Eye Center, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.
Eye (Lond). 2009 Feb;23(2):248-54. doi: 10.1038/eye.2008.60. Epub 2008 Mar 14.
To determine the effectiveness of staining an epiretinal membrane (ERM) with triamicinolone acedonide (TA) during vitrectomy for a retinal detachment (RD) due to a macular hole (MH) in highly myopic eyes.
Thirty-four highly myopic eyes (>-6.0 dioptres) of 34 patients with an RD caused by an MH underwent vitrectomy with TA-assisted ERM removal. The excised ERMs from five eyes were examined by transmission electron microscopy (TEM). The main outcome measures were the retinal status and best-corrected visual acuity (BCVA). The anatomic status of the MH was determined by optic coherence tomography (OCT) in 24 successfully retinal-reattached eyes. The follow-up periods ranged from 5 to 20 months.
The granules of TA adhered to the ERM and the residual posterior hyaloid, which made them more visible and facilitated their removal. Tissues resembling the internal limiting membrane were not detected in any of the five excised tissues. The retinal reattachment rate was 88% after the first surgery. The mean log MAR BCVA significantly improved from 1.83+/-0.50 (mean+/-SD) before surgery to 1.22+/-0.35 at the final follow-up (P<0.001, Wilcoxon signed rank test). OCT showed a normal concave appearance in 11 of 24 eyes (46%), but a central neural epithelial defect was present in 13 of 24 eyes (54%).
TA facilitates the complete removal of both the ERM and residual posterior hyaloid, thus ensuring high anatomical and visual success rates in highly myopic eyes with an RD due to MH.
在治疗孔源性视网膜脱离（RD）合并黄斑裂孔（MH）时，研究在玻璃体切除术中应用曲安奈德（TA）染色内界膜（ERM）的效果。
对 34 例高度近视（>-6.0 屈光度）患者的 34 只眼行玻璃体切除联合 TA 辅助 ERM 撕除术治疗 RD 合并 MH。对 5 只眼的 ERM 组织行透射电镜检查。主要观察指标为视网膜复位情况和最佳矫正视力（BCVA）。24 只眼 OCT 检查 MH 解剖复位情况，随访 5~20 个月。
TA 颗粒可黏附在 ERM 和残余后玻璃体上，使 ERM 和残余后玻璃体更加清晰，便于其彻底清除。在 5 例切除组织中均未发现类似内界膜的组织。初次手术视网膜复位率为 88%。平均 logMAR BCVA 由术前的 1.83+/-0.50 提高到末次随访时的 1.22+/-0.35（P<0.001，Wilcoxon 符号秩检验）。24 例患者中，11 例（46%） OCT 检查示 MH 呈正常凹面形态，13 例（54%）存在中心神经上皮缺损。
TA 有助于 ERM 和残余后玻璃体的彻底清除，可提高高度近视 RD 合并 MH 患者的手术成功率。
