采用或不用内界膜剥除的黄斑裂孔手术

目的:在用或不用吲哚氰绿内界膜染色剥膜的情况下,比较特发性黄斑裂孔术后的解剖及视力结果。方法:对连续采用单纯注气术进行眼内填充的40眼特发性黄斑裂孔进行回顾性分析,所有手术均由一位医生完成。所有的患眼术后至少经过了6月的随访。40眼中的前22眼采用保留内界膜手术(非内界膜剥除组),后18眼采用吲哚氰绿对内界膜染色并进行内界膜剥除手术(内界膜剥除组)。结果:内界膜剥除组和非内界膜剥除组特发性黄斑裂孔解剖复位率分别为88.9%和59.1%,统计结果有显著性差异(Fisher’检验,P =0.038)。内界膜剥除组视力提高较非内界膜剥除组更为明显,平均分别提高了3.46和1.3行(t检验,P =0.0356)。多数病例术后视力提高2行或更多,在内界膜剥除组为66.7%,非内界膜剥除组为31.8%(χ2检验,P = 0.028)。然而在2组之间最终的术后logMAR BC-VA没有明显的差异(t检验,P =0.0073)。结论:根据以上研究,通过吲哚氰绿内界膜染色剥除内界膜可促进特发性黄斑裂孔解剖复位及视力的提高。在此方面进一步的研究是必要的。

Macular hole surgery with or without internal limiting membrane peeling

AIM: To compare the anatomical and visual outcome in primary idiopathic macular hole surgery with or without indocyanine green (ICG) stained internal limiting membrane (ILM) peeling.METHODS: The medical records of the last 40 consecurive eyes receiving primary idiopathic macular hole surgery with gas as internal tamponade performed by a single surgeon were retrospectively reviewed and ahalyzed. All eyes had a follow-up of at least 6 months. In the initial 22 consecutive eyes, no ILM peeling was performed (non-ILM peeling group). The subsequent 18eyes underwent surgery with ICG stained ILM peeling (ILM peeling group).RESULTS: The primary anatomical closure rates were 88.9% and 59.1% in the ILM peeling group and non-ILM peeling group, respectively. The difference was statistically significant (Fisher′s exact test, P=0.038). Improvement in visual acuity was more marked in the ILM peeling group than in the non-ILM peeling group, with a mean improvement of 3.6 and 1.3 lines respectively (two-tailed t-test, P=0.036). There were significantly more cases with improvement of two or more lines of visual acuity after surgery, with 66.7% in the ILM peeling group and 31.8% non-ILM peeling group (Chi-square test P =0.028). However, there was no significant difference in the final postoperative logMAR BCVA between the two groups(two-tailed t-test, P=0.073).CONCLUSION: Based on this study, ICG stained ILM peeling seems to improve the anatomical and visual outcome in primary idiopathic macular hole surgery. Further studies in this aspect are warranted.