吲哚青绿辅助内界膜剥离治疗高度近视眼黄斑裂孔视网膜脱离手术的随访分析  

Follow-up study of indocyanine green-assisted internal limiting membrane peeling on treatment of macular fissure with retinal detachment in high myopia

作　　者：邱庆华[1] 王文莹[2] 张虹[3] 王方[1] 

机构地区：[1]上海交通大学附属第一人民医院眼科,200080 [2]北京市同仁医院眼科 [3]哈尔滨医科大学附属第一人民医院眼科

出　　处：《上海医学》2006年第6期388-391,F0004,共5页Shanghai Medical Journal

摘　　要：目的随访不同术式治疗高度近视眼黄斑裂孔视网膜脱离手术后的视力、黄斑区的形态和视网膜厚度的变化,探讨经扁平部玻璃体切割手术中吲哚青绿(ICG)辅助剥膜的有效性及安全性。方法回顾性分析2001年10月至2003年12月我院收治的高度近视眼黄斑裂孔后极部视网膜脱离患者42例42眼。ICG辅助内界膜剥离(ICG组)15眼,未使用ICG剥离内界膜联合术后激光治疗(激光组)14眼,未剥离内界膜(未剥膜组)13眼。除常规行裂隙灯生物显微镜和间接眼底镜检查外,所有患者均于术前1周及术后2周、4周、3个月、6个月、12个月、＞24个月应用A/B超和光学相干断层扫描(OCT)进行定期检查。结果ICG组一次手术裂孔闭合率为14/15例,激光组为13/14例,未剥膜组为10/13例。3组患者术后视力均较术前明显提高(P＜0．01)。OCT显示,ICG组裸露型(黄斑孔区视网膜神经上皮层缺如)占11/15例,激光组占5/14例,未剥膜组占10/13例；ICG组中央视网膜厚度为(143．45±23．50)μm,激光组为(168．18±39．00)μm,未剥膜组为(194．25±17．56)μm。术后复发5例,其中未剥膜组3例、ICG组1例、激光组1例。对首次手术失败的患者行再次玻璃体切割手术联合硅油填充后视网膜复位,随访时间＞6个月,未见视网膜脱离复发。结论ICG辅助内界膜剥离和术后眼底激光治疗可提高高度近视眼黄斑裂孔视网膜脱离的一次手术成功率。术后OCT显示ICG组以裸露型多见,视网膜厚度变薄,可能与ICG对视网膜色素上皮和神经上皮的毒性有关。Objective Preoperative visual acuity and morphologic changes of macular zone and retinal thickness were followed up after various surgical modalitis for macular fissure in high myopia with evalvation of the efficacy and safety of pars plana vitrectomy utilized indocyanine green （ICG）-assisted internal limiting membrane （ILM） peeling. Methods Retrospective analysis of the 42 eyes in 42 patients with diagnosis as macular fissure with posterior polar detachment in high myopia hospitalized between Oct, 2001-Dec, 2003 was carried out in our hospital. The patients were divided into indocyanine green （ICG）-assisted internal limiting membrane（ILM） peeling group（15 eyes）, laser group（14 eyes） without internal limiting membrane peeling and no internal limiting membrane peeling group（13 eyes）. Besides the routine slitlamp biomicroscopy and indirect ophthalmoscopic inspection, all patients underwent A/B ultrasound, OCT scan examination at 1 week preoperatively and 2 weeks, 4 weeks, 3 months, 6 months, 12 months, 〉24 months postoperatively. Results The one time closure rates from primary operation were 14/15, 13/14, and 10/13 in ICG, laser and ILM no-peeling groups, respectively. The mean postoperative visual acuity improved in all groups postoperatively. More patients in ICG group displayed naked pattern at the macular zone in 11 out of 15 eyes; 5 out of 14 in the laser group; 10 out of 13 in the ILM without peeling group.The central thickness of retina on OCT of the three groups were （ 143.45 ± 23.50 ） μm, （168.18 ±39.00 ） μm and （ 194.25 ± 17.56 ） μm respectively. The macular fissure recurred in 5 patients after operation including 3 in ILM no-peeling group, one in each of the other two groups. The failure cases after the primary procedure were operated again by vitrectomy with silicone oil filling and gained all retina reattachment. Follow-up beyond 6 months showed no recurrence. Conclusion ICG-assisted ILM peeling and postoperative laser after operation can improve the succ

关 键 词：吲哚青绿 高度近视 黄斑裂孔 光学相干断层扫描 

分 类 号：R779.6[医药卫生—眼科]