Kanawati C, Wong D, Hiscott P, Sheridan C, McGalliard J
St John Ophthalmic Hospital, Jerusalem.
Eye (Lond). 1996;10 ( Pt 1):47-52. doi: 10.1038/eye.1996.7.
'En bloc' dissection is a technique in which epiretinal membranes (ERM) are separated from the retina as a single lamina with a 20-gauge blunt flute needle. We used this technique to remove epimacular membranes of various aetiologies in a consecutive series of 25 eyes, with a minimum follow-up of 5 months (mean 10.4 months). Small residual epicentres of ERM away from the fovea remained in 7 (29.1%) eyes only; 3 were inside and 4 outside the temporal vascular arcades. Postoperatively 64% (16/25) of patients achieved a final visual acuity of 6/12 or better and 76% (19/25) achieved a final visual acuity of 6/18 or better. Progressive lens opacities were the most important postoperative complication in phakic eyes that significantly affected the visual results. This technique successfully removed epimacular membranes over a wide area, without the need to find a starting edge or the use of sharp instruments near the retina. Diaphanous ERMs with ill-defined borders and tenaciously adherent membranes could be removed with minimal trauma to the underlying retina. Histopathological and immunohistochemical examination of 10 ERMs demonstrated the absence of internal limiting lamina in 6 (60%).
“整块”剥离是一种使用20号钝头带槽针将视网膜前膜（ERM）作为单个薄片从视网膜上分离的技术。我们采用该技术在连续的25只眼中切除了各种病因的黄斑前膜，最短随访时间为5个月（平均10.4个月）。仅7只眼（29.1%）在远离黄斑中心凹处残留有ERM小的残留中心；3个在颞侧血管弓内，4个在颞侧血管弓外。术后64%（16/25）的患者最终视力达到6/12或更好，76%（19/25）的患者最终视力达到6/18或更好。晶状体混浊进展是有晶状体眼最重要的术后并发症，显著影响视力结果。该技术成功地在广泛区域切除了黄斑前膜，无需寻找起始边缘或在视网膜附近使用锐利器械。边界不清的透明ERM和粘连紧密的膜可以在对下方视网膜造成最小创伤的情况下被切除。对10个ERM进行的组织病理学和免疫组织化学检查显示，6个（60%）不存在内界膜。
