Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair
Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair
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DOI：
10.1016/s0161-6420(01)00593-0
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发表时间：
2001-07-01
期刊：
影响因子：
13.7
通讯作者：
Foster, RE
中科院分区：
文献类型：
--
作者：
Da Mata, AP;Burk, SE;Foster, RE
目的：为确定吲哚菁绿色（ICG）辅助视网膜内界膜（ILM）剥离在黄斑裂孔修复术中的有效性和安全性，设计了干预性、非比较性、前瞻性病例系列研究。参与者：24例连续3期或4期黄斑裂孔患者（24只眼）。干预：所有患眼均接受了平坦部玻璃体切除术，必要时包括后皮质玻璃体剥离。将吲哚菁绿色染料（0.5%）滴入黄斑上方的后玻璃体腔中，并在原位放置3至5分钟。去除ICG后，剥离视网膜ILM。中长效气体填充在所有情况下，所有患者被要求面对1至2 weeks.Main Outcome Measures：Intraoperation staining properties of ICG，技术容易剥离的视网膜ILM，术后解剖结果，视力和并发症recorded.Results：吲哚菁绿色染色的视网膜ILM，但没有染色的基础视网膜。吲哚菁绿色染色极大地促进了外科医生在每种情况下观察和剥离ILM的能力。剥离的组织被送去进行光学和电子显微镜研究，这证实了ICG染色的组织是真正的视网膜ILM。术后观察患者平均123天（范围：23-195天）。21只眼（88%）通过一次手术实现了黄斑裂孔的解剖闭合。24例患者中有23例（96%）术后视力改善。没有与ICG使用相关的术中或术后并发症，也没有ICG毒性的临床或荧光素血管造影证据。结论：吲哚菁绿色染色视网膜ILM。该性质通过在染色的ILM和未染色的视网膜之间提供鲜明的对比而促进ILM剥离。在黄斑裂孔修复的玻璃体手术中，ILM的吲哚菁绿色染色似乎是一种安全和有用的辅助手段。眼科学2001;108：1187-1192（C）2001，美国眼科学会。
Objective: To determine the efficacy and safety of indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling during macular hole repair.Designs interventional, noncomparative, prospective case series.Participants: Twenty-four consecutive patients (24 eyes) with stage 3 or 4 macular holes.Intervention: All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled into the posterior vitreous cavity over the macula and left in place for 3 to 5 minutes. After removal of the ICG, the retinal ILM was peeled. Medium- to long-acting gas tamponade was used in all cases, and all patients were asked to position face down for 1 to 2 weeks.Main Outcome Measures: Intraoperative staining properties of ICG, technical ease of peeling of the retinal ILM, postoperative anatomic results, visual acuity, and complications were recorded.Results: Indocyanine green stained the retinal ILM, but did not stain the underlying retina. Indocyanine green staining greatly facilitated the surgeons' ability to visualize and peel the ILM in each case. Peeled tissue was sent for both light and electron microscopic studies, which confirmed that the ICG-stained tissue was truly retinal ILM. Patients were observed after surgery for an average of 123 days (range, 23-195 days). Anatomic closure of the macular hole was achieved in 21 eyes (88%) with a single surgery. Visual acuity improved in 23 of 24 patients (96%) after surgery. There were no intra- or postoperative complications related to ICG use, and there was no clinical or fluorescein angiographic evidence of ICG toxicity.Conclusions: Indocyanine green stains the retinal ILM. This property facilitates ILM peeling by providing a stark contrast between the stained ILM and the unstained retina. Indocyanine green staining of the ILM appears to be a safe and useful adjunct in vitreous surgery for macular hole repair. Ophthalmology 2001;108:1187-1192 (C) 2001 by the American Academy of Ophthalmology.