黄斑裂孔手术治疗进展综述
A Review of Advances in the Surgical Treatment of Macular Holes
DOI: 10.12677/hjo.2026.152006, PDF,   
作者: 林远烨:华中科技大学同济医学院,湖北 武汉;杨子奇:湖北科技学院口腔与眼视光医学院,湖北 咸宁;刘 欣*:华中科技大学同济医学院附属协和医院眼科,湖北 武汉
关键词: 黄斑裂孔内界膜剥离染料手术进展并发症Macular Hole Internal Limiting Membrane Peeling Vital Dye Surgical Advances Complications
摘要: 黄斑裂孔为常见的导致中心视力严重下降的视网膜疾病,手术治疗为常规有效的治疗方式。随着微创玻璃体手术技术的持续进步,内界膜剥离、气体填充、染料辅助及新型材料应用等关键技术的持续优化,显著提高了黄斑裂孔的解剖闭合率及患者的视力恢复程度。本文旨在系统梳理黄斑裂孔手术的发展及最新进展,重点探讨手术技术的革新、术后视网膜结构与功能的动态变化、术后并发症处理及未来研究方向。
Abstract: Macular hole is a common retinal disease that causes severe loss of central vision, and surgery is a routine and effective treatment. With continuous advances in minimally invasive vitreous surgery techniques, ongoing optimization of key technologies such as internal limiting membrane peeling, gas tamponade, dye assistance, and the application of new materials has significantly improved the anatomical closure rate of macular holes and the extent of visual recovery in patients. This paper aims to systematically review the development and latest advances in macular hole surgery, focusing on innovations in surgical techniques, dynamic changes in postoperative retinal structure and function, management of postoperative complications, and future research directions.
文章引用:林远烨, 杨子奇, 刘欣. 黄斑裂孔手术治疗进展综述[J]. 眼科学, 2026, 15(2): 48-56. https://doi.org/10.12677/hjo.2026.152006

参考文献

[1] Michalewska, Z. and Nawrocki, J. (2022) Fovea Morphology after Vitrectomy in Eyes with Full-Thickness Macular Hole Coexisting with Diabetic Retinopathy. Journal of Vitreo Retinal Diseases, 5, 53-59. [Google Scholar] [CrossRef] [PubMed]
[2] Bringmann, A., Unterlauft, J.D., Barth, T., Wiedemann, R., Rehak, M. and Wiedemann, P. (2021) Müller Cells and Astrocytes in Tractional Macular Disorders. Progress in Retinal and Eye Research, 86, Article 100977. [Google Scholar] [CrossRef] [PubMed]
[3] Gonzalez-Cortes, J.H., Treviño-Herrera, A.B., Gonzalez-Cantu, J.E., Sudhalkar, A., Hernandez-Da Mota, S.E. and Mohamed-Hamsho, J. (2022) Sudden Branch Macular Artery Avulsion during Internal Limiting Membrane Peeling for Idiopathic Macular Hole: A Case Report. International Journal of Surgery Case Reports, 97, Article 107443. [Google Scholar] [CrossRef] [PubMed]
[4] Wang, Y., Zhao, X., Zhang, W., Yang, J. and Chen, Y. (2021) Fovea-Sparing versus Complete Internal Limiting Membrane Peeling in Vitrectomy for Vitreomacular Interface Diseases: A Systematic Review and Meta-Analysis. Retina, 41, 1143-1152. [Google Scholar] [CrossRef] [PubMed]
[5] Wu, J., Xu, Q. and Luan, J. (2021) Vitrectomy with Fovea-Sparing ILM Peeling versus Total ILM Peeling for Myopic Traction Maculopathy: A Meta-Analysis. European Journal of Ophthalmology, 31, 2596-2605. [Google Scholar] [CrossRef] [PubMed]
[6] Ling, L., Liu, Y., Zhou, B., Gao, F., Hu, Z., Tian, M., et al. (2020) Inverted Internal Limiting Membrane Flap Technique versus Internal Limiting Membrane Peeling for Vitrectomy in Highly Myopic Eyes with Macular Hole-Induced Retinal Detachment: An Updated Meta-Analysis. Journal of Ophthalmology, 2020, Article 2374250. [Google Scholar] [CrossRef] [PubMed]
