不同方法剥除内界膜治疗特发性黄斑裂孔的比较研究

The comparison of the effects of different staining of internal limiting membrane in idiopathic macular hole surgery

目的比较采用吲哚氰绿(ICG)、苔盼兰(TB)及不染色剥除内界膜治疗特发性黄斑裂孔的疗效。方法前瞻性随机连续病例研究。2001年1月-2005年9月在我院被确诊为IMH并行玻璃体切除联合内界膜剥除的92例92眼被纳入本研究。所有病例按内界膜剥除时采用不同的染色方法随机分为3组:1)A组(34例34眼):不使用染色剂;2)B组(28例28眼);0.5%吲哚氰绿(ICG);3)C组(30例30眼);0.1%苔盼兰(TB)。比较三者间裂孔内界膜剥除的情况、裂孔愈合情况,术后最佳矫正视力以及视力提高情况的差异。统计学方法采用x2检验和单因素方差分析。结果三组间在患者的年龄,性别、患病时间、术前视力、裂孔分期及大小上差异无显著性意义(p>0.05)。ICG和TB均能有效地使内界膜着色。未染色组与TB染色组各有1眼未完全剥除裂孔旁内界膜,其余眼均完全剥除了内界膜。内界膜剥除的所需时间未染色组(6.3±1.2)min,ICG染色组(4.1±0.83)min,TB染色组(4.2±0.6)min,统计学分析表明未梁色组与染色组间差异有显著性意义,但ICG染色组与TB染色组间差异无显著性意义(p>0.05)。三组间在术后裂孔闭合率、最佳矫正视力和视力提高的程度上均无显著性差异(p>0.05)。三组病例均未发生严重并发症。结论内界膜染色可显著提高内界膜的能见度,提高内界膜剥除的效率。尽管与未染色相比,采用内界膜染色的裂孔的闭合率、视功能的恢复情况并无差异,但考虑到染带来的潜在毒副作用,建议尽可能在不染色的条件下剥除内界膜。

Objective To compare the effects of different staining of internal limiting membrane （ILM） to the prognosis of macular hole surgery. Methods Prospective, randomized, consecutive case series. 92 eyes of 92 patients with IMH in stage Ⅱ, Ⅲ, Ⅳ that underwent vitrectomy combined with ILM peeling during the period of January 2001 to October 2004 were enrolled. All according to the different staining-assisted methods while ILM-P：Group A （34 eyes of 34 patients） of these patients were divided into three groups underwent ILM peeling without any dye, group B （28 eyes of 28 patients） underwent 0.5% ICG-assisted ILM peeling, and group C （30 eyes of 30 patients ）underwent 0.1% Tryban blue-assisted ILM peeling. Preoperative and postoperative data including duration of the macular hole, stage of the macular hole by OCT imaging, macular hole size, lens status of the patient, and the bestorrected visual acuity were recorded. Results ICG and TB can make the ILM better visible and easy removed. The ILM had not removed completely in 1 eye in group A and C respectively. There was no significant difference between Group B and C, while different between Group A and group B/C. Closure rate and the postoperative BCVA had not significant differences among the three groups. Conclusion ICG and TB can make the ILM better visible and be peeled off easily, and dye-assisted ILM peeling demonstrates anatomic and visual results with sigle ILM peeling. But the potential toxicity of ICG andTB should be studied. Internal limiting membrane peeling no staining may be the best choice.