探讨黄斑部视网膜内界膜下出血行577 nm半导体激光内界膜切开术的临床疗效。

收集2017年1月至2021年3月在首都医科大学附属北京同仁医院眼科中心诊断为黄斑部视网膜内界膜下出血的患者10例(10只眼)进行研究。其中，男性6例(6只眼)，女性4例(4只眼)，年龄15~78岁，平均年龄(47.8±18.5)岁。全部患者采用行577 nm激光膜切开术治疗；治疗失败者、发现黄斑裂孔者及1个月以上玻璃体积血仍不吸收者，采取玻璃体切除术。治疗前后检查患眼的最佳矫正视力(BCVA)、眼压、眼前节、眼底及光学相干断层扫描(OCT)。临床资料采用频数和百分比进行描述。

在10例患者(10只眼)中，术前诊断为Valsalva视网膜病变4例(4只眼)、糖尿病视网膜病变3例(3只眼)、视网膜大动脉瘤2例(2只眼)及不明原因1例(1只眼)，分别占40%(4/10)、30%(3/10)、20%(2/10)及10%(1/10)。视网膜内界膜下出血发生时间为1~60 d。全部10例(10只眼)患者经577 nm激光治疗，引流成功者有9例，占90%(9/10)；失败者有1例，占10%(1/10)。其中，于激光当时引流成功者5例，占50%(5/10)；于激光后1周内引流成功者4例，占40%(4/10)。激光后发现黄斑裂孔行玻璃体切除术者1例，占10%(1/10)；激光后发生玻璃体积血者3例，占30%(3/10)；行玻璃体切除术者2例，占20%(2/10)；行玻璃体腔灌洗术者1例，占10%(1/10)；激光后发现黄斑前膜保守治疗者1例，占10%(1/10)。

黄斑部视网膜内界膜下出血的治疗包括保守治疗、激光内界膜切开术及玻璃体切除术等。应用577 nm激光内界膜切开术，选择适当治疗时机和合理激光参数，可以成功引流视网膜内界膜下出血；同时需要关注激光治疗的合并症，适时采取玻璃体切除术。

To investigate the efficiency of 577 nm semiconductor laser membranotomy for macular sub-inner limiting membrane (ILM) hemorrhage.

From January 2017 to March 2021, 10 patients (10 eyes) with macular sub-ILM hemorrhage diagnosed in Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University were enrolled. There were 6 males (6 eyes) and 4 females (4 eyes) with the average age of (47.8±18.5) years-old (ranged from 15 to 78 years-old). All patients were treated with 577nm laser membranotomy. While the membranotomy failed, patients with macular hole, or vitreous blood failed to absorb for more than one month, they were underwent vitrectomy. The best corrected visual acuity (BCVA), intraocular pressure, anterior segment, fundus and optical coherence tomography (OCT) of patients were examined before and after treatment. The clinical data were described by frequency and percentage.

Among of 10 patients (10 eyes) the preoperative diagnosis, 4 cases (4 eyes) were Valsalva retinopathy; 3 cases (3 eyes)were diabetic retinopathy; 2 cases (2 eyes) were retinal artery aneurysms; 1 case (1 eye) was unknown, accounting for 40% (4/10), 30% (3/10), 20% (2/10) and 10% (1/10), respectively. The duration of sub-ILM hemorrhage ranged from 1 to 60 days. Of 10 patients (10 eyes) were treated with 577 nm laser, 9 patients were successful in drainage, accounting for 90% (9/10); one case was failed, accounting for 10% (1/10). Among of them, 5 cases were successful in drainage at the time of laser, accounting for 50% (5/10). 4 cases had successful drainage within one week after laser, accounting for 40% (4/10). One case with macular hole was found after laser and then underwent vitrectomy, accounting for 10% (1/10). 3 cases were vitreous hemorrhage, accounting for 30% (3/10). 2 cases were underwent vitrectomy, accounting for 20% (2/10). 1 case underwent vitreous lavage, accounting for 10% (1/10). One case was found to have epimacular membrane after operation but no further for surgery, accounting for 10% (1/10).

The treatment of macular sub-ILM hemorrhage includes conservative treatment, laser membranotomy and vitrectomy. The application of 577 nm laser membranotomy with appropriate treatment time and rational laser parameters could successfully drain the sub-ILM hemorrhage. At the same time, the complications of laser treatment and timely vitrectomy should be paid attention.