中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2014年
3期
231-234
,共4页
吲哚青绿%黄斑前膜,特发性/手术%内界膜
吲哚青綠%黃斑前膜,特髮性/手術%內界膜
신타청록%황반전막,특발성/수술%내계막
Indocyaine green%Macular epiretinal membrane,idiopathic/surgery%Internal limiting membrane
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.
揹景 特髮性黃斑前膜(IMEM)可與玻璃體黃斑牽拉綜閤徵、黃斑假孔、黃斑闆層裂孔同時髮生,清除眼後極部玻璃體及完整剝離IMEM是治療的關鍵. 目的 探討吲哚青綠(ICG)輔助黃斑前膜聯閤內界膜剝離在IMEM手術治療中的作用.方法 採用繫列病例觀察研究方法.收集2010年6月至2012年9月在鄭州大學第一附屬醫院確診為IMEM患者29例29眼,包括單純黃斑前膜16眼、黃斑前膜閤併玻璃體黃斑牽拉綜閤徵6眼、黃斑前膜閤併黃斑假孔3眼、黃斑前膜閤併黃斑闆層裂孔4眼.採用標準三切口玻璃體切割術,先將0.1ml麯安奈德4 mg註入玻璃體腔染色玻璃體後皮質,對無玻璃體後皮質脫離者或不全性玻璃體後皮質脫離者行誘導脫離併完全切除,然後用1 ml註射器吸取0.1 ml質量分數0.25％ ICG推註3～5滴于黃斑部錶麵,30 s後笛針吸除.染色後有前膜遊離邊緣者用視網膜鑷夾取剝除,之後0.25％ ICG再染色,剝除黃斑區內界膜；無法分辨黃斑前膜範圍或前膜與內界膜貼伏平整或粘連較緊密者則將內界膜及前膜一併剝除.記錄染色及膜剝離效果.主要分析指標包括膜染色形態及成功膜剝離眼數,次要分析指標包括術後視力改善情況及術中、術後併髮癥.結果 染色後所有患眼均能很好地辨認剝離區及未剝離區,黃斑前膜範圍清晰者23眼,佔79％,能夠分辨前膜遊離邊界併直接剝除前膜者17眼,佔58％；染色後無法分辨前膜範圍或前膜與內界膜貼伏平整或粘連緊密者,術中由內界膜起瓣併將前膜及內界膜同時剝離者12眼,佔42％.術後隨訪1～28箇月,平均(9.65±7.58)箇月,20眼術後視力提高,佔69％.患眼術前LogMAR視力為0.72±0.67,術後為0.62±0.56,術後視力明顯提高,差異有統計學意義(t=2.370,P=0.025).術中無嚴重併髮癥,無黃斑前膜複髮病例.結論 ICG染色聯閤內界膜剝除有助于安全、徹底地剝離IMEM,改善術眼視力,併能預防複髮.
배경 특발성황반전막(IMEM)가여파리체황반견랍종합정、황반가공、황반판층렬공동시발생,청제안후겁부파리체급완정박리IMEM시치료적관건. 목적 탐토신타청록(ICG)보조황반전막연합내계막박리재IMEM수술치료중적작용.방법 채용계렬병례관찰연구방법.수집2010년6월지2012년9월재정주대학제일부속의원학진위IMEM환자29례29안,포괄단순황반전막16안、황반전막합병파리체황반견랍종합정6안、황반전막합병황반가공3안、황반전막합병황반판층렬공4안.채용표준삼절구파리체절할술,선장0.1ml곡안내덕4 mg주입파리체강염색파리체후피질,대무파리체후피질탈리자혹불전성파리체후피질탈리자행유도탈리병완전절제,연후용1 ml주사기흡취0.1 ml질량분수0.25％ ICG추주3～5적우황반부표면,30 s후적침흡제.염색후유전막유리변연자용시망막섭협취박제,지후0.25％ ICG재염색,박제황반구내계막；무법분변황반전막범위혹전막여내계막첩복평정혹점련교긴밀자칙장내계막급전막일병박제.기록염색급막박리효과.주요분석지표포괄막염색형태급성공막박리안수,차요분석지표포괄술후시력개선정황급술중、술후병발증.결과 염색후소유환안균능흔호지변인박리구급미박리구,황반전막범위청석자23안,점79％,능구분변전막유리변계병직접박제전막자17안,점58％；염색후무법분변전막범위혹전막여내계막첩복평정혹점련긴밀자,술중유내계막기판병장전막급내계막동시박리자12안,점42％.술후수방1～28개월,평균(9.65±7.58)개월,20안술후시력제고,점69％.환안술전LogMAR시력위0.72±0.67,술후위0.62±0.56,술후시력명현제고,차이유통계학의의(t=2.370,P=0.025).술중무엄중병발증,무황반전막복발병례.결론 ICG염색연합내계막박제유조우안전、철저지박리IMEM,개선술안시력,병능예방복발.
Background Idiopathic macular epiretinal membrane (IMEM) occurs probably along with vitreous macular traction syndrome (VMTS),persudo macular hole (PMH) and lamellar macular hole (LMH).Removing posterior hyaloid and completely peeling IMEM are the key to the treatment.Objective This study was to investigate the effectiveness of indocyanine green (ICG)-assisted macular epiretinal membrane combined internal limiting membrane (ILM) peeling for IMEM.Methods Twenty nine eyes of 29 patients with IMEM were collected in Affiliated First Hospital of Zhengzhou University from June 2010 to September 2012,including 16 eyes with simple macular epiretinal membrane,6 eyes with both IMEM and VMTS,3 eyes with IMEM and PMH,4 eyes with IMEM and LMH.A standard three-port pars plana vitrectomy was performed.After removal of posterior hyaloid,0.25％ ICG was used to assist IMEM and ILM peeling.The process and results were recored.Results After staining,the free boundary of the IMEM became obvious and IMEM was peeled directly in 17 of the 29 eyes (58％).In the others (42％),a free petal of ILM was made,IMEM and ILM were peeled together.In all the 29 eyes,the peeled zone could be easily recognized.No serious intraoperative complication was found.The mean postoperative follow-up was (9.65 ±7.58)months (ranged,1 to 28 months).Visual acuity was improved in 20 eyes (69％).The LogMAR vision was significantly improved in postoperation in comprison with preoperation (0.62 ±0.56 versus 0.72 ±0.67) (t =2.370,P=0.025).No IMEM recurred during the following-up duration.Conclusions ICG-assisted ILM peeling can make the surgery of IMEM safer and prevent recurrence.
