Radetzky Sven, Walter Peter, Fauser Sascha, Koizumi Kan, Kirchhof Bernd, Joussen Antonia M
Department of Vitreoretinal Surgery, Center for Ophthalmology, Joseph Stelzmann-Strasse 9, 50931, Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 2004 Apr;242(4):273-8. doi: 10.1007/s00417-003-0731-8. Epub 2004 Mar 23.
To evaluate the efficacy of inner limiting membrane (ILM) peeling in persistent macular edema.
This retrospective review analyzed a series of 23 eyes from 23 patients with persistent macular edema treated by pars plana vitrectomy (PPV) with indocyanine green (ICG)-assisted peeling of the ILM. Thirteen female and 10 male patients with a mean age of 57.2+/-15.6 (24-77) years underwent operation between May 2000 and October 2001. The main diagnoses were uveitis (anterior, intermediate, posterior and panuveitis) ( n=9), central retinal vein occlusion (CRVO) (n=4), diabetic retinopathy (DR) ( n=5), vitreoretinal traction syndrome ( n=2), and Irvine-Gass syndrome ( n=3). Nine eyes had undergone phacoemulsification (PE) previously and two eyes had been subjected to combined PE and ILM peeling. The eyes were tamponaded with gas (3), silicone oil (5) or air (11). In four cases no endotamponade was used. Improvement in visual acuity of 2 lines or more was regarded as significant.
Visual acuity improved after 3 months in 9 of the 23 patients. After 6 months and at the follow-up, a significant improvement was found in 6/21 and 7/21 patients. This improvement was predominantly seen in patients with uveitis (5/9), or diabetic maculopathy (3/5); One patient with Irvine-Gass syndrome showed a significant reduction, one with vitreoretinal traction an improvement in visual acuity. The group of patients with CRVO showed no significant change during the follow-up. The choice of endotamponade did not alter the visual acuity outcome.
Different patient groups respond differently to ILM peeling. Although overall significant visual acuity improvement was observed in only one third of all cases 12 months after ILM peeling for persistent macular edema, patients with uveitis and nonproliferative diabetic maculopathy demonstrated a benefit. The lack of long-term improvement in the majority of cases is in accordance with the hypothesis that ILM peeling may reduce the intraretinal edema, but does not affect the underlying mechanism causing macular edema. So far, only diabetics have shown improvement (still unproven) from ILM peeling, and this study provides no justification for extending the treatment to macular edema of other causes. Large-scale investigations are needed to evaluate the efficacy in certain diagnosis groups.
评估内界膜（ILM）剥除术治疗持续性黄斑水肿的疗效。
本回顾性研究分析了23例接受玻璃体切割术（PPV）联合吲哚菁绿（ICG）辅助ILM剥除术治疗的持续性黄斑水肿患者的23只眼。2000年5月至2001年10月期间，13例女性和10例男性患者接受了手术，平均年龄为57.2±15.6（24 - 77）岁。主要诊断包括葡萄膜炎（前葡萄膜炎、中间葡萄膜炎、后葡萄膜炎和全葡萄膜炎）（n = 9）、视网膜中央静脉阻塞（CRVO）（n = 4）、糖尿病性视网膜病变（DR）（n = 5）、玻璃体视网膜牵拉综合征（n = 2）和 Irvine - Gass综合征（n = 3）。9只眼之前接受过白内障超声乳化术（PE），2只眼接受过PE联合ILM剥除术。术眼分别用气体（3只）、硅油（5只）或空气（11只）进行眼内填充。4例未行眼内填充。视力提高2行或更多视为有显著改善。
23例患者中，9例在术后3个月视力有所改善。6个月及随访时，分别有6/21和7/21的患者视力有显著改善。这种改善主要见于葡萄膜炎患者（5/9）或糖尿病性黄斑病变患者（3/5）；1例Irvine - Gass综合征患者视力显著下降，1例玻璃体视网膜牵拉患者视力有所提高。CRVO患者组在随访期间视力无显著变化。眼内填充的选择并未改变视力结果。
不同患者群体对ILM剥除术的反应不同。尽管对于持续性黄斑水肿，ILM剥除术后12个月仅有三分之一的病例总体视力有显著改善，但葡萄膜炎和非增殖性糖尿病性黄斑病变患者从中获益。大多数病例缺乏长期改善与ILM剥除术可能减轻视网膜内水肿但不影响黄斑水肿潜在机制的假说相符。到目前为止，只有糖尿病患者显示出（仍未得到证实）ILM剥除术带来的改善，本研究没有理由将该治疗扩展至其他原因引起的黄斑水肿。需要进行大规模研究来评估特定诊断组的疗效。
