over a 10-year period. Continued improvement in BCVA beyond the first year and low complication rates support the use of this technique as an effective and durable surgical approach.