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目的:比较大型特发性黄斑孔两种手术治疗特点。方法:回顾性分析甘肃省人民医院2014年6月至2019年6月大型特发性黄斑孔(孔直径500～800 μm)82例(82眼)的临床资料。根据手术方式分为两组：A组30例行内界膜剥除术，B组52例行内界膜剥除填塞术。术后随访6个月，比较两组孔的闭合率、视力及中心凹的OCT特征。结果:术后B组黄斑孔的闭合率为92.3%(48/52)，优于A组的83.3%(25/30)(n χ2＝9.210，n P＝0.001)；术前A、B两组视力(BCVA，logMAR)分别为1.10±0.36及1.17±0.48；术后4 d为1.05±0.37及1.14±0.46，两组手术前后相比差异均有统计学意义(n P0.05)。术后6个月中心凹结构的OCT特征：A、B两组完整型分别为10眼和21眼，萎缩变薄型分别为8眼和24眼，缺失型分别为7眼和3眼，差异均有统计学意义(n P<0.05)。n 结论:内界膜填塞术可以提高大型特发性黄斑孔的闭合率，较好地恢复中心凹的解剖形态，但在术后视力方面未显示优势。“,”Objective:To compare the characteristic of two surgical methods in the treatment of large idiopathic macular hole.Methods:The clinical data of 82 eyes of 82 patients of large idiopathic macular hole with a diameter of 500-800 μm from Jun. 2014 to Jun. 2019 in Gansu Provincial People’s Hospital were retrospectively analyzed. These cases were divided into two groups based on surgical methods. Group A with 30 cases were treated with internal limiting membrane peeling and air tamponade, group B with 52 cases were treated with internal limiting membrane insertion and gas tamponade. The follow up time was 6 months after operation. Closure rate of the macular hole, best corrected visual acuity and OCT feature in macular fovea were compared between the two groups.Results:The closure rate of group B was 92.3% (48/52), which was better than the 83.3% (25/30) of group A, the difference was statistically significant(n χ2=9.210, n P=0.001). The vision (BCVA, logMAR) of group A and group B were 1.10±0.36 and 1.17±0.48 respectively before operation and 1.05±0.37 and 1.14±0.46 at 4 days after operation respectively. The difference of BCVA were statistically significant between before and 4 dyas after surgery (n P0.05). In OCT feature of macular fovea at 6 months after surgery, the probability of intact type in group A and group B occurred in 10 eyes and 21 eyes respectively; that of atrophy type were in 8 eyes and 24 eyes; that of missing type were in 7 eyes and 3 eyes. The differences were statistically significant (alln P<0.05).n Conclusion:Internal limiting membrane insertion can improve the closure rate of large idiopathic macular hole and can better restore the anatomic morphology of macular fovea, but it has no advantage in visual acuity after operation.