Sheidow Tom G, Blinder Kevin J, Holekamp Nancy, Joseph Daniel, Shah Gaurav, Grand M Gilbert, Thomas Mathew A, Bakal Jeff, Sharma Sanjay
Department of Ophthalmology, University of Western Ontario, London, Ontario, Canada.
Ophthalmology. 2003 Sep;110(9):1697-701. doi: 10.1016/S0161-6420(03)00562-1.
To evaluate the anatomic closure rate and visual outcome in patients undergoing pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling with and without indocyanine green (ICG) enhancement.
Retrospective, noncomparative interventional case series.
One hundred ninety-three consecutive patients (204 eyes) seen at the Barnes Retina Institute with the clinical diagnosis of macular hole who underwent PPV between January 1998 and December 2000.
A consecutive series of 97 patients undergoing PPV with or without unilateral epiretinal membrane removal without ILM peeling (group 1), 44 patients with PPV and ILM peeling without ICG (group 2), and 35 patients with ICG-assisted ILM peeling (group 3).
Overall, 86.4% of the holes closed with one operation, with 75 of 97 (77.3%) eyes in group 1, 43 of 44 (97.7%) eyes in group 2, and 34 of 35 (97.1%) eyes in group 3 (chi(2)= 10.51, P = 0.007). Of the eyes that did not close, 18 patients in group 1 underwent repeat surgery, with 90 of 97 (92.8%) eyes ultimately achieving closure. Visual acuity after surgery was 20/50 or better in 55 of 97 (56.7%) patients, 31 of 44 (70.4%) patients, and 18 of 35 (51.4%) patients in groups 1, 2, and 3, respectively (chi(2) = 3.43, P = 0.18) and increased by 2 or more lines from their preoperative status in 63 of 97 (64.9%) patients, 34 of 44 (77.3%) patients, and 25 of 35 (71.4%) patients, respectively (chi(2)= 2.25, P = 0.32). Multivariate logistic regression demonstrated that use of ILM peeling during vitrectomy increases the chances of developing 20/50 vision or better (odds ratio [OR], 2.4; 95% confidence interval, 1.06-5.45; P = 0.04). No eyes received concurrent cataract extraction with macular hole surgery, but 75 of 166 (45.2%) required cataract extraction postoperatively. Complications included 20 retinal tears, 4 retinal detachments, and 34 patients with postoperative elevations in intraocular pressure (IOP; defined as IOP greater than 30 mmHg).
Although this study is limited by the shorter follow-up in patients undergoing ILM peeling with or without ICG relative to the control group, our experience indicates that the use of ILM peeling is associated with a statistically significant improvement in the rate of primary macular hole closure with a single operation.
评估行玻璃体切除术（PPV）联合或不联合吲哚菁绿（ICG）强化内界膜（ILM）剥除术患者的解剖学闭合率和视觉效果。
回顾性、非对比性干预病例系列。
1998年1月至2000年12月期间在巴恩斯视网膜研究所连续就诊的193例（204只眼）临床诊断为黄斑裂孔并接受PPV的患者。
连续97例接受PPV联合或不联合单侧视网膜前膜切除且未行ILM剥除术的患者（第1组），44例接受PPV联合ILM剥除但未使用ICG的患者（第2组），以及35例接受ICG辅助ILM剥除术的患者（第3组）。
总体而言，86.4%的裂孔一次手术闭合，第1组97只眼中75只（77.3%），第2组44只眼中43只（97.7%），第3组35只眼中34只（97.1%）（χ² = 10.51，P = 0.007）。未闭合的眼中，第1组18例患者接受了再次手术，97只眼中90只（92.8%）最终实现闭合。术后视力在第1组、第2组和第3组分别为97例患者中的55例（56.7%）、44例患者中的31例（70.4%）和35例患者中的18例（51.4%）达到20/50或更好（χ² = 3.43，P = 0.18），且分别有97例患者中的63例（64.9%）、44例患者中的34例（77.3%）和35例患者中的25例（71.4%）较术前视力提高2行或更多行（χ² = 2.25，P = 0.32）。多因素逻辑回归显示，玻璃体切除术中使用ILM剥除术可提高达到20/50或更好视力的几率（优势比[OR]，2.4；95%置信区间，1.06 - 5.45；P = 0.04）。黄斑裂孔手术中无眼同时接受白内障摘除术，但166只眼中75只（45.2%）术后需要白内障摘除术。并发症包括20例视网膜裂孔、4例视网膜脱离和34例术后眼压升高（IOP；定义为IOP大于30 mmHg）的患者。
尽管本研究因接受联合或不联合ICG的ILM剥除术患者的随访时间相对于对照组较短而受到限制，但我们的经验表明，使用ILM剥除术与单次手术黄斑裂孔的初次闭合率在统计学上有显著提高相关。
