内界膜剥离治疗特发性黄斑裂孔

目的 探讨玻璃体切割联合吲哚青绿染色内界膜剥离治疗特发性黄斑裂孔的疗效.方法 采用玻璃体切割联合吲哚青绿染色内界膜剥离治疗特发性黄斑裂孔15例15只眼,对患者手术前、术后视力、黄斑裂孔地愈合情况进行检查随访.结果 本组15例15只眼均成功的剥离内界膜,随访6个月.黄斑裂孔完全愈合13只眼,2例裂孔直径缩小,裂孔封闭的成功率86.66%,视力提高率89.33%,结论玻璃体切割联合内界膜剥离术能有效的封闭特发性黄斑裂孔,提高视力.     

内界膜剥除治疗特发性黄斑裂孔

在三通道睫状体平坦部玻璃体切除术中进行内界膜剥离治疗特发性黄斑裂孔,可以减少对黄斑的切线方向牵拉,使黄斑裂孔封闭,视网膜复位,提高术后视力,减少黄斑裂孔的复发。应用吲哚青绿、台盼蓝、曲安奈德等染色有助于提高内界膜剥离术的成功,但也存在一定的并发症。     

亮蓝辅助内界膜剥离术治疗特发性黄斑裂孔的疗效

目的 探讨亮蓝染色下玻璃体切割注气联合内界膜剥离术治疗特发性黄斑裂孔患者的疗效.方法 对15例(15眼)特发性黄斑裂孔患者行玻璃体切割注气联合亮蓝辅助内界膜剥离术,观察术后黄斑裂孔闭合情况、视力、眼压及并发症等.结果 术中15眼患者内界膜染色效果均较好,剥离顺利.术后随访3个月,13眼黄斑裂孔闭合,闭合率为86.7%;2眼视力无变化.余视力均较术前有不同程度提高;未见由亮蓝注射导致的急性毒性反应和白内障、高眼压、医源性视网膜损伤等并发症.结论 亮蓝辅助内界膜剥离术治疗特发性黄斑裂孔是一种安全有效的方法.     

吲哚青绿辅助黄斑前膜联合内界膜剥除治疗特发性黄斑前膜的临床效果

背景 特发性黄斑前膜（IMEM）可与玻璃体黄斑牵拉综合征、黄斑假孔、黄斑板层裂孔同时发生,清除眼后极部玻璃体及完整剥离IMEM是治疗的关键. 目的 探讨吲哚青绿（ICG）辅助黄斑前膜联合内界膜剥离在IMEM手术治疗中的作用.方法 采用系列病例观察研究方法.收集2010年6月至2012年9月在郑州大学第一附属医院确诊为IMEM患者29例29眼,包括单纯黄斑前膜16眼、黄斑前膜合并玻璃体黄斑牵拉综合征6眼、黄斑前膜合并黄斑假孔3眼、黄斑前膜合并黄斑板层裂孔4眼.采用标准三切口玻璃体切割术,先将0.1ml曲安奈德4 mg注入玻璃体腔染色玻璃体后皮质,对无玻璃体后皮质脱离者或不全性玻璃体后皮质脱离者行诱导脱离并完全切除,然后用1 ml注射器吸取0.1 ml质量分数0.25％ ICG推注3～5滴于黄斑部表面,30 s后笛针吸除.染色后有前膜游离边缘者用视网膜镊夹取剥除,之后0.25％ ICG再染色,剥除黄斑区内界膜;无法分辨黄斑前膜范围或前膜与内界膜贴伏平整或粘连较紧密者则将内界膜及前膜一并剥除.记录染色及膜剥离效果.主要分析指标包括膜染色形态及成功膜剥离眼数,次要分析指标包括术后视力改善情况及术中、术后并发症.结果 染色后所有患眼均能很好地辨认剥离区及未剥离区,黄斑前膜范围清晰者23眼,占79％,能够分辨前膜游离边界并直接剥除前膜者17眼,占58％;染色后无法分辨前膜范围或前膜与内界膜贴伏平整或粘连紧密者,术中由内界膜起瓣并将前膜及内界膜同时剥离者12眼,占42％.术后随访1～28个月,平均（9.65±7.58）个月,20眼术后视力提高,占69％.患眼术前LogMAR视力为0.72±0.67,术后为0.62±0.56,术后视力明显提高,差异有统计学意义（t=2.370,P=0.025）.术中无严重并发症,无黄斑前膜复发病例.结论 ICG染色联合内界膜剥除有助于安全、彻底地剥离IMEM,改善术眼视力,并能预防复发.     

