内界膜翻瓣术治疗黄斑裂孔的配对研究

目的　用配对研究的方法评价内界膜翻瓣术治疗黄斑裂孔（ｍａｃｕｌａｒｈｏｌｅ,ＭＨ）的临床疗效。方法　收集２０１４年１０月至２０１５年６月在天津市眼科医院行玻璃体切割手术的ＭＨ患者３４例（３４眼）,将情况相近的患者进行配对,分为两组,Ａ组术中行内界膜翻瓣术、Ｂ组术中行内界膜剥除术。术后随访６个月,观察记录术后最佳矫正视力（ｂｅｓｔ-ｃｏｒ-ｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、裂孔闭合率、ＭＨ闭合形态及椭圆体区闭合率等指标。结果　Ａ组术后ＢＣＶＡ为（０．５０±０．０７）ｌｏｇ-ＭＡＲ,明显好于Ｂ组（０．９１±０．１２）ｌｏｇＭＡＲ,差异有统计学意义（ｔ＝－３．７８６,Ｐ＝０．００２）;Ａ组裂孔闭合率为９４．１％（１６／１７）,Ｂ组闭合率为７０．６％（１２／１７）,差异无统计学意义（Ｐ＝０．１７５）;Ａ组Ｕ型闭合８例,Ｖ型闭合７例,Ｗ型闭合１例;Ｂ组Ｕ型闭合４例,Ｖ型闭合８例,Ｗ型闭合０例;Ａ组椭圆体区闭合率为２９．４％,Ｂ组椭圆体区闭合率为０,差异有统计学意义（Ｐ＝０．０４４）。结论　玻璃体切割联合内界膜翻瓣术可提高ＭＨ患者术后ＢＣＶＡ和裂孔闭合率,使Ｕ型闭合增加,提高椭圆体区术后闭合率,是治疗ＭＨ的一种安全、有效的方法。     

玻璃体切割联合内界膜填塞或内界膜翻转对特发性大黄斑裂孔患者治疗效果的对比研究

目的　比较玻璃体切割联合内界膜填塞或内界膜翻转在特发性大黄斑裂孔患者治疗中的效果。方法　回顾性非随机临床研究。24例24眼特发性大黄斑裂孔患者均行睫状体平坦部三通道25G玻璃体切割术,术中使用内界膜反折填塞于黄斑裂孔中者12例12眼为内界膜填塞组,使用内界膜反折覆盖于黄斑裂孔中者12例12眼为内界膜翻转组。术后随访6个月,对比两组患者最佳矫正视力（best corrected visual acuity,BCVA）、裂孔闭合率、OCT检查结果及并发症等情况。结果　术后6个月,内界膜填塞组12眼黄斑裂孔全部闭合,黄斑裂孔闭合率为100%;内界膜翻转组12眼中11眼黄斑裂孔闭合,黄斑裂孔闭合率为91.67%,两组黄斑裂孔闭合率差异无统计学意义（Z=-1.00,P=0.32）。术后6个月,内界膜填塞组BCVA为（1.13±0.40）logMAR,内界膜翻转组为（1.03±0.36）logMAR,均较术前明显改善,差异均有统计学意义（均为P=0.00）;术后6个月内界膜翻转组BCVA优于内界膜填塞组,但差异无统计学意义（t=0.59,P=0.56）。OCT检查示,内界膜翻转组有3眼（25.00%）视网膜外层结构部分恢复,内界膜填塞组均未见视网膜外层结构恢复患者。结论　玻璃体切割联合内界膜填塞或内界膜翻转治疗特发性大黄斑裂孔,均能提高黄斑裂孔的闭合率,稳定及改善BCVA。     

Surgical management of retinal detachment resulting from macular hole in a setting of high myopia

 PURPOSE:To evaluate the anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and use of retinal tamponade for retinal detachments resulting from macular hole (MHRD) in highly myopic eyes. METHODS: Twenty-nine highly myopic patients (29 eyes) underwent PPV with ILM peeling and retinal tamponade for MHRD were enrolled. Demographics and best-corrected visual acuity (BCVA) were measured preoperatively and at final follow-up. Anatomical success and macular hole closure were analyzed. RESULTS:Patients' mean age of patients was 58.7 ± 10.6 years, mean follow-up was 11.7 ± 7.4 months. Twenty three eyes (23/26, 88.5%) undergoing primary PPV combined with ILM peeling had successful initial retinal reattachment, including 19 eyes (19/19, 100%) with silicone oil tamponade and in 4 eyes (4/7, 57.1%) with sulfur hexafluoride (C3F8) tamponade. Overall anatomical success was achieved in 27 eyes (27/29, 93.1%). The macular hole closure was observed in 17 eyes (17/26, 65.4%) with final anatomical success. Compared to preoperative BCVA, the mean postoperative BCVA in the eyes with anatomical success was significantly improved (P = 0.007, Wilcoxon signed rank test). CONCLUSION:As a primary or secondary procedure, PPV combined with ILM peeling and usage of retinal tamponade serves as an effective method for MHRD in highly myopic eyes.     

