CAJ | 학술논문

目的探讨特发性黄斑前膜( IEM)患者手术前后黄斑厚度变化与功能的相关性.方法回顾性病例系列研究.回顾性分析37例(37只眼)IEM患者的临床资料.所有患者均采用标准三切口闭合式玻璃体切除术,剥除视网膜前膜.患者手术前后均先采用国际标准视力表检查最佳矫正视力( BCVA),再转换为最小分辨角的对数视力(logMAR)进行分析.应用相干光断层扫描(OCT)检测患者黄斑中心凹厚度(CFT),应用MP-1微视野计检测患者黄斑中心10°区域视网膜平均光敏感度(MS).患者手术前后BCVA比较,采用秩和检验；手术前后CFT、MS比较,采用配对资料t检验；对BCVA与CFT和MS的相关性进行分析,其中CFT和MS为计量资料,采用Pearson相关分析法；BCVA为等级资料,采用Spearman秩相关分析法.结果 37例(37只眼)患者术前BCVA 0.3 ～1.3,中位数0.7；术后BCVA为0.1 ～0.7,中位数0.4；术后BCVA较术前显著提高(Z=-4.97,P＜0.05).患者术前CFT为199～ 641 μm,平均(482.2±101.8) μm；术后CFT为172 ～ 381 μm,平均( 246.2±60.4)μm；术后CFT较术前显著减少(t=15.86,P＜0.05)；患者术前黄斑中心10°区域视网膜MS为5.5 ～19.9 dB,平均(14.1 ±3.4)dB；术后黄斑中心10°区域视网膜MS为11.6～20.0 dB,平均(18.6± 1.8)dB；术后MS较术前显著提高(t=-9.20,P＜0.05).患者术前CFT值越高,则术前黄斑中心10°区域视网膜MS值越低(r=-0.82,P＜0.05)、术前BCVA水平越低(rs=0.91,P＜0.05)、术后BCVA水平也越低(rs=0.63,P＜0.05).但患者术前CFT值越高,术后CFT值下降越明显(r=0.81,P＜0.05)、BCVA提高也越明显(rs =0.71；P＜0.05).结论玻璃体切除联合黄斑前膜剥除术可以有效促进IEM患者黄斑厚度及功能的恢复.观察分析IEM患者术前CFT、BCVA及黄斑区视网膜MS,有助于客观预测患者术后CFT及功能恢复水平.
목적 탐토특발성황반전막( IEM)환자수술전후황반후도변화여공능적상관성.방법 회고성병례계렬연구.회고성분석37례(37지안)IEM환자적림상자료.소유환자균채용표준삼절구폐합식파리체절제술,박제시망막전막.환자수술전후균선채용국제표준시력표검사최가교정시력( BCVA),재전환위최소분변각적대수시력(logMAR)진행분석.응용상간광단층소묘(OCT)검측환자황반중심요후도(CFT),응용MP-1미시야계검측환자황반중심10°구역시망막평균광민감도(MS).환자수술전후BCVA비교,채용질화검험；수술전후CFT、MS비교,채용배대자료t검험；대BCVA여CFT화MS적상관성진행분석,기중CFT화MS위계량자료,채용Pearson상관분석법；BCVA위등급자료,채용Spearman질상관분석법.결과 37례(37지안)환자술전BCVA 0.3 ～1.3,중위수0.7；술후BCVA위0.1 ～0.7,중위수0.4；술후BCVA교술전현저제고(Z=-4.97,P＜0.05).환자술전CFT위199～ 641 μm,평균(482.2±101.8) μm；술후CFT위172 ～ 381 μm,평균( 246.2±60.4)μm；술후CFT교술전현저감소(t=15.86,P＜0.05)；환자술전황반중심10°구역시망막MS위5.5 ～19.9 dB,평균(14.1 ±3.4)dB；술후황반중심10°구역시망막MS위11.6～20.0 dB,평균(18.6± 1.8)dB；술후MS교술전현저제고(t=-9.20,P＜0.05).환자술전CFT치월고,칙술전황반중심10°구역시망막MS치월저(r=-0.82,P＜0.05)、술전BCVA수평월저(rs=0.91,P＜0.05)、술후BCVA수평야월저(rs=0.63,P＜0.05).단환자술전CFT치월고,술후CFT치하강월명현(r=0.81,P＜0.05)、BCVA제고야월명현(rs =0.71；P＜0.05).결론 파리체절제연합황반전막박제술가이유효촉진IEM환자황반후도급공능적회복.관찰분석IEM환자술전CFT、BCVA급황반구시망막MS,유조우객관예측환자술후CFT급공능회복수평.
Objective To compare the thickness and functional changes of the macula after idiopathic macular epiretinal membrane (IEM) surgery. Methods A retrospective study. Thirty-seven patients (37 eyes) received surgical treatment of IEM.All patients received standard three-port vitrectomy as well as epiretinal membrane peeling.The best corrected visual acuity (BCVA,LogMAR) were recorded and optical coherence tomography (OCT) were used to evaluate central foveal thickness (CFT).Microperimetry (MP)-1 was used for the mean sensitivity (MS) of central 10° macula area.SPSS13.0 was used for statistical analysis. Rank and testing methods were used to compare the preoperative and postoperative BCVA,paired t testing method was used to compare the preoperative and postoperative CFT and MS values. Correlation analysis was used to study the BCVA,CFT,and MS. Pearson correlation analysis was applied to analyze measurement data and Spearman rank correlation analysis was used to analyze rating data.Results Postoperatively,the BCVA (0.1-0.7,median 0.4) was significantly better ( Z =- 4.97,P ＜ 0.05 ) than the preoperative one ( 0.3-1.3,median 0.7 ).The CFT ( 246.2 ± 60.4 ) μm was significantly thinner (t =15.86,P ＜ 0.05 ) than the preoperative one (482.2 ± 101.8 ) μm.The MS of central 10° macula area ( 18.6 ± 1.8 ) dB was significantly higher ( t =- 9.20,P ＜ 0.05 ) than the preoperative one ( 14.1 ± 3.4) dB.Thicker preoperative CFT was associated with a lower preoperative BCVA (rs =0.91,P ＜0.05),a lower MS of central 10° macula area (r =-0.82,P ＜0.05) and a lower postoperative BCVA level (rs =0.63,P ＜0.05 ).But with a significant postoperative CFT reduce( r =0.81,P ＜ 0.05 ) and a significant postoperative BCVA increase ( rs =0.71,P ＜ 0.05 ).Conclusions Vitrectomy combined with macular epiretinal membrane removal can effectively promote the recovery of macular thickness and function in patients with IEM.Examinationand analysis of preoperative CFT,BCVA and MS of macula area may help to predict the recovery of CFT and function objectively in patients of IEM.