Kuhn Ferenc, Kiss Gyöngyi, Mester Viktória, Szijártó Zsuzsanna, Kovács Bálint
Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA.
Graefes Arch Clin Exp Ophthalmol. 2004 May;242(5):402-8. doi: 10.1007/s00417-004-0876-0. Epub 2004 Feb 18.
Little has been published on internal limiting membrane (ILM) removal for clinically significant macular oedema (CSME) in eyes not improving following maximal laser treatment.
Retrospective review of the charts and intraoperative video films of 30 consecutive eyes of 27 patients undergoing vitrectomy, ILM peeling, and gas tamponade by a single surgeon.
The average patient was 52 years old; 56% were males. The oedema was caused by diabetes in 87% of the eyes, 42% of which had proliferative disease. The oedema was diffuse in 16 eyes (53%) and cystoid (CME) in 14 (47%). In 21% of eyes, spontaneous vitreous detachment was present or the eye had already undergone vitrectomy. All but one eye had at least 6 months of follow-up (mean 12 months). The oedema resolved completely in 26 eyes (90%) and partially in 3 eyes (10%). The visual acuity improved at least two Snellen lines in 19 eyes (66%) and one line in 4 eyes (14%); the average improvement was 4 lines. The acuity was unchanged in three eyes (10%) and worsened in three eyes (10%), all due to cataract. Among the 14 eyes with CME, 11 (79%) became completely dry and the visual acuity improved in 11 eyes (79%). No ILM-related complication was encountered in any eye.
Vitrectomy with ILM peeling is a promising approach to eyes with CSME. It appears to offer visual improvement at a much higher rate than laser therapy and with a longer-lasting effect than that of intravitreal triamcinolone. A larger study is necessary to confirm these preliminary findings.
对于在接受最大程度激光治疗后仍未改善的眼中，因具有临床意义的黄斑水肿（CSME）而进行内界膜（ILM）切除的相关报道较少。
对由一名外科医生连续为27例患者实施玻璃体切除术、ILM剥除术及气体填塞的30只眼的病历和术中视频进行回顾性分析。
患者平均年龄为52岁，56%为男性。87%的眼水肿由糖尿病引起，其中42%患有增殖性疾病。16只眼（53%）水肿为弥漫性，14只眼（47%）为囊样水肿（CME）。21%的眼存在自发性玻璃体脱离或已接受过玻璃体切除术。除一只眼外，所有眼均至少随访6个月（平均12个月）。26只眼（90%）水肿完全消退，3只眼（10%）部分消退。19只眼（66%）视力至少提高两行，4只眼（14%）提高一行；平均提高4行。3只眼（10%）视力未变，3只眼（10%）视力下降，均因白内障所致。在14只患有CME的眼中，11只（79%）完全消退，11只眼（79%）视力提高。未发现任何与ILM相关的并发症。
玻璃体切除术联合ILM剥除术对于患有CSME的眼是一种有前景的治疗方法。与激光治疗相比，其视力改善率似乎更高，且与玻璃体内注射曲安奈德相比，效果更持久。需要进行更大规模的研究来证实这些初步发现。
