黄斑裂孔手术有无内界膜剥除对疗效的影响

目的比较我院5年内一组30例特发性黄斑裂孔有/无内界膜（internal limiting membrane,ILM）剥除手术的结果。方法所有病例均施行平坦部玻璃体切除有/无内界膜剥除,玻璃体内注气,术后头俯位,无其他辅助治疗。结果术后随访只少6个月以上,13眼有ILM剥除的黄斑裂孔术后均己闭合,比较17眼黄斑裂孔无ILM剥除者中14眼术后裂孔闭合（P〉0.05）。5眼2期黄斑裂孔全闭合（100%）,3、4期黄斑裂孔术后闭合率各为93%和80%。未发现有何严重的并发症,最后视力多有进步、特别在2期黄斑裂孔之眼。结论对选择性病例,施行玻璃体切除并用ILM剥除是一有用且有效的治疗黄斑裂孔手术。     

Macular hole surgery with and without internal limiting membrane peeling

OBJECTIVE: To compare results of surgery for idiopathic macular hole with and without internal limiting membrane (ILM) peeling in a series of consecutive patients over a 5-year period. DESIGN: A retrospective, nonrandomized, comparative trial with concurrent control group. PARTICIPANTS: Forty-four eyes with macular holes of less than or equal to 6 months duration without ILM peeling were compared to 116 eyes with ILM peeling and the same hole duration. A third group of 65 eyes with ILM peeling and duration greater than 6 months was also evaluated. INTERVENTION: All eyes underwent pars plana vitrectomy with or without ILM peeling, intravitreous gas, and positioning face down. No adjunctive therapies were used in any group. MAIN OUTCOME MEASURES: Comparing the closure and/or reopening rate, prognosis, visual acuity, and complications for macular holes with and without ILM peeling. RESULTS: All patients had postsurgical follow-up of 18 months or greater. Primary closure was significantly improved with ILM peeling with 116 of 116 eyes (100%) showing no reopenings versus 36 of 44 holes (82%) primarily closed, 9 of which (25%) reopened without ILM peeling (P: < 0.00001) in holes less than or equal to 6 months. The 27 eyes without ILM peeling that had successful surgery displayed a mean postoperative vision of 20/40, which is the same as the successful eyes with ILM peeling (P: = 0.6). The 52 stage II eyes with ILM peeling had a mean postoperative vision of 20/30, and 48 of the 52 eyes (92%) were 20/40 or better. Stage III eyes (greater than 400-microm holes) without ILM peeling had a poor prognosis, with 6 of the 25 eyes (24%) having initial surgery fail and an additional 4 of 25 eyes (16%) reopening. Without ILM peeling, holes less than 300 microm had only one reopen, whereas holes greater than or equal to 300 microm had 16 of the 17 (94%) primary failures and/or reopenings (P: < 0.001). All 12 holes that reopened and/or primarily failed were repaired with ILM peeling with excellent visual recovery. Macular holes with a duration greater than 6 months were treated with ILM peeling, and 63 of 65 holes (97%) were closed primarily and 65% had an increase in vision by two or more Snellen lines. CONCLUSIONS: ILM peeling significantly improves visual and anatomic success in all stages of recent and chronic macular holes and reopened and failed holes, while eliminating reopening for holes greater than 300 microm.     

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 edema and visual loss after macular pucker surgery with ICG-assisted internal limiting membrane peeling

PURPOSE: To describe the occurrence of massive macular edema and visual loss after indocyanine green-assisted (ICG) macular pucker surgery. METHODS/RESULTS: A 74 years old female presented with a macular pucker and a hypertrophy of the retinal pigment epithelium (RPE) in her left eye. The preoperative visual acuity (VA) was 20/100. Surgery consisted of cataract extraction, lens implantation and standard pars plana vitrectomy with peeling of epiretinal tissue followed by the removal of the internal limiting membrane (ILM) remnants stained using a 0.05% ICG solution. One day after surgery, VA was counting fingers. There was an extensive macular edema and retinal thickening with hyperfluorescence during fluorescein angiography and pronounced autofluorescence using ICG filters. During follow up, the macular edema resolved completely, but VA decreased to 20/800 at six months postoperatively. There was a central scotoma and unstable fixation seen during microperimetry. DISCUSSION: This case report indicates that ICG might come into contact with bare retina if injected following removal of epiretinal membranes. Whether the observed RPE hypertrophy might have contributed to the pathogenesis of the adverse effect described remains hypothetical.     

Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling

Background: 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 consecutive eyes receiving primary idiopathic macular hole surgery with gas as internal tamponade performed by a single surgeon were retrospectively reviewed and analysed. All eyes had a follow‐up period of at least 6 months. In the initial 22 consecutive eyes, no ILM peeling was performed (non‐ILM peeling group). The subsequent 18 eyes 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 best‐corrected visual acuity between the two groups (two‐tailed t‐test, P = 0.073). Conclusions: 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.     

Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling: A comparative study

Purpose  

To compare visual acuity and macular morphology after epiretinal membrane (ERM) removal with and without internal limiting membrane (ILM) peeling.     

内界膜剥除与不剥除术治疗特发性黄斑前膜的疗效对比观察

目的 比较单纯黄斑前膜剥除术、黄斑前膜剥除联合黄斑区内界膜剥除术两种手术方法治疗特发性黄斑前膜的疗效,探讨剥除视网膜内界膜对特发性黄斑前膜患者术后影响.方法 回顾分析特发性黄斑前膜患者38只患眼的手术疗效.其中A组：黄斑前膜剥除联合内界膜剥除术18眼,B组：单纯黄斑前膜剥除术20眼.手术后随诊3个月以上,于手术前和手术后3个月时对患者行视力、MERG及OCT检查,分别对每组手术前后临床资料、两组之间临床资料进行分析.结果 手术前两组患者的年龄、视力、黄斑中心凹厚度、MERG的1环和2环P波振幅及潜时均无明显差异.手术后3个月时两组视力较手术前均明显提高,黄斑中心凹厚度较手术前明显降低,A组术后MERG的1环和2环P波振幅明显降低,但术后3个月时两组之间视力、黄斑中心凹厚度、MERG潜时差异无显著性,A组MERG的振幅比B组有明显的降低.结论 黄斑前膜剥除术是治疗特发性黄斑前膜的有效方法,内界膜剥除术在手术后短期内未显示其有效性,需进一步随访观察.     

Epiretinal membrane surgery with or without internal limiting membrane peeling

BACKGROUND: The purpose of the present paper was to evaluate the visual outcome and recurrence rate of epiretinal membrane (ERM) formation following vitreoretinal surgery with and without internal limiting membrane (ILM) peel. METHODS: The medical records of 42 consecutive patients who underwent surgery for macular ERM by a single surgeon were reviewed. All patients underwent pars plana vitrectomy and ERM removal with a subset undergoing ILM peel. Recurrence of macular ERM within 18 months and the final visual outcome after surgery were compared between patients with and without ILM removal. RESULTS: Twenty-five patients (59.5%) underwent ERM surgery with ILM peeling and 17 patients (40.5%) underwent ERM surgery without ILM peeling. The mean preoperative logMAR visual acuity was 0.77 and 0.96 for the ILM peeling and non-ILM peeling groups, respectively. Visual acuity improved significantly in both the ILM and non-ILM peeling groups after ERM surgery (P < 0.001 and P = 0.003, respectively). Eighteen months after surgery, 3/17 eyes without ILM peeling (17.6%) developed recurrent macular ERM, compared with none of the 25 eyes with ILM peeling (log-rank test, P = 0.030). CONCLUSIONS: Internal limiting membrane removal during macular ERM surgery may minimize the recurrence of ERM, without adverse visual outcome. Further controlled prospective studies are needed to determine the role of ILM peeling in ERM surgery.     

Macular hole surgery with triamcinolone acetonide-assisted internal limiting membrane peeling: one-year results

PURPOSE: To report the 1-year results of macular hole surgery with triamcinolone acetonide (TA)-assisted internal limiting membrane (ILM) peeling and to compare those with results of indocyanine green (ICG)-assisted ILM peeling. METHODS: In a nonrandomized, retrospective, interventional case series, 40 eyes of 39 consecutive patients with idiopathic full-thickness macular holes underwent macular hole surgery with TA-assisted ILM peeling. Surgical results 1 year after surgery, including changes in best-corrected visual acuity (BCVA) and macular hole closure, were evaluated. Moreover, we compared the results for these 40 eyes (TA group) with those for 27 eyes of 27 consecutive patients who had undergone macular hole surgery with 0.25% ICG-assisted ILM peeling (ICG group). RESULTS: In the TA group, macular holes were closed in 39 (98%) of 40 eyes. Mean BCVA +/- SD significantly improved from 0.78 +/- 0.31 logarithm of the minimal angle of resolution (logMAR) preoperatively to 0.20 +/- 0.30 logMAR (P < 0.001). BCVA improved by > or =0.2 logMAR in 37 eyes (93%). BCVA was 20/40 or better in 33 (83%) of 30 eyes. In the ICG group, macular holes were closed in all 27 eyes (100%), and mean BCVA +/- SD significantly improved from 0.81 +/- 0.4 logMAR preoperatively to 0.34 +/- 0.2 logMAR 1 year postoperatively (P < 0.001). BCVA improved by > or =0.2 logMAR in 22 eyes (81%). BCVA was 20/40 or better in 16 (59%) of 27 eyes. Significant differences between groups were seen in mean BCVA 1 year after surgery (P = 0.049) but not in BCVA of 20/40 or better (P = 0.17) or change in BCVA by > or =0.2 logMAR (P = 0.05). CONCLUSION: TA is useful as an adjuvant for ILM peeling in macular hole surgery, and BCVA 1 year after surgery might be more favorable when compared with ICG-assisted ILM peeling.     