[7] Nakano, H., Terashima, H., Hasebe, H. and Fukuchi, T. (2025) Inverted Internal Limiting Membrane Flap Technique for Macular Hole Retinal Detachment in High Myopia Compared to Internal Limiting Membrane Peeling. Scientific Reports, 15, Article No. 21537. [Google Scholar] [CrossRef] [PubMed]
[8] Takeyama, A., Imamura, Y., Shibata, M., Komiya, Y. and Ishida, M. (2021) Inner Retinal Structure and Visual Function after Idiopathic Epiretinal Membrane Surgery with and without Brilliant Blue G. Japanese Journal of Ophthalmology, 65, 689-697. [Google Scholar] [CrossRef] [PubMed]
[9] Hong, S.Y., Yi, S.U., Kim, M. and Park, Y.H. (2025) Long-Term Outcomes and Prognosis in Vitrectomy with Autologous Platelet Concentrate Injection for Large, High Myopic, or Recurrent Macular Holes. Japanese Journal of Ophthalmology, 69, 387-394. [Google Scholar] [CrossRef] [PubMed]
[10] Carlà, M.M., Giannuzzi, F., Hu, L., Rizzo, C., Crincoli, E., Catania, F., et al. (2026) The Human Amniotic Membrane in Vitreoretinal Surgery: Applications, Outcomes and Limitations. Survey of Ophthalmology, 71, 14-24. [Google Scholar] [CrossRef] [PubMed]
[11] Bokor, Á., Makhoul, S., Pásztor, O. and Fodor, M. (2023) Autologous Neurosensory Retinal Transplantation. Orvosi Hetilap, 164, 1511-1517.
[12] Pellegrini, M., Adamo, G., Vivarelli, C., et al. (2025) Macular Hole Surgery and Retinal Tectonics: The Impact of Internal Limiting Membrane Peeling Size on Tangential Retinal Displacement. Retina, 45, 23-29.
[13] Cheng, D., Tao, J.W., Yu, X.T., et al. (2022) Characteristics of Macular Microvasculature before and after Idiopathic Macular Hole Surgery. International Journal of Ophthalmology, 15, 98-105. [Google Scholar] [CrossRef] [PubMed]
[14] Akada, M. and Tabuchi, H. (2023) Time Course of Eccentric Macular Hole Formation after Pars Plana Vitrectomy for Epiretinal Membrane Detected by Optical Coherence Tomography. American Journal of Ophthalmology Case Reports, 32, Article 101914. [Google Scholar] [CrossRef] [PubMed]
[15] Lasota, P.R. (2024) Macular Phototoxicity after Macular Hole Surgery. Ophthalmic Surgery, Lasers and Imaging Retina, 55, 479-480. [Google Scholar] [CrossRef] [PubMed]
[16] Kelkar, A., Bolisetty, M. and Mondal, S. (2024) Iatrogenic Macular Hole Following PFCL Injection: Implications of Retinal Dimpling as an Intraoperative Indicator. American Journal of Ophthalmology Case Reports, 36, Article 102122. [Google Scholar] [CrossRef] [PubMed]
[17] Cundy, O., Lange, C.A., Bunce, C., Bainbridge, J.W. and Solebo, A.L. (2023) Face-Down Positioning or Posturing after Macular Hole Surgery. Cochrane Database of Systematic Reviews, 2023, CD008228. [Google Scholar] [CrossRef] [PubMed]
[18] Lachance, A., You, E., Garneau, J., Bourgault, S., Caissie, M., Tourville, É., et al. (2021) Revision Surgery for Idiopathic Macular Hole after Failed Primary Vitrectomy. Journal of Ophthalmology, 2021, 1-7. [Google Scholar] [CrossRef] [PubMed]
[19] Tarakcioglu, H.N., Tulu, B. and Ozkaya, A. (2019) Subtotal Vitrectomy in Idiopathic Macular Hole Surgery. Saudi Journal of Ophthalmology, 33, 369-373. [Google Scholar] [CrossRef] [PubMed]
[20] Pradhan, D., Agarwal, L., Joshi, I., Kushwaha, A., Aditya, K. and Kumari, A. (2022) Internal Limiting Membrane Peeling in Macular Hole Surgery. German Medical Science, 20, Doc07.