玻璃体切割联合改良倒置内界膜瓣覆盖及自体血封闭术治疗难治性黄斑裂孔

目的　观察玻璃体切割（PPV）联合改良倒置内界膜（ILM）瓣覆盖及自体血封闭术治疗难治性黄斑裂孔（MH）患者的临床疗效。方法　回顾性病例研究。选取2019年1月至2020年6月在南京医科大学眼科医院确诊并行PPV联合改良倒置ILM瓣覆盖及自体血封闭术治疗的难治性MH患者14例14眼纳入研究。所有入组患者均接受经睫状体扁平部三通道23G PPV联合改良倒置ILM瓣覆盖及自体血封闭术。术后至少随访6个月,观察MH闭合情况,计算裂孔闭合率,对比分析最佳矫正视力(BCVA)、微视野检查结果（黄斑10°平均视网膜光敏感度、固视稳定性）等,记录术中及术后并发症。结果　14例14眼难治性MH患者中,术前最小裂孔直径为264～785 μm,基底径为451～1630 μm。术后MH闭合率为100.0%,且随访期间均未见复发。患者术前BCVA为(1.25±0.30) logMAR,术后6个月随访时BCVA为(0.86±0.35) logMAR,差异有统计学意义(P=0.004);术后BCVA 提高12眼,2眼无提高,无视力下降者。患者黄斑10°视网膜平均光敏感度术前、术后6个月分别为（17.64±4.40）dB和（21.87±5.86） dB,差异有统计学意义 (P=0.040)。术前固视不稳定14眼,术后6个月固视稳定11眼（78.6%）,相对稳定2眼（14.3%）,不稳定1眼（7.1%）。术中及随访期间均未见严重并发症发生。结论　PPV联合改良倒置ILM瓣覆盖及自体血封闭术治疗难治性MH安全有效,可提高难治性MH的手术成功率及裂孔闭合率,促进视功能的恢复。     

空气填充联合内界膜翻转治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔性视网膜脱离

目的：评估空气填充联合内界膜翻转及自体血治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。

方法：回顾性非对照研究分析高度近视眼MHRD患者的治疗效果。玻璃体切割术中使用曲安奈德染色清除玻璃体后皮质,内界膜翻转后应用自体血固定翻转的内界膜后空气填充。记录术后黄斑裂孔闭合率、视网膜复位率及术后最佳矫正视力(BCVA)。

结果：研究共纳入高度近视MHRD患者24例24眼。患者随访至少6mo,平均13.58±7.00mo。末次随访时21眼(88%)黄斑裂孔闭合,20眼(83%)视网膜复位。其中17眼(71%)黄斑裂孔闭合且视网膜复位,3眼(13%)黄斑裂孔未闭合但视网膜复位,4眼(17%)黄斑裂孔闭合但仍有视网膜下液。所有病例无需接受二次玻璃体切割手术。末次随访BCVA(LogMAR)较术前显著提高(0.65±0.34 vs 1.36±0.49,P<0.001)。12眼(50%)的BCVA提高大于等于2行。

结论：玻璃体切割术联合内界膜翻转、自体血及空气填充是治疗高度近视眼MHRD的有效方法。     

PPV联合内界膜翻转覆盖或填塞术治疗大底径特发性黄斑裂孔

目的:探讨玻璃体切除术(PPV)联合内界膜(ILM)翻转覆盖术或填塞术治疗底径大于1000μm特发性黄斑裂孔(IMH)的有效性及安全性.方法:回顾性临床研究.选取2018-01/2020-12在汕头国际眼科中心就诊的IMH底径大于1000μm的56例患者57眼作为研究对象,根据手术方式的不同分为2组,其中PPV联合IL...     

