玻璃体切割联合气体填充未剥离内界膜治疗近视黄斑中心凹襞裂

Aim: To evaluate the clinical and anatomical outcomes of pars plana vitrectomy and gas tamponade without internal limiting membrane (ILM) peeling in symptomatic patients caused by myopic foveoschisis. Methods: Nine eyes in eight highly myopic patients who had myopic foveoschisis with foveal detachment underwent vitrectomy without ILM peeling followed by gas tamponade. Main outcome measures include change in best corrected visual acuity (BCVA) and changes in height of the foveal detachment and resolution of the myopic foveoschisis measured by optical coherence tomography (OCT). Results: After surgery, BCVA improved in eight eyes with the median BCVA improved from 20/80 to 20/50 (p=0.012). The mean line of visual improvement was 3.6 lines. OCT showed complete resolution of myopic foveoschisis with complete foveal reattachment in seven (77.8% ) eyes with partial resolution in two (22.2% ) eyes. The mean height of foveal detachment decreased from 505 μ m preoperatively to 21 μ m postoperatively (p < 0.001). Conclusions: Vitrectomy without ILM peeling followed by gas tamponade appeared to result in favourable visual and anatomical outcomes for treating myopic foveoschisis in highly myopic eyes. The results are comparable with studies in which ILM removal was performed. Further controlled study will be useful to determine the role of ILM peeling in these patients.

视网膜前膜术中吲哚青绿引导下剥离内界膜:临床和组织学研究

Purpose To evaluate the clinical out come and quantify histologically the amount of microscopic internal limiting membrane(ILM)and epiretinal membrane(ERM)pre-sent in ILM and ERM specimens obtained from ERM surgery.Design Interventional con secutive case series.Methods Patients scheduled for ERM s urgery were re-cruited prospectively.Pars plana v itrectomy,removal of ERM,and ILM peeling with indocyanin e green(ICG)staining were performed in all patie nts.Epiretinal mem-brane and ILM specimens were sent for histologic exam-ination.The amount of ERM present in ILM specimens and the amount of ILM present in ERM sp ecimens were quantified by manual counting.Outc ome measures in-clude change in best corrected visual acuity(BCVA),proportion of cases with 2or more lin es of visual im-provement,anatomic outcome,proportions of microscopic ERM within ILM,and microscopic ILM w ithin ERM.Results Eighteen eyes in 18patients were operated with a mean follow-up of 19.3months.There were 13primary ERMs and five secondary ERMs.The mea n logMAR BC-VA improved from 0.83preoperatively to 0.49postop-eratively(P<0.001).The mean lines of improvement in BCVA was 3.3lines with 14patients(77.8%)who had 2or more lines of BCVA improvemen t.Histologic e-valuation of the specimens showed no significant correla-tion with the final BCVA of 20/50or better.Eleven(61.1%)of the ILM specimens showed various a mount of microscopic ERM and 16(88.9%)of the ERM speci-mens showed various amount of ILM fra gments.The mean proportion of ERM within ILM specime ns was 4.69%and that of ILM within ERM specimens was 51.5%.No sig-nificant recurrence of ERM was found.Conclusion Re-currence of ERM may be minimized by re moving residual microscopic ERM present on the ILM.I ndocyaninegreen-assisted ILM peeling in ERM su rgery appears to have favorable visual and anatomic o utcomes.