[21] Meshkin, R.S. and Eliott, D. (2025) Refractory Macular Hole Surgery: A Review of Recent Surgical Innovations. International Ophthalmology Clinics, 65, 17-25. [Google Scholar] [CrossRef] [PubMed]
[22] Caporossi, T., Carlà, M.M., Gambini, G., De Vico, U., Baldascino, A. and Rizzo, S. (2022) Spotlight on the Internal Limiting Membrane Technique for Macular Holes: Current Perspectives. Clinical Ophthalmology, 16, 1069-1084. [Google Scholar] [CrossRef] [PubMed]
[23] Saygılı, O. and Seyyar, S.A. (2025) Macular Hole Surgery without Postoperative Head Positioning: A Technique of Viscoelastic Device Injection Covering the Temporal Internal Limiting Membrane Flap. Ophthalmic Surgery, Lasers and Imaging Retina, 56, 120-122. [Google Scholar] [CrossRef] [PubMed]
[24] Chen, N., Li, X., Yao, X., Chen, D. and Liu, X. (2025) Nonvitrectomizing Vitreous Surgery in Patients with Macular Holes. Retina, 45, 2353-2359. [Google Scholar] [CrossRef] [PubMed]
[25] Popescu, I.S., Mușat, O., Stanca, S., Cernat, C., Patoni, C., Negru, S., et al. (2021) Vital Dyes in Macular Hole Surgery. Experimental and Therapeutic Medicine, 21, Article No. 527. [Google Scholar] [CrossRef] [PubMed]
[26] Zhang, L., Xi, H., Chen, J., Sheng, A., Fan, W., Li, S., et al. (2023) Inverted Pedicled Internal Limiting Membrane Flap Attached to an Optic Disc with Autologous Blood Clot for Large Macular Holes. Journal of Ophthalmology, 2023, Article 7640476. [Google Scholar] [CrossRef] [PubMed]
[27] Gürelik, İ.G., Özdemir, H.B., Acar, A.B. and Aydın, B. (2025) Descemet’s Membrane Transplantation for the Treatment of Recurrent High Myopic Macular Hole Associated with Retinal Detachment. Graefes Archive for Clinical and Experimental Ophthalmology, 263, 105-110. [Google Scholar] [CrossRef] [PubMed]
[28] Galletero Pandelo, L., Olaso Fernández, H., Sánchez Aparicio, J.A., Rodríguez Vidal, C. and Martínez-Alday, N. (2022) Results of Large Macular Hole Surgery Using Different Interposition Techniques. A Report on 9 Cases. Archivos de la Sociedad Española de Oftalmologia, 97, 457-463.
[29] Rinaldi, M., Cennamo, G., Passaro, M.L. and Costagliola, C. (2023) Changes in Macular Pigment Optical Density after Full-Thickness Macular Hole Closure Using Inverted Flap Technique. Photodiagnosis and Photodynamic Therapy, 45, Article 103950. [Google Scholar] [CrossRef] [PubMed]
[30] Wang, T., Ran, R., Ma, Y. and Zhang, M. (2021) Polymeric Hydrogel as a Vitreous Substitute: Current Research, Challenges, and Future Directions. Biomedical Materials, 16, Article 042012. [Google Scholar] [CrossRef] [PubMed]
[31] Qin, H.C., Li, F.Q., Jin, S.Y. and Zhao, J.S. (2024) Retinal Displacement after Surgery for Idiopathic Macular Hole. International Journal of Ophthalmology, 17, 1545-1556. [Google Scholar] [CrossRef] [PubMed]
[32] Rossi, T., Querzoli, G., Ripandelli, G., Placentino, L., Parravano, M., Steel, D.H., et al. (2025) Retinal Displacement after Idiopathic Macular Hole Surgery. Retina, 45, 410-419. [Google Scholar] [CrossRef] [PubMed]
[33] Qin, H., Zhao, J., Jin, S. and Zhang, H. (2024) The Impact of Preoperative Parameters on Postoperative Foveal Displacement in Idiopathic Macular Hole. Scientific Reports, 14, Article No. 3755. [Google Scholar] [CrossRef] [PubMed]
[34] Lauermann, P., Dülk, J., van Oterendorp, C., Hoerauf, H., Feltgen, N. and Bemme, S. (2020) Reorganization of the Perifoveal Microvasculature after Macular Hole Closure Assessed via Optical Coherence Tomography Angiography. Experimental Eye Research, 198, Article 108132. [Google Scholar] [CrossRef] [PubMed]
[35] von Goscinski, C., Gözlügöl, N., Schick, T., et al. (2024) Predictive Parameters for Anatomical Surgical Success in Full-thickness Macular Holes: A Retrospective Evaluation of 391 Eyes. Ophthalmologie, 121, 746-752.
