改良内界膜染色在特发性黄斑裂孔手术的临床应用

摘要

目的：评估改良吲哚菁绿视网膜内界膜染色法在特发性黄斑裂孔手术中的应用效果。　　方法：回顾性分析2013－03／2014－12因特发性黄斑裂孔在我院行23 G玻璃体切割联合视网膜内界膜剥除并注气术的连续患者27例27眼的病历资料，术中将5mg／mL吲哚菁绿、50％高糖溶液和黏弹剂适量混合后做为染色剂行黄斑裂孔孔周乳斑束间内界膜局部染色，观察其在术中的应用效果。　　结果：术中局部染色后的内界膜着染成淡绿色，可视性好，有助于辨识和撕除内界膜，撕除孔周内界膜范围2 PD ×2PD，术后黄斑裂孔闭合24眼（88．9％），黄斑裂孔未完全闭合3眼（11．1％），裂孔直径均较术前有明显缩小，其中1例1眼患者术后2 mo内接受再次手术，采用扩大内界膜剥除范围术后裂孔闭合。随访6～15mo，所有患者视力均较术前提高。　　结论：改良吲哚菁绿局部着染内界膜的方法可以减少术中吲哚菁绿在眼内的弥散和残留，可降低吲哚菁绿对黄斑裂孔区裸露色素上皮、视网膜和视神经的毒性作用。%? AIM: To evaluate the efficacy of modified staining technique of internal limiting membrane ( ILM ) with indocyanine green ( ICG ) in surgeries for idiopathic macular hole ( IMH) . ? METHODS: Twenty -seven eyes of 27 consecutive patients with idiopathic macular hole in our hospital from March 2013 to December 2014 were retrospectively analyzed, which had undergone 23 gauge pars plana vitrectomy, ILM peeling and intraocular gas tamponade. ILM was stained around the IMH with a mixture of 5mg/ml indocyanine green, 50% hypertonic glucose and moderate viscoelastic. The application efficacy was observed. ?RESULTS:The ICG-staining ILM showed viridescent with good visibility, which helped recognizing and peeling ILM.The range of peeling was about 2PD ×2PD.Macular hole was closed completely in 24 eyes ( 88.9%) postoperatively.Macular hole was closed partly in 3 eyes (11.1%) postoperatively, but shrank in diameter.It was worth mentioning that one eye among which showed macular hole closure completely after undergoing a second surgery with an expanding peeling 2mo after the first surgery.The visual acuity of all patients improved in 6~15mo follow-up. ?CONCLUSION:The modified staining technique of ICG for ILM peeling surgery can reduce residual and diffusion of ICG in eyes, and reduce the toxicity of ICG to retina, exposed epithelia and optic nerve.