CAJ | 학술논문

目的：观察玻璃体切割术中使用亮蓝染色与无染色内界膜剥除术治疗特发性黄斑裂孔的效果及并发症。方法回顾性分析2012年1月至2014年10月于我院眼科行玻璃体切割联合视网膜内界膜剥除术治疗的特发性黄斑裂孔患者共计33例34眼，其中染色组16例16眼，术中使用亮蓝辅助剥除内界膜；无染色组共17例18眼，术中不使用染色剂。比较两组术后黄斑裂孔闭合，最佳矫正视力提高情况，剥除视网膜内界膜手术时间，mfERG变化情况。结果随访至术后6个月时，两组患者黄斑裂孔均完全闭合。染色组术后最佳矫正视力提高2行及以上者12眼(67.8%)，无染色组13眼(80.0%)两组比较差异无统计学意义(P>0.05)；染色组内界膜剥除手术时间为(238.4±1.897)s，无染色组为(326.4±1.888)s，两组比较差异有统计学意义(均为P<0.05)。两组mfERG一阶函数的1环和2环P1波反应密度均较术前明显增加，与术前相比差异均有统计学意义(均为P<0.05)，但染色组增加幅度与无染色组相近，两组之间比较差异无统计学意义(P>0.05)。在术后裂孔闭合率无显著性差异（P>0.05）。结论内界膜染色后，显著提高内界膜的能见度，内界膜剥除的效率提高，缩短了内界膜剥除所需的时间，使困难的操作变得相对容易，而且手术结果与未染色方法相比差异无显著性。但考虑到染色带来的潜在毒副作用，因此对于初学者及手术中撕内界膜不完整、撕除内界膜困难时可采用亮蓝辅助进行内界膜剥离，以提高手术成功率，一般情况下如术者能熟练剥除内界膜，在不增加手术风险时可不染色剥离内界膜，以回避因染色带来的可能风险。
목적：관찰파리체절할술중사용량람염색여무염색내계막박제술치료특발성황반렬공적효과급병발증。방법회고성분석2012년1월지2014년10월우아원안과행파리체절할연합시망막내계막박제술치료적특발성황반렬공환자공계33례34안，기중염색조16례16안，술중사용량람보조박제내계막；무염색조공17례18안，술중불사용염색제。비교량조술후황반렬공폐합，최가교정시력제고정황，박제시망막내계막수술시간，mfERG변화정황。결과수방지술후6개월시，량조환자황반렬공균완전폐합。염색조술후최가교정시력제고2행급이상자12안(67.8%)，무염색조13안(80.0%)량조비교차이무통계학의의(P>0.05)；염색조내계막박제수술시간위(238.4±1.897)s，무염색조위(326.4±1.888)s，량조비교차이유통계학의의(균위P<0.05)。량조mfERG일계함수적1배화2배P1파반응밀도균교술전명현증가，여술전상비차이균유통계학의의(균위P<0.05)，단염색조증가폭도여무염색조상근，량조지간비교차이무통계학의의(P>0.05)。재술후렬공폐합솔무현저성차이（P>0.05）。결론내계막염색후，현저제고내계막적능견도，내계막박제적효솔제고，축단료내계막박제소수적시간，사곤난적조작변득상대용역，이차수술결과여미염색방법상비차이무현저성。단고필도염색대래적잠재독부작용，인차대우초학자급수술중시내계막불완정、시제내계막곤난시가채용량람보조진행내계막박리，이제고수술성공솔，일반정황하여술자능숙련박제내계막，재불증가수술풍험시가불염색박리내계막，이회피인염색대래적가능풍험。
Objective: To observe the effect and complication of Brilliant blue G assisted and no stain for internal limiting membrane peeling in the treatment of idiopathic macular holes.Method: 33 patients (34 eyes) of idiopathic macular holes who were treated with Pars plana vitrectomy ( PPV) combined with internal limiting membrane peeling in the affiliated hospital of Panzhihua college from January 2012 to October in 2014 were enrolled in this retrospective and controlled clinical study. There were 16 patients (16 eyes) in Staining group who were stained with Brilliant blue G; There were 17 patients (18 eyes) in No stain group who were not using staining reagent. The macular anatomic closure,visual outcomes, the operative time of internal limiting membrane peeling, and the change of mfERG were evaluated;Results: Followed-up for 6 months after opertation, anatomic macular hole were closed in this two groups, but the difference between these two groups were no siginificant (P>0.05); The visual acuity was increasing to two line in Staining group(12 eyes, 67. 8%) and in No stain group(13 eye, 80. 0%),the difference between these two groups were no siginificant (P>0.05). The operative time of Staining group was 238.4 ± 1.897 s,and the No stain group was 326.4 ± 1.888s, the difference between these two groups were siginificant (P<0.05);The amplitude of wave P1 of ring 1and ring 2 were improved significantly, compared with preoperation of two groups (P<0.05),but the increase range was nearly between two goups,the difference between these two groups were no siginificant (P>0.05);Conclusion: Brilliant blue G assisted internal limiting membrane peeling could improve the membrane visibility and the efficiency of internal limiting membrane peeling, cut down the time of internal limiting membrane peeling; But the surgical results was no significant difference between Staining group and No stain group; So in consideration of the toxic and side effect of staining,the operator could tear internal limiting membrane expertly without staining.