吲哚青绿染色联合内界膜剥除术治疗特发性黄斑前膜安全性及疗效的研究

To investigate the safety and efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes

目的探讨吲哚青绿染色对采用玻璃体切除联合内界膜剥除术治疗特发性黄斑前膜的患者视功能恢复的影响。方法回顾性分析60例（60只眼）因特发性黄斑前膜接受玻璃体切除联合内界膜剥除术患者的临床资料，对所有患者均行最佳矫正视力、眼压、裂隙灯、眼底照相、OCT检查，随访6个月，观察手术前后最佳矫正视力、主观症状、黄斑中心凹视网膜厚度（CRT）、椭圆体区的变化。对手术中是否采用吲哚青绿染色内界膜分为两组：吲哚青绿组32只眼，对照组28只眼。术前椭网体区完整26只眼，不完整34只眼。对各项指标进行正态性分析，正态数据的采用t检验；非正态数据采用秩和检验。分布数据采用卡方检验。结果患者年龄28～79岁，平均（60．3±10．9）岁，其中男性25例，女性35例，左眼25例，右眼35例。60例患者中，随访6个月视力提高38只眼（63．33％），视力不变21只眼（35．00％），视力下降1只眼（1．67％）。术前最佳矫正视力平均值（LogMar）为0．85±0．44，术后1、3、6个月分别为0．57±0．40、0．54±0．42、0．54±0．42，术后最佳矫正视力较术前差异均有统计学意义（Z=4．155，4．268，4．268；P〈0．05）。OCT检查示60例患者术前CRT为（578．45±144．61）μm，术后1、3、6个月分别为（466．31±87．80）、（442．33±98．92）、（417．15±96．49）Ixm，术后CRT较术前差异均有统计学意义（Z=4．787，5．495，6．304；P〈0．05），呈进行性下降，与视力恢复趋势一致。吲哚青绿组和对照组在手术前后最佳矫正视力和CRT差异不明显。椭厕体区完整组术前最佳矫正视力及术后视力恢复情况要明显好于椭圆体区不完整组。椭圆体区完整组26例有15例观察到术后1个月椭圆体区的紊乱或断裂，术后3及6个月的随访中逐渐恢复。结论玻璃体切除联合吲哚青绿染色下内界膜剥除术治疗特发性黄斑前膜安全有效，术后患者的视力、视物变形症状、视网膜组织结构得到一定程度的改善。术前椭圆体区完整的患者能够获得相对较好的预后，虽然术后可能出现一过性的椭圆体区的紊乱或断裂，但能在3-6个月内逐渐恢复。而在术中采用吲哚青绿辅助内界膜剥除可以帮助顺利完成手术且未见明显毒性作用。

Objective To observe the efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes（IMEM）. Methods Retrospectively studied 60 patients with IMEM who all underwent the surgery of vitrectomy combined with internal limiting membrane peeling from 2011 to 2013. Best corrected visual acuity （BCVA）, intraocular pressure（NCT）, slit-lamp examination, fundus photography, optical coherence tomography （OCT） were committed. Patients were followed for 6 months. They were divided into two groups according to whether indoeyanine green（ICG） was used or not with 32 members in ICG group and 28 members in none ICG group. They were divided into two groups according to the intergrity or disruption of the ellipsoid zone （EZ band） with 26 members in EZ band intergrity group and 34 members in EZ band disruption group. Results Age ranged from 28 to 79 years and the average age was 60.3±10.9. Twenty-five males and 35 females were included. Twenty-five left eyes and 35 right eyes were incorporate. Among the 60 patients, 38 cases （63.33%） underwent visual acuity improvement after operation（BCVA improved at least 2 rows） and 21 （35%）patients＇ vision remained the same（BCVA changes less than 2 rows）, while only one patient（1.67%） experienced decreased visual aeuity（BCVA decline at least 2 rows）. Average best corrected visual acuity （BCVA） （LogMar）and central retina thiekness（CRT）（μm）of all patients preoperationwere 0.85 ± 0.44 and 578.45±144.61 respectively, which were 0.57±0.40,466.31±87.80 for one month and 0.54±0.42, 442.33± 98.92 three and six months postoperation（P〈0.05）. Compared to group of disruption EZ band, the BCVA of group of integral EZ band was better（P〈0.05）. 15 of 26 members in group of integral EZ band came up with EZ band cells loss in one month after operation and recovered by three or six months later. There was no statistical significance in BCVA and CRT between ICG group and none ICG group（P〈0.05）. Conclusions Indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling in the treatment of IMEM is safe and effective. The symptoms of decreased vision, metamorphopsia were greatly ameliorated. Besides, retinal organization structures showed a certain extent of improvement. The transient occurrence of EZ band disruption postoperation could recovery 3 to 6 months later. And internal limiting membrane peeling assisted with ICG is a promising approach to the accomplishment of surgery without obvious toxicity.