吲哚青绿染色视网膜内界膜剥离手术后近红外光荧光特点及临床意义

The characteristics of near-infrared fundus fluorescence after indocyanine green-assisted internal limiting membrane peeling

目的观察分析吲哚青绿（ICG）染色视网膜内界膜（ILM）剥离手术后近红外眼底荧光（NIR—FF）特点及临床意义。方法20例22只眼纳入观察。其中，黄斑裂孔12只眼；黄斑前膜6只眼；视网膜中央静脉阻塞1只眼；糖尿病视网膜病变3只眼。2只眼伴随视网膜色素上皮层脱离；2只眼残留增生膜；1只眼伴随融合玻璃膜疣；2只眼伴视网膜脉络膜萎缩斑；2只眼曾经行视网膜激光光凝治疗。手术前所有患眼均行眼底照相检查；2只眼行ICG血管造影检查；联合应用共焦激光眼底血管造影仪Ⅱ（HRAⅡ）与频域光相干断层扫描（SD-OCT）仪观察13只眼NIR-FF特点及视网膜微结构变化。全部患眼眼底照相未见ICG染料，13只眼进行手术前NIR—FF评估均未见ICG荧光。所有患眼均行ICGⅡ。M染色的玻璃体切割手术（PPV）。ICG浓度为0．125mg／ml。手术后1d、2周～1个月、1．5～2个月、2．5～5个月、6～12个月对所有眼行HRAⅡ和SD-OCT联合NIR—FF检查，观察ICG在眼内代谢情况。结果全部患眼手术后黄斑部均可观察到类圆形弱荧光区域而视盘处呈现强荧光状态。其中，5只眼持续至手术后5个月，1只眼持续至手术后1年。16只眼在手术后2周～5个月即观察到黄斑部膜样结构，其余6只眼SD-OCT像表现为ILM缺失。1只眼手术后第1天整个眼底呈弥漫NIR-FF增强。手术后第2周至1年，全部患眼呈现神经纤维走形处荧光增强后消失过程。此外，在黄斑裂孔、激光光凝斑、残留增生膜、视网膜色素上皮脱离及玻璃膜疣等处均表现为强荧光信号，而脉络膜视网膜萎缩区域为弱荧光信号。结论ICG辅助PPV手术后NIR—FF检查显示黄斑部均可观察到类圆形弱荧光区域而视盘处呈现强荧光状态，在黄斑裂孔、激光光凝斑、残留增生膜、视网膜色素上皮脱离及玻璃膜疣等处均表现为强荧光信号，而脉络膜视网膜萎缩区域为弱荧光信号。ICG代谢周期较长，在眼内最长可积存至手术后1年。

Objective To observe the characteristics of near-infrared fundus fluorescence （NIR-FF） after indocyanine green （ICG） -assisted internal limiting membrane peeling. Methods Twenty-two eyes of twenty patients （12 eyes with macular hole, 6 eyes with epiretinal membrane, 1 eye with central retinal vein occlusion, 3 eyes with diabetic retinopathy） who underwent pars plana vitrectomy （PPV） with ICG-assisted internal limiting membrane peeling were enrolled in this study. ICG solution at a concentration of 0. 125 mg/ml was injected. All the patients were examined by fundus photography. Fundus fiuorescein angiography （FFA） and ICGA were performed in some patients. Spectralis optical coherence tomography （SD-OCT） were performed to observe retinal microstructural changes. One day, 2 weeks - 1 month, 1.5 2 months, 2.5 - 5 months, 6 - 12 months after surgery, the ICG metabolism was observed. Results No ICG staining of the fundus was visible ophthalmoscopically and there was no ICG fluorescence in preoperative NIR-FF of 13 eyes. Every eye had a round reduced fluorescence area in the macula and hyperfluorescence in optic disc, while five eyes were followed for up to 5 months and 1 eye was followed for 1 year after surgery. Within the round reduced fluorescence region, the membrane like structure was observed in 16 eyes during 2 weeks to 5 months after surgery and the other 6 eyes showed ILM deficiency in SD-OCT. One eye demonstrated that resident ICG scattered across the macula once on the first postoperative day, and the optic nerve fiber showed especially intense fluorescence in the area along the vascular arcade from 2 weeks to 1 year after PPV and then disappeared. Otherwise, there was enhanced ICG fluorescence in macular hole, photocoagulation scars, resident proliferative membrane and retinal pigment epithelium detachment （RPED） and drusen area, while hypofluorescence was observed in retinal and choroidal atrophy. Conclusions There are weak fluorescence areas in the macula and choroidal atrophy, while hyperfluorescenee in optic disc, macular hole, photocoagulation scars, resident proliferative membrane, RPED and drusen area after ICG-assisted vitrectomy. ICG metabolic duration is longer, lasting up to 1 year after surgery.