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目的 评价视网膜内界膜(ILM )剥离对糖尿病黄斑水肿患者手术后视力恢复的影响。探讨吲哚青绿(ICG)在ILM剥离术中的作用。 方法 对3 0例(3 1只眼)增生期糖尿病视网膜病变伴黄斑水肿患者行玻璃体切割治疗。患者随机分成两组,A组:单纯玻璃体切割16只眼,手术中行全视网膜光凝及2 0 %SF6眼内填充;B组:玻璃体切割加吲哚青绿(ICG)染色ILM剥离15只眼,在A组术式基础上手术中增加ICG染色后极部ILM ,并行ILM剥离。所有患者手术后保持面朝下体位10 14d。患者定期随访3 12个月。 结果 A组16只眼中,视力提高2行或2行以上10只眼(62 .5 % ) ,黄斑水肿消退9只眼(5 6 2 % ) ,手术后光相干断层扫描检查黄斑厚度平均3 93 μm。B组15只眼中视力提高2行或2行以上14只眼(93 . 3 % ) ,黄斑水肿消退14只眼(93 .3 % ) ,黄斑厚度平均3 19μm。B组手术后视力提高明显优于A组(χ2 =4 2 10 ,P =0 .0 5Fisher确切检验法) ;B组患者手术后黄斑区视网膜厚度明显低于A组(P <0 .0 1独立秩和检验)。手术标本证实为ILM。 结论 玻璃体切割术是治疗糖尿病黄斑水肿的有效方法,ILM剥离能明显提高手术的疗效;ICG能较好地染色ILM ,使ILM的剥离更加安全确切。
Objective To evaluate the effect of retinal detachment (ILM) on the recovery of visual acuity in patients with diabetic macular edema. To investigate the role of indocyanine green (ICG) in ILM dissection. Methods Thirty (31 eyes) proliferative diabetic retinopathy with macular edema underwent vitrectomy. The patients were randomly divided into two groups. Group A: 16 eyes were vitrectomy alone. Retinal photocoagulation and 20% SF6 intraocular filling were performed during the operation. Group B: 15 eyes were dissected with vitrectomy and indocyanine green (ICG) A group of surgical procedures based on the increase of ICG stained pole ILM, parallel ILM stripping. All patients remained face-down for 10 14 days after surgery. Patients were followed up regularly for 3 12 months. Results In group A, visual acuity was improved by 2 lines or more than 10 lines (62.5%) in 2 eyes and 9 eyes (562%) with macular edema subsided. The average thickness of the macula was 3 93 after the operation μm. Visual acuity was improved in 2 eyes or more than 2 eyes in 93 eyes (93.3%) in 15 eyes of Group B, 14 eyes (93.3%) of macular edema subsided, and the average thickness of the macula was 3 19μm. Visual acuity after operation in group B was significantly better than that in group A (χ2 = 4 2 10, P = 0.05Fisher exact test); in group B, macular retinal thickness was significantly lower than that in group A (P <0.01 Independent rank sum test). Surgical specimens were confirmed as ILM. Conclusions Vitrectomy is an effective method for the treatment of diabetic macular edema. ILM exfoliation can significantly improve the curative effect of surgery. ICG can better stain ILM, making stripping ILM safer and more accurate.