Efficacy of Internal Limiting Membrane Peeling Combined with Mouse Nerve Growth Factor Injection for Idiopathic Macular Hole

Abstract

Objective: To compare the differences of macular microcirculation and microperimetry in patients with Idiopathic Macular Hole (IMH) after Pars Plana Vitrectomy (PPV) with ILM peeling with ILM peeling and intravitreal injection mouse Nerve Growth Factor(mNGF). Methods: A retrospective study was performed in adults’ patients. 44 eyes of 43 patients with IMH (25 females, 18 males) who received surgical treatment in the Affiliated Ophthalmological Hospital of Nanchang University in Nanchang City, Jiangxi Province from March 2021 to October 2021 were selected. 24 eyes of 23 patients who managed PPV combined with ILM peeling and intravitreal mNGF (combined group) and 20 eyes of 20 patients who underwent PPV combined with ILM peeling (placebo group). The BCVA, OCTA and MP-3 microperimetry were carried out and observed at baseline, 1 week(1W), 1,3 and 6 months (1M,3M,6M) postoperatively. Results: During the observation, the hole that was closed in the placebo group and combined group were 18 eyes (90%) and 23 eyes (95.8%) respectively, and the difference was not statistically significant (p=0.583). Compared to pre-surgery, the perimeter and circularity of FAZ in the placebo group decreased at 1M,3M,6M and 1M,6M respectively post-surgery, and both that showed significant reduction in the combined group at each follow-up time point (both values of p<0.05). In the combined group, the vascular density of SCP increased at 1W (p=0.031) and 6M (p=0.007), the perfusion density of SCP was significantly improved at each follow-up time point (all values of p<0.05). The BCVA of the placebo group improved with the time, but the improvement was not statistically significant (all values of p>0.05), and that increased significantly at each follow-up time point in the combined group, the difference was statistically significant (all values of p<0.05). The BCVA in the combined group was more obvious than that in the placebo group at 1M, 3M and 6M after operation (t1=2.248, p1=0.030; t3=3.546, p3=0.001; t6=3.054, p6=0.004). The changes of BCVA in the combined group was more conspicuous than that in the placebo group at each follow-up time point, and the difference was statistically significant (t1=2.206,p1=0.033;t2=2.54,p2=0.015;t3=3.546,p3=0.001;t6=3.124,p6=0.003).Compare-d to pre-operation, the VA at 2°, 4° and 12° in the placebo group was decreased and the difference was statistically significant (all values of p<0.05) at each follow-up time point. In the combined group, the VA of 2°and 12°were significantly improved at 1M, 3M and 6 M postoperatively, and the VA of 4° was improved at each follow-up time point, the difference was statistically significant (all values of p<0.05). At 1M, 3M and 6M, the VA of 2° and 4° in the combined group was better than that in the placebo group. During various time points, the VA of 12°in the combined group was better than that in the placebo group, the difference was statistically significant (p<0.05). Conclusion: PPV combined with ILM peeling and intravitreal injection mNGF is more effective than PPV combined with ILM for IMH, which can not only increase the blood flow and VA in macular, but also improve the visual function of patients.