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.

The postoperative visual function's comparison of idiopathic macular hole by different concentration indocyanine green assisted internal limiting membrane peeling

Objective To compare postoperative visual function of idiopathic macular hole(IMH)by different concentration of indocyanine green(ICG)solution assisted internal limiting membrane(ILM)peeling.Methods Forty-four cases(44 eyes)of IMH were randomly divided into four groups.Group Ⅰ:9 cases (9 eyes),Group Ⅱ:20 cases(20 eyes),Crroup Ⅲ:10 cases(10 eyes),group Ⅳ:5 cases(5 eyes).All patients underwent a three-port pars plana vitrectomy,ILM peeling and C3F8 tamponade.During the surgery,we used ICG solution to stain ILM,and the concentration of ICG solution was 5.0,2.5,1.25,0.5mg/ml respectively.In group Ⅰ,before using indocyanine-green to stain ILM,we used small amount of viscoelastic material to seal the macula hole temporarily.In group Ⅱ,Ⅲ andIV,we did not use any material to seal the macular hole during the surgery.After the surgery,the patients were followed-up regularly.Pre-operation and post-operation,we recordedthe patients' ratio of macular hole closure,vision,visual field examination and multifocal electroretinogram(MERG)examination.Results The ratio of macular hole closure was low in group Ⅳ.The postoperative best corrected vision in group Ⅲ was better than that in other three groups.The postoperative incidence of peripheral visual field loss in group Ⅰ and Ⅱ was significantly higher than that in group Ⅲ and IV.And the postoperative peak amplitude of MERG's second-order response of pefipheral retina was significantly lower than that of pre-operation in group Ⅰ and Ⅱ,but the peak amplitude of MERG's second-order response of peripheral retina was not significantly different with that of pre-operation in group Ⅲ and IV.Conclusions The assisted peeling of ILM by ICG solution of high concentration is toxic to the rotiBa and not good to the postoperative visual function recovery of macular hole patients.However,the assisted peeling of ILM by ICG solution of low concentration can significantly reduce the toxicity of ICG to retina,and not affect the postoperative visual function recovery of macular hole patients.