剥除视网膜内界膜的玻璃体切除术治疗黄斑孔性视网膜脱离  

The clinical observation of internal limiting membrane peeling in PPV in the treatment of retinal detachment caused by idiopathic macular hole

作　　者：梁晓颖[1] 曾福利[1] 

机构地区：[1]首都医科大学附属北京安贞医院眼科,北京100029

出　　处：《中国实用眼科杂志》2004年第12期1029-1031,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的　观察剥除视网膜内界膜的玻璃体切除手术治疗黄斑孔性视网膜脱离的临床疗效。方法　选择黄斑裂孔性视网膜脱离患者 2 1例 (2 1只眼 ) ,经常规睫状体平坦部三切口闭合式玻璃体切除、气 -液交换、应用 1/2 0 (气体状态下 )或 1/9(液体状态下 )的吲哚青绿染色、剥除视网膜内界膜、自体浓缩血小板或血清封孔、玻璃体腔填充惰性气体 (2 0 %SF6、 16%C2F6、 16%C3F8)或硅油 ;术后常规俯卧位及头低位 ,局部应用抗炎滴眼剂及散瞳剂治疗。结果　 2 0例 (95 2 4% )患者黄斑裂孔愈合 ,视网膜复位。仅一例因颞上方视网膜周边裂孔而导致视网膜脱离复发。随访时间 >2个月 ,2 0例(95 2 4% )仍保持视网膜复位 ,黄斑裂孔解剖封孔 ;视力≥ 0 1者 13例 ;主要并发症为晶状体混浊和一过性高眼压。结论　玻璃体切除手术术中应用吲哚青绿染色、剥除视网膜内界膜并尽量切除周边部玻璃体、应用自体浓缩血小板或血清封孔 ,可有效地提高黄斑孔视网膜脱离的解剖复位率。Objective To observe the curative effect of internal limiting membrane(ILM)peeling in PPV in the treatment of retinal detachment caused by idiopathic macular hole.Methods 21 cases(21 eyes)of retinal detachment caused by idiopathic macular hole were used,each case was treated through pars plana vitrectomy(PPV),gas-liquid exchange,dyed with indocyanine green(ICG)1/20(gas state)or 1/9(liquid state),peeled retinal internal limiting membrane,closed the macular hole by concentrated blood platelet or blood serum,filled vitreous with inert gases(20%SF6、16%C2F6、16%C3F8)or silicone oil.Keep abdomen down or head down after surgery,use topical antibiotics and pupil-dilated eye drops.Results 20 cases(95 24%)were healed,retina reattached.Only one case reoccurred caused by temporal peripheral retinal hole.Follow up duration >2months,20cases(95 24%)still reattached,macular hole were anatomically closed;in 13 cases,the visual acuity≥0 1;the common complication is lens opacity and temporary high intraocular pressure.Conclusions The anatomical reattachment rate can beincreased effectively through dyeing with indocyanine green,internal limiting membrane peeling in PPV,ablating the peripheral vitreous sufficiently,and closing the macular hole by concentrated blood platelet or blood serum.

关 键 词：视网膜内界膜 视网膜脱离 治疗 黄斑孔 玻璃体切除 浓缩血小板 吲哚青绿 目的观 结论 气体状态 

分 类 号：R774[医药卫生—眼科] R779[医药卫生—临床医学]