曲安奈德和吲哚青绿双染法辅助下玻璃体切除术治疗特发性黄斑孔

目的 探讨曲安奈德(TA)和吲哚青绿(ICG)双染法辅助下玻璃体切除联合内界膜剥除术治疗特发性黄斑孔的疗效.方法 26例(26眼)均行玻璃体切除联合内界膜剥除术,术中应用TA和ICG辨认玻璃体后皮质和内界膜,术毕填充16％C3F8气体.结果 随访3～18个月,2例失访,23例黄斑孔完全闭合,1例未闭合者伴近锯齿缘处小裂孔后以硅油填充后闭合.随访患者24例中,21眼视力提高,2眼不变,1眼视力稍下降.结论 术中应用TA可以更清晰地辨认玻璃体后皮质,ICG的应用则有助于内界膜的剥除.TA和ICG双染法辅助下玻璃体切除术治疗特发性黄斑孔安全有效.     

吲哚青绿辅助内界膜剥离治疗3或4期黄斑裂孔

目的探讨吲哚青绿(indocyaninegreen,ICG)辅助内界膜(internallimitingmembrane,ILM)剥离治疗3或4期特发性黄斑裂孔(idiopathicmacularhole,IMH)的疗效。方法33例(33眼)3期(14眼)或4期(19眼)IMH患者,均行玻璃体切割术,ICG染色辅助ILM剥离,术毕填充14?F8气体,术后患者俯卧位2周,随访6～24月,平均11月。结果术后最终随访30眼裂孔闭合,闭合率90.9%,Snellen视力表提高2行以上者28眼(84.8%)。结论ICG辅助视网膜内界膜剥离治疗3或4期IMH安全有效。     

玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔

目的评价玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔的临床疗效。方法采用玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔17例17眼,对患者术前术后视功能、术后黄斑裂孔闭合及手术主要并发症等进行检查和随访。结果本组17眼均成功剥离内界膜。随访5～24个月,其中13眼黄斑裂孔完全闭合,4眼裂孔直径缩小,裂孔封闭成功率为76.47%;17眼中14眼视力提高,视力提高率为82.35%;视物变形等症状也有明显改善。并发症主要有术中毛细血管性出血、术后一过性高眼压及晶状体后囊下混浊。结论玻璃体切割联合内界膜剥离术可有效封闭特发性黄斑裂孔,提高视功能。     

ICG染色下行内界膜剥离术治疗老年特发性黄斑裂孔

目的：探讨吲哚靛青绿（indocyanine green,ICG)染色下行玻璃体切割内界膜剥离术治疗老年特发性黄斑裂孔的手术效果。方法：对老年特发性黄斑裂孔伴视网膜脱离者16眼行玻璃体切割及ICG染色下内界膜剥离术，术中明确剥离着染成绿色的视网膜内界膜（inner limiting membrane,ILM)，并使视网膜复位。结果：ILM剥暾顺利，术中未见明显并发症，随访3-18个月，视网膜均复位，14眼黄斑裂孔闭锁，闭锁率87.5%,3眼视力无变化，余均有不同程度的视力提高，视物变形改善。结论：ICG染色下行内界膜剥离术治疗老年特发性黄斑裂孔安全，有效，目前未见不良反应。     

25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔疗效评估

目的 探讨25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔的临床疗效.方法 回顾性分析2014年5月至2016年8月在丽水市人民医院眼科行25G玻璃体切割术的黄斑裂孔患者28例28只眼的临床资料,所有患者行25G玻璃体切割,在0.25 mg/ml亮蓝染色下剥除内界膜,玻璃体腔内消毒空气填充.术后主要观察手术时间、最佳矫正视力、眼压、裂孔闭合情况及手术并发症.术后随访3～24个月,平均（12.23.6）个月.结果 总手术时间为22～40 min,平均28 min,28只眼内界膜均顺利剥除,28例患者黄斑裂孔均闭合（100％）,21例患者术后视力较术前均有提高（75％）,无视力下降患者,平均视力为0.650.194,与术前相比显著提高（t=13.768,P=0.000）.术后1周平均眼压为（15.33.7） mmHg,与术前水平相近.8只眼剥除IMH时视网膜表面少量细小点状出血,4只眼术后随访期间发生核性白内障,3只眼发生一过性高眼压.所有病例在随访期内无其它严重并发症发生.结论 25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔,能促进裂孔愈合,提高术后视力,缩短手术时间,减少并发症,是一种安全有效的微创手术方法.     