玻璃体切割联合内界膜覆盖术治疗高度近视黄斑裂孔视网膜脱离

目的：比较玻璃体切割联合内界膜剥除术或内界膜覆盖术治疗高度近视黄斑裂孔视网膜脱离(MHRD)的疗效。

方法：回顾性临床研究。选取2020-01/2021-06于我院行玻璃体切割联合内界膜剥除术或内界膜覆盖术治疗的高度近视MHRD患者38例38眼,根据手术方式分为对照组(行玻璃体切割联合内界膜剥除术)和观察组(行玻璃体切割联合内界膜覆盖术)。随访至术后3mo,比较两组患者手术时间、最佳矫正视力(BCVA)、黄斑裂孔闭合和视网膜复位情况。

结果：两组患者手术时间无差异(30.71±4.55min vs 35.20±5.44min,P=0.384)。末次随访时,两组患者BCVA均较术前明显改善(均P<0.01),但两组患者BCVA(LogMAR)无差异(1.39±0.24 vs 1.46±0.27,P=0.700); 观察组患者黄斑裂孔闭合率高于对照组(100% vs 71%,P=0.024),但两组患者视网膜再脱离率比较无差异(0 vs 10%,P=0.492)。

结论：两种手术方式均可改善患者视力,但玻璃体切割联合内界膜覆盖术后黄斑裂孔闭合率更高。     

自体游离内界膜移植术治疗玻璃体切割联合内界膜剥除术后未闭合黄斑裂孔患者的临床疗效

目的　评价自体游离内界膜移植术治疗玻璃体切割联合内界膜剥除术后未闭合黄斑裂孔患者的临床疗效。方法　本研究为回顾性病例研究。收集2016年3月至2018年6月14例（14眼）玻璃体切割联合内界膜剥除术后未闭合黄斑裂孔患者，行自体游离单层内界膜移植术，将黄斑区外残留的内界膜剥除一片略大于黄斑裂孔直径的游离植片，放置于黄斑裂孔中，并将植片边缘置于裂孔边缘下，起到固定作用，然后行气液交换，术后严格俯卧位3～5 d。术前，术后1 d、2周、1个月、3个月通过频域光学相干断层扫描图像观察黄斑裂孔直径及是否闭合，记录患者最佳矫正视力（best corrected visual acuity，BCVA）和眼压。结果　术后3个月，13眼黄斑裂孔完全闭合，裂孔闭合率为92.9%；1眼黄斑裂孔直径较术前明显缩小，裂孔周围视网膜贴附良好，但黄斑中心凹可见裸露的RPE层，未见神经上皮层组织。术后各时间BCVA较术前明显提高，差异均有统计学意义（均为P<0.05），其中11眼较术前提高，3眼无变化，但所有患者自诉视物变形症状较术前明显好转。术后2周，仅有1眼眼压高，为33.4 mmHg（1 kPa=7.5 mmHg），给予降眼压滴眼液后恢复正常。术后2周所有患者气体均完全吸收。14眼均未出现手术相关并发症。结论　自体游离内界膜移植术治疗玻璃体切割联合内界膜剥除术后未闭合黄斑裂孔，术后裂孔闭合率高，患者视功能改善明显。     

微创玻璃体切割联合内界膜剥除术治疗高度近视黄斑裂孔

目的　观察微创玻璃体切割联合内界膜剥除术治疗高度近视黄斑裂孔的临床效果。方法　回顾性非随机临床对照研究。收集２０１０年１月至２０１５年１月高度近视性黄斑裂孔患者２４例２４眼,同期收集特发性黄斑裂孔患者４３例４３眼作为对照组,两组均行标准三通道经睫状体平坦部２３Ｇ微创玻璃体切割联合内界膜剥除术。观察两组术前及术后最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）及光学相干断层扫描检查黄斑裂孔封闭情况。结果　高度近视性黄斑裂孔组与特发性黄斑裂孔组的解剖闭合率（７９．２％ 和８８．４％）及术后ＢＣＶＡ（ＬｏｇＭＡＲ）（０．５６±０．４２和０．６３±１．３８）比较,差异均无统计学意义（均为Ｐ＞０．０５）,两组末次随访时ＢＣＶＡ（ＬｏｇＭＡＲ）分别与治疗前比较,差异均有统计学意义（ｔ＝４．８８６、６．７３５,均为Ｐ＜０．００１）。两组术中均未见医源性裂孔形成,术后无眼内出血或眼内炎等严重并发症发生。结论　玻璃体切割联合内界膜剥除术是修复高度近视眼解剖和功能的有效方式。     

