黄斑裂孔第3、4期視網膜内界膜染色舆剥除的前瞻性研究

目的爲了確定用吲哚青綠介導特發性黄斑裂孔第3、4期視網膜内界膜剥除手術的解剖和視覺效果.方法連績研究3～4期特發性黄斑裂孔病人28例28祗眼.所有眼都施行平部玻璃體次全切除術,必要時清除後部玻璃體及任何可見的視網膜前膜.將濃度爲每毫升0.25mg至1.25mg的ICG溶液緩慢地注入到黄斑,待浸漬時停止.内界膜被染色,距黄斑裂孔邊緣1～2個視盤直徑環行剥除内界膜.手術結束時使用12%Perfluoropropane(C3F8)氣體.術後病人需要保持面朝下2周.結果隨訪時間爲6～14個月,平均9.5個月.14祗眼(50%)為黄斑裂孔第4期,另14祗眼(50%)爲黄斑裂孔第3期.11祗眼(39.3%)爲1年以上的慢性黄斑裂孔.最後隨訪時25祗眼(89.3%)解剖復位,黄斑裂孔閉合.其中21祗眼(75%)黄斑裂孔封閉,另4眼(14.3%)黄斑裂孔變平.18祗眼(64.3%)視力提高兩行或兩行以上.視力平均提高2.6行(範圍2～7行).非慢性裂孔和慢性裂孔分别提高3.4行和1.4行.經統計學處理,兩組間具有顯著性差异(P=0.031).結論ICG介導視網膜内界膜剥除在封閉特發性黄斑裂孔第3～4期中是很有幫助的.

A prospective study ofstaining and removal of retinal internal limiting membrane in stages 3 and 4 macular holes

Objective To determine the anatomical and visual outcome in primary surgery for idiopathic stage 3 or 4 macular holes with indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling. Methods A prospective consecutive study of 28 eyes of 28 patients with primary idiopathic stage 3 or 4 macular holes was conducted. All eyes underwent a subtotal pars plana vitrectomy with removal of the posterior hyaloid and any visible epiretinal membrane when necessary. ICG solution of concentration ranging from 0.25mg/ml to 1.25mg/ml was gently injected over the macular region with the infusion temporarily stopped. The ILM was stained and removed in a circular fashion 1-2 disc-diameter from the edge of the macular hole. At the end of the surgery, 12% perfluoropropane gas was used and patients were required to maintain a facedown posture for two weeks postoperatively. Results The mean follow-up duration was 9.5 months (range, 6-14 months). Fourteen (50.0%) eyes had stage 3 macular holes and the other fourteen (50.0%) eyes had stage 4 macular holes. Eleven (39.3%) had chronic macular holes of duration more than one year. At the last follow-up, twenty-five (89.3%) eyes had successful anatomical closure of the macular hole. These included twenty-one (75.0%) close macular holes and four (14.3%) flat macular holes. Eighteen (64.3%) eyes had improvement of two or more lines of visual acuity. The mean improvement in visual acuity was 2.6 lines (range,-2 to 7 lines), with 3.4 lines and 1.4 lines for non-chronic and chronic holes respectively. This difference was statistically significant (two-tailed t test, P= 0.031). Conclusion ICG-assisted retinal ILM removal appears beneficial in closing primary idiopathic stage 3 or 4 macular holes.