糖尿病黄斑弥漫性水肿的手术治疗

目的 探讨玻璃体手术联合内界膜剥离治疗糖尿病黄斑弥漫水肿的临床效果.方法 选择糖尿病黄斑弥漫水肿16例(17只眼).9例(10只眼)行标准三切口玻璃体手术,7例(7只眼)行25G玻璃体手术.其中曲安奈得染色7只眼,膜盼蓝染色6只眼;0.25%吲哚青绿染色4只眼,所有病例行内界膜剥离.术后随访3～12月,平均6.5月.结果 手术后视力提高2行及以上11只眼(占68.8%),黄斑水肿明显消退15只眼(占83.3%).结论 应用玻璃体切割联合内界膜剥离能有效的治疗糖尿病黄斑弥漫水肿.     

不同染色剂辅助内界膜剥除治疗IMH手术前后微视野的变化

目的：观察研究应用不同染色剂辅助内界膜剥除治疗特发性黄斑裂孔( idiopathic macular hole,IMH)手术治疗前后黄斑区微视野的变化情况。
　　方法：回顾性对比分析50例50眼特发性黄斑裂孔患者应用曲安奈德( triamcinolone acetonide, TA )或吲哚青绿( indocyanine green,ICG)辅助内界膜剥除治疗前后黄斑裂孔的闭合情况、最佳矫正视力以及微视野的改变。
　　结果：术后随访6mo,经光学相干断层扫描( optical coherence tomography,OCT)检查TA组黄斑裂孔完全闭合76%、未闭合但裂孔平复16%、未闭合8%;ICG组黄斑裂孔完全闭合72%、未闭合但裂孔平复16%、未闭合12%,两组患者手术治疗后最佳矫正视力( best corrected visual acuity,BCVA)均明显改善但两组间比较差异无统计学意义,两组患者中央20o范围内黄斑微视野视网膜敏感度得到明显提高,TA组较ICG组更为明显。
　　结论：玻璃体切割联合内界膜剥除术可有效的促进特发性黄斑裂孔的闭合、明显改善黄斑区视网膜敏感度以及视力。黄斑区微视野检查可以较好的随访评价IMH手术治疗后黄斑区视功能变化情况。     

内界膜剥离治疗特发性黄斑裂孔的早期愈合观察

目的：探讨玻璃体切除联合内界膜剥离治疗特发性黄斑裂孔的早期愈合情况。方法：回顾分析了2001年1月～2003年10月在我院行手术治疗的特发性黄斑裂孔25例(25只限),所有病人均采用经平坦部玻璃体切除联合黄斑前膜和(或)内界膜剥离,气-液交换和16％全氟丙烷(C3F8)充填。术后保持面朝下体位至少2周。采用裂隙灯、前置镜,光学相干断层扫描(OCT)检查观察手术后1个月内的黄斑裂孔的关闭情况。手术后第1周内每天检查,14、21和28d行常规裂隙灯前置镜检查;根据手术后玻璃体腔气体吸收的情况行OCT检查,当气体吸收超过50％,黄斑部露出时即行OCT检查。结果：25只眼中23只眼术中完整的撕除黄斑裂孔周围内界膜,2只眼未能完整撕除裂孔旁的内界膜。在手术后24—48h,23只眼裂隙灯及裂隙灯前置镜检查未发现黄斑裂孔的形态,1个月内的OCT检查证实23只眼黄斑裂孔均闭合．裂孔闭合率为92％,随访期间未发现裂孔再裂开现象。未闭合的2只眼均为手术中未能完整撕除内界膜眼,其中1只眼为3期黄斑裂孔,1只眼为4期黄斑裂孔,在随访期间未见裂孔关闭。术后早期黄斑裂孔关闭的23只眼的OCT形态主要表现为：正常的中心凹形态(简单闭合)15只眼(65,2％),桥样结构8只眼(34．8％)。结论：大部分特发性黄斑裂孔在手术后早期即已关闭,提示特发性黄斑裂孔在形成过程中不伴局部的视网膜组织缺损或缺损极少,手术解除玻璃体,特别是内界膜的机械牵拉后视网膜可复位,裂孔闭合。     