[36] Arias, J.D., Córdoba-Ortega, C.M., Martinez-Pulgarín, D.F., Viteri, E.J., Parra, M.M. and Rangel, C.M. (2026) Plasma Membrane Rich in Growth Factors for the Treatment of Macular Holes Associated with Macular Telangiectasia Type 2. Retinal Cases & Brief Reports, 20, 43-46. [Google Scholar] [CrossRef] [PubMed]
[37] Dhami, A., Sharma, P., Dhami, N.B. and Dhami, G.S. (2022) To Evaluate the Functional and Anatomical Outcomes for Autologous Retinal Autograft with Finesse Flex Loop for Failed Macular Holes. Indian Journal of Ophthalmology, 70, 3033-3037. [Google Scholar] [CrossRef] [PubMed]
[38] Hayakawa, Y. and Inada, T. (2025) Amniotic Membrane Coverage for Intractable Large Macular Holes: A First Report with Japanese Patients. Journal of Clinical Medicine, 14, Article 3708. [Google Scholar] [CrossRef] [PubMed]
[39] Fallico, M., Jackson, T.L., Chronopoulos, A., Hattenbach, L., Longo, A., Bonfiglio, V., et al. (2021) Factors Predicting Normal Visual Acuity Following Anatomically Successful Macular Hole Surgery. Acta Ophthalmologica, 99, e324-e329. [Google Scholar] [CrossRef] [PubMed]
[40] Zgolli, H., Abdelhedi, C., Mabrouk, S., Fekih, O., Zghal, I., Malek, I., et al. (2023) Prognostic Factors for Visual Recovery after Successful Large Macular Hole Surgery Using the Inverted Flap Technique. Journal Français dOphtalmologie, 46, 1069-1078. [Google Scholar] [CrossRef] [PubMed]
[41] Lee, Y.H., Lee, S.J., Jang, J.H. and Kim, Y.C. (2022) Prognostic Factors in Fluid-Gas Exchange after Primary Idiopathic Macular Hole Surgery. International Ophthalmology, 42, 2811-2818. [Google Scholar] [CrossRef] [PubMed]
[42] Zou, J., Wang, N., Zhang, F., Lian, H., Zeng, J. and Yang, Y. (2025) Prognostic Factors for Postoperative Macular Microcirculation Remodeling in Idiopathic Full-Thickness Macular Hole. Photodiagnosis and Photodynamic Therapy, 55, Article 104767. [Google Scholar] [CrossRef] [PubMed]
[43] Romano, M.R., Rossi, T., Borgia, A., Catania, F., Sorrentino, T. and Ferrara, M. (2022) Management of Refractory and Recurrent Macular Holes: A Comprehensive Review. Survey of Ophthalmology, 67, 908-931. [Google Scholar] [CrossRef] [PubMed]
[44] Al-Ruwaili, R.M., Babaker, R.K., Al-Onazi, R.H., Al-Amoudi, S.A., Al-Harbi, M.H. and Al-Dhibi, H.A. (2025) Optimal Approaches for Managing Recurrent Macular Holes: A Comprehensive Systematic Review and Meta-Analysis. Graefes Archive for Clinical and Experimental Ophthalmology, 263, 3301-3317. [Google Scholar] [CrossRef
[45] Cao, J.L. and Kaiser, P.K. (2021) Surgical Management of Recurrent and Persistent Macular Holes: A Practical Approach. Ophthalmology and Therapy, 10, 1137-1153. [Google Scholar] [CrossRef] [PubMed]
[46] Azimi, R., Hassan, A.K., Ghafari, E., Kuppermann, B.D. and Mehta, M.C. (2025) Secondary Macular Hole Closure with Sub-Tenon Triamcinolone Acetonide. Journal of Vitreo Retinal Diseases, 9, 876-880. [Google Scholar] [CrossRef] [PubMed]
[47] Lee, Y.M., Bahrami, B., Selva, D., Casson, R.J. and Chan, W.O. (2024) Scoping Review of Nonsurgical Treatment Options for Macular Holes. Survey of Ophthalmology, 69, 677-696. [Google Scholar] [CrossRef] [PubMed]
[48] Saad, S.M., Rizvi, S.F., Tufail Khan, M.A., et al. (2021) Outcome of Recurrent Macular Hole Closure with Amniotic Membrane Plug. Journal of Ayub Medical College Abbottabad, 33, 179-182.