采用或不用内界膜剥除的黄斑裂孔手术

目的:在用或不用吲哚氰绿内界膜染色剥膜的情况下,比较特发性黄斑裂孔术后的解剖及视力结果。方法:对连续采用单纯注气术进行眼内填充的40眼特发性黄斑裂孔进行回顾性分析,所有手术均由一位医生完成。所有的患眼术后至少经过了6月的随访。40眼中的前22眼采用保留内界膜手术(非内界膜剥除组),后18眼采用吲哚氰绿对内界膜染色并进行内界膜剥除手术(内界膜剥除组)。结果:内界膜剥除组和非内界膜剥除组特发性黄斑裂孔解剖复位率分别为88.9%和59.1%,统计结果有显著性差异(Fisher’检验,P =0.038)。内界膜剥除组视力提高较非内界膜剥除组更为明显,平均分别提高了3.46和1.3行(t检验,P =0.0356)。多数病例术后视力提高2行或更多,在内界膜剥除组为66.7%,非内界膜剥除组为31.8%(χ2检验,P = 0.028)。然而在2组之间最终的术后logMAR BC-VA没有明显的差异(t检验,P =0.0073)。结论:根据以上研究,通过吲哚氰绿内界膜染色剥除内界膜可促进特发性黄斑裂孔解剖复位及视力的提高。在此方面进一步的研究是必要的。     

miRNA-145/miRNA-205 inhibits proliferation and invasion of uveal melanoma cells by targeting NPR1/CDC42

AIM:To investigate the role of microRNA-145(miRNA-145)and microRNA-205(miRNA-205)in proliferation and invasion of uveal melanoma(UM)cells.METHODS:The expression level of miRNA-145 and miR NA-205 from samples of UM patients were determined by real-time polymerase chain reaction(RT-PCR).The growth and invasion inhibitory effects were observed by the transfection of UM cells with miRNA-145 and miRNA-205.Several epithelial-to-mesenchymal transition(EMT)-related proteins were screened by Western blotting.UM clinical samples from The Cancer Genome Atlas(TCGA)were applied to search for potential protein interaction.Pearson’s correlation analysis was applied to estimate co-expression between genes.Dual-luciferase reporter assay was used to verify the binding sites on target protein for miRNA-145 and miRNA-205.RESULTS:The expression levels of miRNA-145 and miRNA-205 in the samples from patients with UM were significantly lower than those in the normal tissue samples.Significant growth and invasion inhibitory effects were observed in human UM cells with miRNA-145 and miR NA-205 overexpression.The miRNA-145 and miRNA-205 could decrease the expression level of cell division control protein 42(CDC42).After database searching and sequence alignment,we identified that Neuropilin 1(NRP1)had binding sites for both miRNA-145 and miRNA-205.CONCLUSION:The miRNA-145 and miRNA-205 can reduce the proliferation,migration and invasion of UM cells by targeting the mRNA of its upstream protein NRP1 to down-regulate the expression level of CDC42.     

25G玻璃体切除联合内界膜剥除及空气填充治疗高度近视黄斑劈裂的临床观察

 目的 观察25G玻璃体手术联合内界膜剥除及空气填充治疗高度近视性黄斑劈裂的疗效。设计 回顾性病例系列。研究对象 北京爱尔英智眼科医院2010-2014年眼轴26 mm以上的高度近视性黄斑劈裂患者20例24眼。方法 采用25G三通道平坦部玻璃体切除联合内界膜剥除及空气填充。其中6眼合并白内障,术中同时行白内障超声乳化及人工晶状体植入。术前及术后检查矫正视力（LogMAR视力）、裂隙灯显微镜、间接检眼镜及相干光断层扫描（OCT）。OCT图像根据ETDRS分区分为黄斑中心、上方、下方、鼻侧及颞侧。术后随访3个月以上,平均随访时间（20.54±38.63）周。主要指标 矫正视力,OCT图像黄斑区视网膜厚度。结果 术前患眼平均视力1.41±0.51,术后3个月0.58±0.69 (P=0.001)。术前黄斑中心、上方、下方、鼻侧及颞侧视网膜厚度分别为（452.36±111.28）μm、（425.05±78.39）μm、（415.10±74.43）μm、（404.55±56.03）μm、 （451.45±93.49）μm,术后12周时分别为（233.09±78.72）μm、（260.18±41.04）μm、（260.36±29.85）μm、（289.41±28.38）μm、（237.55±53.57）μm（P均=0.000）。结论 玻璃体切除联合内界膜剥除及空气填充有助于近视性黄斑劈裂眼的视力提高及黄斑劈裂解剖复位。     