特发性黄斑裂孔不同浓度吲哚青绿辅助剥除内界膜后视功能对比研究

目的 观察对比不同浓度吲哚青绿(ICG)辅助剥除内界膜后视功能的恢复.方法 取44例(44只眼)特发性黄斑裂孔患者随机分为四组:第1组9例(9只眼),第2组20例(20只眼),第3组10例(10只眼),第4组5例(5只眼).手术方式采用标准三切口玻璃体切割、内界膜剥除联合C3F8填充术.手术中使用ICG辅助剥除内界膜,1、2、3、4组ICG溶液的浓度分别为5.0、2.5、1.25、0.5mg/ml.手术中第1组用少量黏弹剂暂时封闭黄斑裂孔,而第2、3、4组未用任何物质封闭黄斑裂孔.术后定期随访,记录患者的黄斑裂孔闭合率,视力,视野,多焦视网膜电图(MERG).结果 第4组术后黄斑裂孔闭合率偏低.第3组的术后最佳矫正视力优于其它3组.第1,2组术后周边视野缺损的发生率明显高于第3、4组.第1、2组术后MERG周边视网膜二级反应的振幅明显低于手术前,而第3、4组手术前后周边视网膜二级反应的振幅无明显差异.结论 高浓度ICG辅助剥除内界膜对视网膜存在毒性,不利于黄斑裂孔患者术后视功能的恢复;而低浓度ICG辅助剥除内界膜可明显降低ICG对视网膜的毒性,不影响黄斑裂孔患者术后视功能的恢复.     

Residual triamcinolone acetonide at macular hole after vitreous surgery

Post traumatic macular holes have shown successful anatomic outcomes with vitrectomy with internal limiting membrane (ILM) peeling and gas injection. Intraocular use of triamcinolone acetonide (TA) crystals is gaining popularity in patients for visualization of the vitreous cortex, posterior vitreous detachment induction and ILM peeling during macular hole surgery. However, the possibility of residual steroid crystals clogging the hole at the conclusion of surgery exists. In our case, residual TA was observed biomicroscopically in the fovea on the seventh day after surgery, Optical Coherence Tomography (OCT) image of the eye showed a hyper reflective mass corresponding to the TA. However, a repeat OCT carried out four weeks after surgery showed recovery of the foveal morphologic features to an almost normal depression, with closure of the hole. Residual TA crystals in the macular hole post vitreous surgery may not interfere with ultimate macular hole closure or visual improvement.     

内界膜剥除治疗特发性黄斑裂孔的研究进展

特发性黄斑裂孔(IMH)是指无明显病因,并非眼底疾病引发的黄斑裂孔.内界膜剥除术(ILMP)是治疗IMH的有效治疗方法.ILMP可解除黄斑牵拉,提高手术成功率,改善术后患者视力,已成为IMH手术治疗中的一个重要环节.本文就内界膜的染色方法、术中玻璃体腔气体填充、面向下头位要求、术后裂孔愈合过程以及术后效果等进行综述.     

Clinical findings in macular hole surgery with indocyanine green-assisted peeling of the internal limiting membrane

PURPOSE: Indocyanine green (ICG) staining of the internal limiting membrane has facilitated ILM peeling in macular hole surgery. However, it has been reported that ICG-assisted peeling of the ILM may result in retinal damage and unfavorable functional outcome. Therefore, we analyzed our visual and anatomical results of ICG assisted macular hole surgery. METHODS: In a retrospective study the records of a consecutive series of 37 patients with full-thickness idiopathic macular holes operated with ICG-assisted ILM peeling by a single surgeon were analyzed. All patients underwent a standard three-port vitrectomy with surgically induced posterior vitreous detachment, staining of the ILM with ICG, peeling of the ILM in a circular manner around the fovea, and SF6 20% endotamponade. RESULTS: A total of 37 patients (37 eyes) were included in the study. The mean age was 69+/-7 years (range 52-81 years), and there were 26 women and 11 men. The follow-up ranged from 6 to 30 months (mean 18+/-6 months). At baseline visual acuity ranged from 20/400 to 20/40. Anatomically, 13 eyes had stage 2 holes, 21 eyes (57%) stage 3 holes, and three eyes stage 4 holes. At the postoperative visit (8-12 weeks after surgery) anatomical closure of the macular hole was achieved in 36 eyes. Visual acuity ranged between 20/400 and 20/20. At the last follow-up after initial surgery the macular hole was closed in all eyes. Visual acuity ranged from 20/200 to 20/20. CONCLUSION: In our retrospective series anatomical and functional results of macular hole surgery with ICG-assisted peeling of the ILM are satisfactory. Primary hole closure was achieved in 97% of eyes and visual acuity increased in 62% of eyes in our series.     