[49] Quiroz-Reyes, M.A., Quiroz-Gonzalez, E.A., Quiroz-Gonzalez, M.A. and Lima-Gomez, V. (2024) Safety and Efficacy of Human Amniotic Membrane Plug Transplantation in Cases of Macular Hole. A Scoping Review. International Journal of Retina and Vitreous, 10, Article No. 82. [Google Scholar] [CrossRef] [PubMed]
[50] Iwama, Y., Sugase-Miyamoto, Y., Onoue, K., Uyama, H., Matsuda, K., Hayashi, K., et al. (2024) Transplantation of Human Pluripotent Stem Cell-Derived Retinal Sheet in a Primate Model of Macular Hole. Stem Cell Reports, 19, 1524-1533. [Google Scholar] [CrossRef] [PubMed]
[51] Garweg, J.G., Ouassi, D. and Pfister, I.B. (2020) Hybrid 23/27 Gauge Vitrectomy—Combining the Charm of 27G with the Efficacy of 23G. Clinical Ophthalmology, 14, 299-305. [Google Scholar] [CrossRef] [PubMed]
[52] Kumar, S., Rao, G.N., Sinha, N., Rath, B., Pattanayak, S.S. and Pal, A. (2024) Predictive Relevance of Optical Coherence Tomography Indices in Conjunction with Visual Acuity and Surgical Outcomes of Idiopathic Macular Hole. Heliyon, 10, e39261. [Google Scholar] [CrossRef] [PubMed]
[53] Kiyohara, K., Ishikawa, K., Yuge, K., Yamana, S., Nakao, S. and Sonoda, K. (2025) Initial Clinical Use of the Intraocular Endoscope Holding Robot in Pars Plana Vitrectomy. Japanese Journal of Ophthalmology, 70, 358-366. [Google Scholar] [CrossRef
[54] Bishop, S.N. and Selber, J.C. (2021) Minimally Invasive Robotic Breast Reconstruction Surgery. Gland Surgery, 10, 469-478. [Google Scholar] [CrossRef] [PubMed]
[55] Shemmeri, E. and Wee, J.O. (2021) Robotics and Minimally Invasive Esophageal Surgery. Annals of Translational Medicine, 9, 898-898. [Google Scholar] [CrossRef] [PubMed]
[56] Vo, C.D., Jiang, B., Azad, T.D., Crawford, N.R., Bydon, A. and Theodore, N. (2020) Robotic Spine Surgery: Current State in Minimally Invasive Surgery. Global Spine Journal, 10, 34S-40S. [Google Scholar] [CrossRef] [PubMed]
[57] Pérez de la Torre, R.A., Ramanathan, S., Williams, A.L. and Perez-Cruet, M.J. (2022) Minimally-Invasive Assisted Robotic Spine Surgery (MARSS). Frontiers in Surgery, 9, Article 884247. [Google Scholar] [CrossRef] [PubMed]