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After that, indocyanine green (0.25%) solution was applied to stain internal limiting membrane (ILM) and was immediately removed by suction. If left, it was then trimmed using the vitreous cutter as much as possible. If present, LHEP was gently peeled together with ERM with a special care to avoid tearing it from the FTMH edge. Posterior vitreous detachment was induced if it was not present. Following the core vitrectomy, vitreous gel was visualized by the injection of triamcinolone acetonide (MaQaid, Wakamoto Pharmaceutical, Tokyo, Japan) during midperipheral vitrectomy. Before vitrectomy, phacoemulsification and intraocular lens implantation (PEA + IOL) were performed using the same machine for all phakic eyes. Standard 25- or 27-gauge TSV with a wide-angle noncontact viewing system (Resight® Carl Zeiss Meditec AG, Jena, Germany) was performed under sub-Tenon anesthesia by approximately 4 mL of 2% lidocaine using the Constellation Vision System (Alcon Laboratories Inc., Fort Worth, TX, USA) in all cases.
FORMATION XLSTAT SOFTWARE
The size of FTMH was manually measured using the software Caliper in OCT. The presence of ERM was also judged either by OCT images or intraoperative observation. The presence of LHEP was judged either by OCT images or intraoperative observation of yellowish pigment around the macular hole.
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The presence of FTMH and the continuity of EZ and ELM were judged by images obtained from commercially available spectral-domain optical coherence tomography (OCT, Spectralis HRA + OCT Heidelberg Engineering, Heidelberg, Germany). We did not include the presence or absence of ERM as a variable for the statistical analysis because ERM did not exist in all cases of FTMH without LHEP and exists in all cases of FTMH with LHEP in this study. The following variables were analyzed: sex, age, preoperative best corrected visual acuity (pre-BCVA), BCVA 6 months after the surgery (6M-BCVA), the axial length of eye (EL), the minimum diameter of FTMH, the diameter of basal side of FTMH, the continuity of subfoveal ellipsoid zone (EZ) and external limiting membrane (ELM) 6 months after the surgery, and the preoperative presence or absence of LHEP. Eyes with FTMH secondary to high myopia, defined as preoperative refractive error (spherical equivalent) greater than −6.0 diopters (D) in phakic eyes or axial length longer than 26 mm, a history of prior intraocular surgeries for vitreoretinal diseases, and with a postoperative follow-up period less than 6 months were excluded in this study. 158 eyes of 158 consecutive patients were enrolled. This study was approved by the institutional review board in each institution and conformed to the tenets of the Declaration of Helsinki. This multicenter retrospective comparative study reviewed all medical records of patients with idiopathic FTMH treated with 25-gauge or 27-gauge TSV from January 2010 to April 2015. The purpose of this study was to compare the functional and morphologic outcomes of TSV for FTMH with LHEP in reference to FTHM without LHEP. However, there is no comparative study which investigated whether the presence of the LHEP affects postoperative visual function and morphologic characteristics following transconjunctival sutureless pars plana vitrectomy (TSV) for FTMH. A recent study has demonstrated that the LHEP was present in 8–9.6% of FTMH cases as well. It has recently been reported that 30.5–60% of LMH involve lamellar hole-associated epiretinal proliferation (LHEP), which is thickened yellowish-pigmented tissue, and that the presence of LHEP is inversely related to the integrity of photoreceptor and visual function in LMH cases. It is well known that LMH frequently involves ERM. On the other hand, the other is the separation of the fovea due to the contraction of epiretinal membrane (ERM) on the lamellar macular hole (LMH).
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A major mechanism is vitreomacular separation secondary to tangential vitreofoveal traction. Two distinct mechanisms have been reported for the full-thickness macular hole (FTMH) formation.