特发性黄斑裂孔手术前后矫正视力及多焦视网膜电图比较

目的 观察特发性黄斑裂孔(IMH)玻璃体切割手术(PPV)联合吲哚青绿(ICG)辅助内界膜剥除治疗前后的矫正视力及多焦视网膜电图(mfERG)的改变.方法 回顾分析我科接受PPV联合0.25%ICG辅助内界膜剥除治疗的特发性黄斑裂孔患者19例19只眼的临床资料.所有患眼手术前裂孔情况和手术后2个月裂孔闭合情况均以OCT检查为依据.采用VERIS Science 4.9视觉诱发反应图像系统观察手术前及手术后2、6、12个月患者mfERG6个环形视网膜区域mfERG的P1波振幅密度,同时分析比较手术前后最佳矫正视力的改变情况.结果 手术后2个月,OCT检查显示16例16只眼黄斑裂孔闭合,占84.21%;3例3只眼黄斑裂孔未闭合,占15.79%.手术后最佳矫正视力较手术前提高,其中以手术后2个月提高幅度最大(F=6.389,P=0.045).手术后2、6、12个月mfERG各环P1波振幅较手术前均明显降低,其差异均有统计学意义(t=6.140,P＜0.05).结论 IMH患者手术后最佳矫正视力提高;手术后P1波振幅较手术前降低.     

Long-term outcomes of internal limiting membrane peeling with and without indocyanine green in macular hole surgery

PURPOSE: To compare the long-term anatomic closure rate and visual outcome in patients who underwent internal limiting membrane (ILM) peeling with and without indocyanine green (ICG) dye staining for idiopathic macular hole repair. DESIGN: Retrospective, nonrandomized, comparative study of consecutive case series. METHODS: A total of 190 eyes of 182 patients with idiopathic macular holes underwent macular hole repair between March 1998 and June 2003. Surgery consisted of pars plana vitrectomy, lensectomy if phakic, ILM peeling, intravitreal gas tamponade, and 1 week's face-down positioning. In the initial 94 consecutive eyes, ILM peeling was performed without adjuvants (non-ICG group). The subsequent 96 eyes underwent surgery with ICG-stained ILM peeling (ICG group), in which the ILM was stained with intravitreal application of 0.1 to 0.2 mL of 0.1% ICG solution. RESULTS: Two groups of patients had comparable clinical backgrounds preoperatively. Mean follow-up time was 30.7 months in non-ICG group and 26.2 months in ICG group. Anatomic closure of the macular hole was achieved in 99% of the cases in both groups, with both groups showing statistically significant visual improvement. There was no statistically significant difference in visual acuity between the two groups at each follow-up visit. There were also no intraoperative or postoperative complications attributed to the use of ICG. CONCLUSIONS: Long-term follow-up of patients undergoing ILM peeling for idiopathic macular hole repair shows equivalent anatomic and visual outcomes with and without the use of ICG.     

无染色剂下视网膜内界膜剥离联合笛针吸引治疗特发性黄斑裂孔

目的:探讨玻璃体切割(PPV)联合无染色剂下视网膜内界膜剥离(ILMP)、笛针吸引、空气填充术治疗特发性黄斑裂孔(IMH)的临床疗效。方法:回顾性非随机对照研究。选取2018-01/2019-01在我院确诊的IMH患者76例76眼,按手术方式分为两组,其中38眼行PPV联合无染色剂下ILMP、空气填充术(A组),38眼行PPV联合无染色剂下ILMP、笛针吸引、空气填充术(B组)。术后随访6mo以上,观察两组患者黄斑裂孔闭合、最佳矫正视力(BCVA)及并发症发生情况。结果:术后6mo,A组患者黄斑裂孔闭合率和BCVA提高率均显著低于B组(84%vs 100%,76%vs 95%,均P<0.05)。随着术后时间的推移,两组患者BCVA逐渐改善,且术后7、14d,1、3、6mo B组患者BCVA优于A组(均P<0.05)。术后随访期间,两组患者均未出现严重并发症。结论:无染色剂下ILMP联合笛针吸引治疗IMH临床疗效确切,在裂孔闭合率及BCVA改善方面明显优于单纯ILMP组。     

Internal limiting membrane peeling with different dyes in the surgery of idiopathic macular hole: a systematic review of literature and network Meta-analysis

AIM: To evaluate the effect of internal limiting membrane (ILM) peeling with indocyanine green (ICG), brilliant blue G (BBG), triamcinolone acetonide (TA), trypan blue (TB), or without dye for the treatment of idiopathic macular hole (IMH). METHODS: A search was conducted using PubMed, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS: A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION: BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.