玻璃体切割联合视网膜填塞术治疗难治性黄斑裂孔的疗效观察

目的　观察玻璃体切割联合视网膜填塞术治疗难治性黄斑裂孔的临床疗效。方法　回顾性分析2016年3月至10月就诊于首都医科大学附属北京友谊医院眼科,且诊断为难治性黄斑裂孔、并接受玻璃体切割联合视网膜填塞手术治疗的患者14例（14眼）,术后随访3~13个月,使用频域光学相干断层成像评估黄斑裂孔闭合情况,比较术前术后视力。结果　14例（14眼）患者年龄38~73（62.71±8.94）岁,随访3~13（5.78±3.33）个月。其中特发性黄斑大裂孔8例,高度近视黄斑裂孔3例,外伤性黄斑裂孔2例,再次手术1例。行内界膜翻瓣术12例,内界膜移植术2例。术后视力提高者11例,视力提高率为78.57％。术后随访期间,14例（100%）患者黄斑裂孔完全闭合,且随访期内未见裂孔复发,但有2例患者为视网膜色素上皮裸露愈合,裂孔周围视网膜贴附良好。结论　玻璃体切割联合视网膜填塞术可以达到理想的黄斑裂孔闭合率,并对视功能的改善有显著意义。     

Internal limiting membrane flap technique in macular hole surgery

Vitrectomy combined with internal limiting membrane (ILM) peeling is popular for the treatment of macular hole (MH). However, the improvements of MH closure rate and postoperative visual acuity are not satisfactory especially in large and refractory MHs. Currently, the ILM flap technique has gradually been applied for the treatment of MH and achieved high MH closure rate. The ILM flap technique has many variations, including the difference of the size, shape, number, and manner in which the flaps put on the MHs. The ILM flap technique also has some auxiliary means including perfluoro-n-octane (PFO), dye, autologous blood and adhesive viscoelastics. There is controversy about the effects between several technique variations of ILM flap, and it needs to be explored in the future.     

内界膜翻转填塞联合自体血封闭术治疗大孔径特发性黄斑裂孔

目的　观察内界膜翻转填塞联合自体血封闭术治疗大孔径特发性黄斑裂孔的疗效。方法　回顾性分析18例18眼特发性黄斑裂孔的临床资料,黄斑裂孔最小孔径＞400 μm,均行玻璃体切割+内界膜翻转填塞+自体血封闭术,术后随访3个月。观察最佳矫正视力、黄斑裂孔闭合情况及并发症情况。结果　18眼中,17眼黄斑裂孔闭合,闭合率94.4%。术后最佳矫正视力提高者16眼,不变者2眼。术前最佳矫正视力为（1.15±0.42）logMAR,术后为（0.53±0.23）logMAR,差异有统计学意义（t=7.381,P=0.000）。术中及术后均未见严重并发症发生。结论　内界膜翻转填塞联合自体血封闭术治疗大孔径特发性黄斑裂孔是安全有效的,但仍需要大样本、长期观察对该术式进行更完善评估。     

Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes

Purpose: To report the surgical outcome of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling in three highly myopic patients with macular retinoschisis and associated posterior staphyloma. Methods: We report three highly myopic patients with macular retinoschisis and foveal detachment who underwent simple PPV without ILM peeling, with long‐acting gas tamponade. Main outcome evaluations included best corrected visual acuity, biomicroscopic appearance and optical coherence tomography findings. Results: Pars plana vitrectomy without ILM peeling resulted in anatomic and functional improvement in all three operated eyes for follow‐up periods of ≥ 12 months. Conclusions: Pars plana vitrectomy without ILM peeling is effective for treating macular retinoschisis and foveal detachment in highly myopic eyes with posterior staphyloma. Visual and anatomic outcomes are comparable with those in previous studies in which ILM removal was performed.     

内界膜剥除方式进展

内界膜剥除术因能够有效地解除玻璃体视网膜界面的牵拉而在多种玻璃体视网膜疾病中得到应用,但其对巨大、难治性黄斑裂孔及高度近视性黄斑裂孔等棘手疾病的效果欠佳.同时,内界膜剥除本身及染色剂的使用均可导致黄斑发生结构和功能的改变.为了更好地保持黄斑结构的完整性,多种改良的内界膜剥除术,如翻转内界膜瓣、自体内界膜移植、保留中心凹的内界膜剥除术应运而生.研究显示这些新术式在治疗巨大黄斑裂孔、高度近视性黄斑裂孔以及难治性黄斑裂孔上表现出较好的解剖和功能疗效,且无明显的并发症,但仍需要更多大样本的长期随访研究来证实.本文就内界膜剥除术的改良方式及其在玻璃体视网膜中的应用情况进行综述.     

玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术治疗大孔径特发性黄斑裂孔

目的　探讨玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术治疗大孔径特发性黄斑裂孔的疗效。方法　回顾性分析2017年3月至2019年12月在我院行玻璃体切割术治疗的大孔径（最小直径＞400 μm）特发性黄斑裂孔患者68例,其中40例联合内界膜翻转填塞治疗（传统术式组）,28例联合玻璃酸钠凝胶辅助内界膜翻转填塞治疗（改良术式组）。比较两组患者术前及术后最佳矫正视力及裂孔闭合率。结果　传统术式组术后6个月视力（0.842±0.340）logMAR较术前（1.160±0.310）logMAR明显改善（P<0.05）,改良术式组术后6个月视力（0.825±0.288)logMAR较术前（1.204±0.334）logMAR也明显改善（P<0.05）,但两组患者术后视力改善程度差异无统计学意义（P>0.05）。改良术式组术后裂孔闭合率（100.00%）高于传统术式组（77.50%）,差异有统计学意义（P<0.05）,且随着裂孔直径的增大,传统术式组术后裂孔闭合率逐渐降低。超大孔径特发性黄斑裂孔（裂孔直径>700 μm）分组中,传统术式组和改良术式组患者术后裂孔闭合率分别为61.53%、100.00%,差异也有统计学意义（P<0.05）。结论　玻璃体切割联合玻璃酸钠凝胶辅助内界膜翻转填塞术是一种安全有效的手术方式,不仅在一定程度改善大孔径黄斑裂孔患者术后视力,还可大幅提高大孔径特发性黄斑裂孔闭合率,尤其是超大孔径黄斑裂孔的闭合率。     

Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling

Background: To compare the anatomical and visual outcome in primary idiopathic macular hole surgery with or without indocyanine green (ICG) stained internal limiting membrane (ILM) peeling. Methods: The medical records of the last 40 consecutive eyes receiving primary idiopathic macular hole surgery with gas as internal tamponade performed by a single surgeon were retrospectively reviewed and analysed. All eyes had a follow‐up period of at least 6 months. In the initial 22 consecutive eyes, no ILM peeling was performed (non‐ILM peeling group). The subsequent 18 eyes underwent surgery with ICG‐stained ILM peeling (ILM peeling group). Results: The primary anatomical closure rates were 88.9% and 59.1% in the ILM peeling group and non‐ILM peeling group, respectively. The difference was statistically significant (Fisher's exact test, P = 0.038). Improvement in visual acuity was more marked in the ILM peeling group than in the non‐ILM peeling group, with a mean improvement of 3.6 and 1.3 lines, respectively (two‐tailed t‐test, P = 0.036). There were significantly more cases with improvement of two or more lines of visual acuity after surgery, with 66.7% in the ILM peeling group and 31.8% non‐ILM peeling group (Chi‐square test P = 0.028). However, there was no significant difference in the final postoperative logMAR best‐corrected visual acuity between the two groups (two‐tailed t‐test, P = 0.073). Conclusions: Based on this study, ICG‐stained ILM peeling seems to improve the anatomical and visual outcome in primary idiopathic macular hole surgery. Further studies in this aspect are warranted.     

内界膜瓣在难治性黄斑裂孔手术中的应用进展

难治性黄斑裂孔主要包括大直径、高度近视性、持续性、复发性、外伤性黄斑裂孔。相较于普通裂孔,难治性黄斑裂孔经常规玻璃体切割联合内界膜(internal limiting membrane, ILM)剥除术术后裂孔闭合率大大降低且视功能恢复欠佳。为此,ILM瓣技术开始应用于治疗难治性黄斑裂孔中,并且随着国内外学者不断改进,衍生出了在大小、形态、数量和方式上各异的多种ILM瓣技术,整体提高了裂孔闭合率和改善了术后视功能。然而,ILM瓣技术都各有其优缺点和应用限制,到目前为止,尚未出现公认的有效治疗难治性黄斑裂孔的术式。本文就国内外文献中出现的ILM瓣技术的手术方法和治疗效果予以综述,旨在为难治性黄斑裂孔临床术式的选择提供具体参考,并为未来新术式的改良提供借鉴。