Triamcinolone-assisted internal limiting membrane peeling

PURPOSE: To review our experience with triamcinolone-assisted pars plana vitrectomy for internal limiting membrane (ILM) peeling for various retinal diseases. METHODS: Twenty-one patients underwent surgery in which intraoperative triamcinolone acetonide (TA) was used. Indications for surgery included epiretinal membrane (3 patients), branch retinal vein occlusion associated with macular edema (2), traction retinal detachment (3), diabetic macular edema (4), vitreous hemorrhage with diabetic macular edema (4), macular hole (4), and cystoid macular edema (1). RESULTS: TA was useful in the removal of the ILM in all cases. There were no intraoperative complications or toxicity. The mean follow-up was 22 weeks (range, 9-30 weeks). Eleven patients improved by >or=2 Snellen lines, 1 lost >or=2 Snellen lines, and 9 were within 2 Snellen lines of preoperative vision at the last follow-up. CONCLUSIONS: The intraoperative use of TA improves visualization of ILMs associated with a variety of conditions. No intraoperative or postoperative complications were observed. TA-assisted removal of the ILM appears to be safe and cost effective. TA-assisted ILM peeling should be considered as an alternative to the use of intraoperative dyes.     

Macular hole surgery: experience with autologous platelet concentrate and indocyanine green-assisted internal limiting membrane peeling

BACKGROUND: To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery. PATIENTS AND METHODS: Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 +/- 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 +/- 0,1 x 10(8) thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients. RESULTS: After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed. CONCLUSION: Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling     

Functional and structural measurements for the assessment of internal limiting membrane peeling in idiopathic macular pucker

OBJECTIVE: To investigate the role of structural and functional measurements in the assessment of internal limiting membrane (ILM) peeling for the treatment of eyes with macular pucker. METHODS: Ten patients with macular pucker who underwent pars plana vitrectomy with ILM peeling were studied prospectively. Visual acuity measurement, standard automated achromatic perimetry, multifocal electroretinography (mfERG), and optical coherence tomography (OCT) were performed before and 3 months after surgery. Four surgical samples obtained from similar patients were analyzed with electron microscopy. RESULTS: Three months after surgery, mean visual acuity +/- SD was significantly improved from 0.4 +/- 0.11 logMAR to 0.19 +/- 0.13 logMAR (P < or = 0.002), and mean central retinal thickness +/- SD was significantly decreased 428 +/- 73 microm to 326 +/- 34 microm (P < or = 0.002). The mfERG response amplitudes were slightly decreased in eight patients, and five of these patients also had asymptomatic decreases in visual field sensitivity. The electron micrographs revealed segments of Müller cell footplates on the retinal side of the ILM in all four specimens. CONCLUSION: In this study, the use of mfERG, OCT, and standard automated achromatic perimetry showed changes in macular function and structure postoperatively. These measures of visual function and structure allow for better evaluation of the surgical outcome and understanding of the changes that may occur after ILM peeling.     

Macular configuration determined by optical coherence tomography after idiopathic macular hole surgery with or without internal limiting membrane peeling

