CAJ | 학술논문

目的探讨特发性黄斑前膜(IEM)患者微创玻璃体切割术后视力预后的影响因素.方法回顾性连续性病例研究.回顾性分析68例(76只眼)IEM患者的临床资料.患者均行BCVA、眼压、裂隙灯联合前置镜双目间接眼底镜检查、眼底照相及SD-OCT眼底扫描检查,并均采用23G联合25G经结膜无缝合微创玻璃体切割手术治疗,剥除视网膜前膜.手术后随访6～24个月,平均随访时间(6.9±4.3)个月.采用多因素Logistic回归分析法分析年龄、病程、术前最佳矫正视力、术前黄斑中心凹平均厚度、术前感光细胞层内外节(IS/0S)是否连续、术中是否剥除内界膜、术中是否曲安奈德染色等因素对视力预后的影响.结果视力提高52只眼,占68.4％;未提高24只眼,占31.6％.随访期间,所有患者均未发生眼底出血、低眼压、高眼压、眼内炎等并发症.多因素Logistic回归分析显示,病程(r =0.793,P=0.008)、手术前黄斑中心凹平均厚度(r=0.979,P=0.011)及术前IS/OS连续状态(r=1.358,P=0.010)与视力预后密切相关.结论特发性黄斑前膜的手术疗效受多种因素的影响,病程、术前最佳矫正视力、术前黄斑中心凹平均厚度、术前感光细胞层内外节(IS/0S)是否连续是影响玻璃体视网膜手术治疗视力预后的重要因素.其中感光细胞层IS/0S状态关系与预后关系更为密切,可作为良好评判指标.
목적 탐토특발성황반전막(IEM)환자미창파리체절할술후시력예후적영향인소.방법 회고성련속성병례연구.회고성분석68례(76지안)IEM환자적림상자료.환자균행BCVA、안압、렬극등연합전치경쌍목간접안저경검사、안저조상급SD-OCT안저소묘검사,병균채용23G연합25G경결막무봉합미창파리체절할수술치료,박제시망막전막.수술후수방6～24개월,평균수방시간(6.9±4.3)개월.채용다인소Logistic회귀분석법분석년령、병정、술전최가교정시력、술전황반중심요평균후도、술전감광세포층내외절(IS/0S)시부련속、술중시부박제내계막、술중시부곡안내덕염색등인소대시력예후적영향.결과 시력제고52지안,점68.4％;미제고24지안,점31.6％.수방기간,소유환자균미발생안저출혈、저안압、고안압、안내염등병발증.다인소Logistic회귀분석현시,병정(r =0.793,P=0.008)、수술전황반중심요평균후도(r=0.979,P=0.011)급술전IS/OS련속상태(r=1.358,P=0.010)여시력예후밀절상관.결론 특발성황반전막적수술료효수다충인소적영향,병정、술전최가교정시력、술전황반중심요평균후도、술전감광세포층내외절(IS/0S)시부련속시영향파리체시망막수술치료시력예후적중요인소.기중감광세포층IS/0S상태관계여예후관계경위밀절,가작위량호평판지표.
Objective To investigate the postoperative vision in idiopathic epiretinal macular membranes (IEM),and its influencing factors.Methods A retrospective interventional case series of 76 eyes in 68 patients with IEM.All patients underwent micro-invasive vitrectomy with peeling off of the epiretinal macular membrane.All the patients had underwent the examinations of best corrected visual acuity (BCVA),slit lamp microscope,direct ophthalmoscope,binocular indirect ophthalmoscope,optical coherence tomography (OCT) and underwent 3-port pars plana vitrectomy using 23-guage instrumentation and 25-gauge infusion.Follow-up duration varied from 6 to 36 months,with the mean of (6.9+4.3) months.The multiple factors related with age,course,preoperative best-corrected visual acuity (BCVA),preoperative mean central macular thickness (CMT),internal limit membrane peeling technique,triamcinolone-assisted internal limiting membrane peeling technique and the integrity of the IS/OS junction were analyzed.Logistic regression analysis was performed to predict the prognosis of visual acuity.Results The postoperative visual acuity was improved in 52 eyes (68.4％),decreased in 24 eyes (31.6％).No ocular complications such as fundus hemorrhage,low or high intraocular pressure,endophthalmitis were found.The course,preoperative BCVA (r =0.793,P =0.008),preoperative CMT (r =0.979,P =0.011) and the photoreceptor inner and outer segment (IS/OS) junction line continuity (r =1.358,P =0.010) were closely related to visual prognosis.Conclusions The effect of surgery on the treatment of IEM determined by several factors.The course,BCVA,preoperative CMT and photoreceptor defects,were present in patients with IEM.Estimation of those changes may be an important prognostic factor in cases of epiretinal membranes.And the integrity of the IS/OS junction reading is closely related to patients' visual acuity.