视网膜内界膜剥离治疗糖尿病黄斑水肿的疗效观察

Curative effect of peeling of the internal limiting membrane on diabetic macular edema

目的 评价视网膜内界膜(ILM )剥离对糖尿病黄斑水肿患者手术后视力恢复的影响。探讨吲哚青绿(ICG)在ILM剥离术中的作用。 方法 对3 0例(3 1只眼)增生期糖尿病视网膜病变伴黄斑水肿患者行玻璃体切割治疗。患者随机分成两组,A组:单纯玻璃体切割16只眼,手术中行全视网膜光凝及2 0 %SF6眼内填充;B组:玻璃体切割加吲哚青绿(ICG)染色ILM剥离15只眼,在A组术式基础上手术中增加ICG染色后极部ILM ,并行ILM剥离。所有患者手术后保持面朝下体位10 14d。患者定期随访3 12个月。 结果 A组16只眼中,视力提高2行或2行以上10只眼(62 .5 % ) ,黄斑水肿消退9只眼(5 6 2 % ) ,手术后光相干断层扫描检查黄斑厚度平均3 93 μm。B组15只眼中视力提高2行或2行以上14只眼(93 . 3 % ) ,黄斑水肿消退14只眼(93 .3 % ) ,黄斑厚度平均3 19μm。B组手术后视力提高明显优于A组(χ2 =4 2 10 ,P =0 .0 5Fisher确切检验法) ;B组患者手术后黄斑区视网膜厚度明显低于A组(P <0 .0 1独立秩和检验)。手术标本证实为ILM。 结论 玻璃体切割术是治疗糖尿病黄斑水肿的有效方法,ILM剥离能明显提高手术的疗效;ICG能较好地染色ILM ,使ILM的剥离更加安全确切。

Objectives To evaluate the effect of peeling of internal limiting membrane (ILM) on the post-operative visual acuity in patients with diabetic macular edema, and to detect the role indocyanine green (ICG) plays in the surgery of peeling of ILM. Methods Thirty patients (31 eyes) with diabetic retinopathy at proliferative stage with macular edema underwent vitrectomy. The patients were randomly divided into two groups: 16 eyes in group A underwent single vitrectomy with panretinal photocoagulation and ocular filling with 20% SF6; 15 eyes in group B underwent vitrectomy and peeling of ILM after the posterior pole was stained with ICG. All of the patients were asked to keep the posture of facing down for 10-14 days. The follow-up lasted 3-12 months. Results In 16 eyes in group A, the visual acuity increase of 2 or more lines in 10 (62.5%) and alleviation of macular edema in 9 (56.2%) were found; the postoperative average macular retinal thickness examined by optic coherence tomography (OCT) was 393 μm. In 15 eyes in group B, the visual acuity increase of 2 or more lines in 14 (93.3%) and alleviation of macular edema in 14 (93.3%) were found; the postoperative average macular retinal thickness was 319 μm. The postoperative improvement of visual acuity in group B was much better than that in group A ( χ 2=4.210, P =0.05), while the postoperative macular retinal thickness in group B was obviously lower than that in group A ( P <0.01). The operative sample was proved to be the ILM. Conclusions Vitrectomy is effective for diabetic macular edema and the curative effect may be improved by peeling of ILM; ICG can dye ILM well, which ensures the safe and accurate peeling of ILM.