玻璃体手术中吲哚青绿对视网膜结构的影响

The effect of indocyanine green on retinal structure during vitrectomy

目的研究吲哚青绿(ICG)辅助视网膜内界膜(ILM)染色的玻璃体切割手术后,不同浓度ICG对视网膜结构的影响。方法选取健康家兔25只,体重2～2.5kg,2个月龄,雌雄不限。从中随机选取5只家兔,作为手术空白对照组(10只眼球)。根据人眼手术中实际应用ICG的浓度,实验分为0.025、0.25、2.5和25g/L4个不同浓度组,每组5只家兔(10只眼球)作为实验组。手术空白对照组与实验组均行模拟人眼的玻璃体切割手术,术中实验组行ICG染色ILM,空白对照组用平衡盐溶液做对照。所有实验动物术后14d摘取眼球制作光镜标本,低浓度组(0.025、0.25g/L)眼球制作电镜标本,观察拍片。结果ICG染色ILM玻璃体切割术后,光镜观察低浓度组,视网膜结构仅见轻微改变。高浓度组(2.5、25g/L)视网膜结构改变明显,感光细胞内外节水肿严重,空隙增大。内外核层极性紊乱,内外丛状层变薄。电镜观察0.025g/L组仅见内核层少许细胞胞质水肿,0.25g/L组可见内外核层及神经节细胞内线粒体空泡变。结论ICG染色ILM玻璃体切割术后,ICG对视网膜的结构有损伤作用。

Objective Studing the affection of indocyanine green （ICG） on retinal morphology in different solution after the internal limiting membrane （ILM） staining with ICG during vitrectomy. Methods Select 25 two months healthy general rabbits whose weight are about 2.5 kg and their gender is unlimited. Five rabbits from them selected at random are regarded as operational blank control group （10 eyes）. According to ICG solution used in vitrectomy for humans, animals were divided into 4 solution groups, 0. 025, 0.25, 2.5 and 25 g/L, in our experiment, 5 rabbits in each group （10 eyes） as experimental group. ILM was stained by ICG in experimental group and balanced salt solution instead of ICG was in operational blank control group during the vitrectomy. The eyes were enucleated and observed by light microscope, in addition in the low concentration groups （0. 025,0.25 g/L） the eyes were also observed by electron microscope on day 14 after the operation. Results After the vitrectomy with ICG, only little change of retinal structure was observed by light microscope in low concentration groups. In high concentration groups （2.5,25 g/L）, the change of retinal structure observed by light microscope was conspicuous, the edema of inner and outer segment of photoreceptor cell was severe and vacant space between cells increased. The polarity of inner and outer nuclear layer was confused, inner and outer plexiform layer were thinning. By electron microscope, we can see few cells＇ endcehylerna was edema in inner nuclear layer of 0. 025 g/L group, the mitcehondrias in inner and outer nuclear cells and ganglion cells were vacuolated. Conclusion After the vitrectomy with ICG staining ILM, we observered that ICG was harmful to retinal morphology. With ICG concentration increased, the harmful effect was severe gradually.