AIMS: To evaluate the effect of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling on the closure and configuration of idiopathic macular holes (IMH). METHODS: PPV was performed for IMH on 44 eyes with ILM peeling (ILM peeled group) and on 42 eyes without ILM removal (ILM preserved group). Optical coherence tomography (OCT) was performed on 34 ILM peeled eyes and 14 ILM preserved eyes after successful surgery. The repaired macular holes were classified by the OCT images as being of "good shape" (nearly normal foveal contour) or "poor shape" (abnormal foveal contour with flat fovea and steep edge, or with a thick retina without a foveal pit). RESULTS: The anatomical closure rate was significantly higher in the ILM peeled group (93.2%) than in the ILM preserved group (76.2%) (p = 0.028). In the ILM peeled group, 31 eyes had a fovea of good shape and three eyes had a fovea with a poor shape, while in the ILM preserved group, six eyes had a fovea of good shape and eight eyes had a fovea of poor shape. The percentage of eyes with good macular configuration in the ILM peeled group was significantly higher than in the ILM preserved group (p = 0.0003). No significant difference was found in the postoperative visual acuity and the increase of visual acuity between the ILM peeled group and the ILM preserved group (p = 0.26, and p = 0.91 respectively). There was also no significant difference in the postoperative visual acuity and improvement in visual acuity between eyes with a fovea of good shape and those with fovea of poor shape fovea (p = 0.99 and p = 0.66, respectively). CONCLUSIONS: ILM peeling may provide better anatomical success and recovery of the macular shape, but the postoperative visual acuity and improvement of visual acuity were not related to the morphological results.     

Efficiency comparison with fovea-sparing internal limiting membrane peeling and complete internal limiting membrane peeling for treating myopic traction maculopathy

Graefe's Archive for Clinical and Experimental Ophthalmology - To explore whether the efficacy of fovea-sparing internal limiting membrane peeling (FS-ILMP) is better than that of complete...     

Vitreous surgery with and without internal limiting membrane peeling for macular hole repair

PURPOSE: To compare surgical results for idiopathic macular holes with and without internal limiting membrane (ILM) peeling in a series of consecutive patients during an 8-year period. METHODS: A retrospective, nonrandomized, comparative trial. Four hundred seventeen eyes with macular holes without ILM peeling were compared with 175 eyes with ILM peeling. All eyes underwent pars plana vitrectomy with intravitreous gas, followed by head-down positioning. No adjunctive therapies were used. Comparison of closure and reopening rates and visual acuity with and without ILM peeling was analyzed. RESULTS: Initial success rate significantly improved from 81% to 92% with ILM peeling. ILM peeling significantly improved the initial success rates in all categories of preoperative features. Reopening rates significantly decreased from 7% to 0.6% with ILM peeling. Among successful cases, line improvement was 6.0 in ILM-reserved eyes and 5.8 in ILM-peeled eyes. Among all cases, line improvement was 5.4 in ILM-reserved eyes and 5.7 in ILM-peeled eyes. Initial success rate of holes measuring more than 400 microm was significantly less than that of holes measuring less than 400 microm with or without ILM peeling. Initial success rate of holes older than 6 months old was significantly less than that for holes less than 6 months old without ILM peeling. CONCLUSIONS: Internal limiting membrane peeling shows high closure and low reopening rates in macular hole surgery. ILM peeling is beneficial in older holes but is limited in larger holes. ILM peeling does not significantly improve visual acuity.     

Macular changes after peeling of the internal limiting membrane in macular hole surgery

PURPOSE: To report the incidence of macular changes following pars plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole. DESIGN: Prospective consecutive series. METHODS: In a prospective study 105 eyes of 105 patients underwent vitrectomy for idiopathic macular holes. Surgery consisted of a standard three-port vitrectomy, induction of a posterior hyaloid detachment, removal of epiretinal membranes including the ILM, fluid-air exchange and intraocular gas tamponade (15% hexafluoroethane (C2F6) gas mixture) followed by head-down positioning for at least five days. No adjuvants were used during surgery. In addition to the clinical examination, static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105) was performed pre- and 6 or 12 weeks postoperatively. The stimulus size was 0.2 degrees (Goldmann II), intensities employed were 0 and 12 dB. For all tests, 20-degree fields were used. RESULTS: Anatomic closure of macular holes was achieved in 92 (87.6%) of 105 patients by one operation. Eight patients underwent a successful second procedure. The closure rate after two operations was 95.2%. Best corrected visual acuity increased from a median of 0.2 (range 0.05 to 0.5) preoperatively to a median of 0.5 (range 0.05 to 1.0) postoperatively. Anatomical macular changes were found in 8 (7.6%) patients: There were two cases of macular edema following secondary cataract extraction and six cases of retinal pigment epithelium changes. Formation of postoperative epiretinal membranes or late reopenings were not noted. Small, mostly asymptomatic paracentral scotomata were seen in 59 (56.2%) of 105 patients. CONCLUSION: Anatomical changes of the macula following vitrectomy with removal of the ILM are infrequent. However, paracentral scotomata observed in our series might be caused by a trauma to the nerve fibers during ILM peeling. To achieve reliable results a standardized procedure for microperimetry should be developed.