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4.1吲哚青绿
吲哚青绿（indocyanine green，ICG）是一种无毒三碳花青苷染料，着染内界膜呈淡绿色。常用浓度有2.5,5g/L。文献显示，ICG对视网膜的毒副作用与剂量相关，同时与ICG的浓度，溶剂的渗透压，与视网膜接触时间，玻璃体切割导光波长相关，而且与ICG作用于液体中还是气体中有关，液体内毒副作用较小[19,20]。也有部分研究[16,18]表明，ICG的使用并没有对视网膜造成毒性作用。而在黄斑全层裂孔的手术治疗中，因为ICG与视网膜神经细胞直接接触而引起损伤[21,22]。在内眼手术中使用ICG可能对视网膜毒副作用的各影响因素的阈值尚需要进一步的实验研究。
4.2台盼蓝
台盼蓝（trypan blue,TB）是一种高分子量的活性染色剂，着染内界膜呈淡蓝色，临床常用浓度为1g/L。在Ito等[23]的体外实验中，0.04～4g/L台盼蓝对人视网膜色素上皮细胞的存活率与对照组没有统计学差异。一定浓度的台盼蓝在光照作用下对视网膜没有明显毒副作用，不会造成视网膜组织细胞结构的改变，而ICG会影响视网膜色素上皮细胞的存活率[24,25]。Haritoglou等[26]在人死后24h的尸眼模拟手术中发现，1.5g/L及2.5g/L台盘蓝染色的视网膜存在形态学的改变，视网膜表面粗糙，Müller细胞突触小节结构破坏，ILM缺损，而0.2g/L台盘蓝较为安全。
4.3曲安奈德
不溶于水的曲安奈德（triamcenolone acetonide,TA）白色颗粒可附着于玻璃体、视网膜前膜和视网膜内界膜，能清晰辨认和更为安全彻底的剥除，临床常用浓度有40mg/mL，50mg/5mL。Kimura等[27]在玻璃体切割术治疗黄斑裂孔的过程中，清除玻璃体后皮质后，在后极部注入TA，辅助剥除离ILM，操作安全简单。研究[28]表明，将TA注入视网膜表面，TA的白色颗粒可粘附于视网膜前膜和视网膜内界膜，手术中容易剥除。TA对视网膜是否存在毒性作用，是目前最令人关注的问题。早期的动物试验提示多种皮质类固醇制剂对视网膜的毒性作用，是由于制剂中的赋性剂和异常渗透压所致，但TA并未显示出类似的毒性作用。研究表明[29]，当大剂量注射TA时，Müller细胞空泡化、变性，外丛状层与外核层之间的突触小泡空泡化，最终导致光感受器的变性，产生视网膜毒性作用。
5展望
ILMP作为治疗某些黄斑病变的重要手段，颇受视网膜外科医师的青睐及关注， 复习近10a的文献，主张ILMP 治疗特发性黄斑裂孔者占大多数。但是也应当看到，ILMP后带来的视网膜功能上的变化我们还知之甚少，许多病理、生理、生物化学以及生物电活动方面的改变还需要我们在今后的临床实践中进一步研究和探索。需要进一步加强视网膜功能方面的基础研究，尤其是视网膜内界膜功能的研究。需要进行多中心、随机、前瞻性,甚至双盲研究，建立统一的标准及疗效评价体系。
【参考文献】
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