Purpose: To evaluate the effect of internal limiting membrane peeling and air tamponade for idiopathic macular hole, and explore reasons and interventions for persistent holes. Methods: One hundred and thirty-five eyes with Stage III and IV idiopathic macular hole that underwent 23-gauge vitrectomy, internal limiting membrane peeling, and air tamponade were reviewed. Eyes with persistent holes underwent a second surgery. Outcome-related factors and interventions treating persistent holes were discussed. Results: The initial closure (Type I) rate was 89.63% (121/135). Eyes that underwent the second surgery all obtained final closure (Type I). Diameter of macular hole was significantly smaller (P < 0.001) and duration of symptoms was significantly shorter (P = 0.017) in initially closed cases than in unclosed ones. Binary logistic regression indicated large diameter of macular hole as a risk factor for initial closure (P = 0.004). A cutoff value of 677 μm was provided by receiver operating characteristic curve to predict initial closure (P < 0.001). Best-corrected visual acuity of all individuals improved significantly (P < 0.001) from 20/154 to 20/40 (mean follow-up: 4.5 months). Conclusion: Internal limiting membrane peeling and air tamponade for idiopathic macular hole provide satisfactory morphologic and functional outcomes. Large diameter of macular hole and long duration of symptoms are risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.

BackgroundVitreomacular adhesion (VMA) has been reported to associated with age-related macular degeneration (AMD). Understanding the mechanisms underlying cyclic stretch induced in retinal pigment epithelial cells (RPE) may be important for the treatment of VMA-related AMD.MethodCyclic stretch (1HZ, 20% elongation) was applied to cultured ARPE-19 cells for 15 min, 2 h, 6 h, 12 h, 24 h by flexcell FX-5000 Tension system. Total reactive oxygen species (ROS) were detected using DCFH-DA. Mitochondrial superoxide were detected using MitoSOX Red mitochondrial superoxide indicator. NADPH oxidases (NOX) and signaling pathways, such as p38 and PKC, were detected using western blot. Apocycin (Apo) were used as NOX inhibitors.ResultHigh levels of total ROS were detected from 15 min to 24 h, whereas mitochondrial superoxide were higher only in early time. NOX2 were significantly increased at 24 h. NOX4 were significantly increased at 2 h and reach its peak at 24 h. P-p38 was significantly increased at 12 h and 24 h. P-PKC was significantly increased at 15 min and kept a persistent high level. The upregulated expression of NOX4 by cyclic stretch can be significantly decreased under p-PKC inhibitor other than p-p38 inhibitor.ConclusionCyclic stretch induce oxidative stress from both mitochodrial and NADPH oxidase in RPE cells, which may prompt oxidative damage in VMA-related AMD.

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