中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2014年
4期
361-365
,共5页
王泓%张平%陈凤娥%邱庆华%孙涛
王泓%張平%陳鳳娥%邱慶華%孫濤
왕홍%장평%진봉아%구경화%손도
黄斑%膜%外科手术,微创性%玻璃体切除术
黃斑%膜%外科手術,微創性%玻璃體切除術
황반%막%외과수술,미창성%파리체절제술
Macula lutea%Membranes%Surgical procedures,minimally invasive%Vitrectomy
目的 对比分析23G玻璃体切割手术联合与不联合内界膜(ILM)剥除治疗特发性黄斑前膜(IMEM)的临床效果.方法 临床确诊为IMEM并行23G经睫状体平坦部三切口闭合式玻璃体切割手术治疗的40例患者40只眼纳入研究.其中,联合ILM剥除20只眼(ILM剥除组),不联合ILM剥除20只眼(ILM未剥除组).ILM剥除组患眼在曲安奈德染色辅助下剥除视网膜前膜,然后在吲哚青绿染色辅助下剥除黄斑血管弓区域内ILM;ILM未剥除组患眼只在曲安奈德染色辅助下剥除视网膜前膜.ILM剥除组、ILM未剥除组手术后平均随访时间分别为(15.85±3.79)、(16.45±3.72)个月.两组患者间性别、年龄、眼别、最小分辨角对数(logMAR)矫正视力(BCVA)、黄斑中心凹厚度(CMT)、黄斑体积(TMV)及随访时间比较,差异均无统计学意义(P＞0.05).观察两组患眼手术中及手术后并发症的发生情况.对比分析末次随访时两组患眼BCVA、CMT及TMV的差异.同时对手术后BCVA与CMT、TMV的关系进行相关性分析.结果 ILM剥除组与ILM未剥除组手术中及手术后均未发生视网膜脱离、眼内炎等严重并发症,亦未见IMEM复发.末次随访时,ILM剥除组、ILM未剥除组平均logMAR BCVA分别为0.53±0.27、0.54±0.26,均较手术前明显提高.ILM剥除组、ILM未剥除组手术前后logMAR BCVA比较,差异均有统计学意义(t=5.035、4.964,P＜0.05).两组间手术后logMAR BCVA比较,差异无统计学意义(t=0.176,P＞0.05).ILM剥除组、ILM未剥除组平均CMT分别为(343.55±48.74)、(311.70±42.48) μm,均较手术前明显变薄.ILM剥除组、ILM未剥除组手术前后CMT比较,差异均有统计学意义(t=9.508、8.549,P＜0.05).ILM剥除组手术后CMT较ILM未剥除组更厚,差异有统计学意义(t=-2.203,P＜0.05).ILM剥除组、ILM未剥除组平均TMV分别为(7.78±0.40)、(7.88±0.43) mm3,均较手术前明显缩小.ILM剥除组、ILM未剥除组手术前后TMV比较,差异均有统计学意义(t=11.098、15.372,P＜0.05).两组间手术后TMV比较,差异无统计学意义(t=0.755,P＞0.05).相关性分析发现,ILM剥除组、ILM未剥除组手术后logMAR BCVA与CMT(r=0.244、0.266)、TMV(r=-0.096、0.157)之间均无相关性(P＞0.05).结论 23G玻璃体切割手术联合与不联合ILM剥除均能安全有效地治疗IMEM.联合ILM剥除较不联合ILM剥除在改善视力方面并未显示出更大优势,且其手术后CMT更厚.
目的 對比分析23G玻璃體切割手術聯閤與不聯閤內界膜(ILM)剝除治療特髮性黃斑前膜(IMEM)的臨床效果.方法 臨床確診為IMEM併行23G經睫狀體平坦部三切口閉閤式玻璃體切割手術治療的40例患者40隻眼納入研究.其中,聯閤ILM剝除20隻眼(ILM剝除組),不聯閤ILM剝除20隻眼(ILM未剝除組).ILM剝除組患眼在麯安奈德染色輔助下剝除視網膜前膜,然後在吲哚青綠染色輔助下剝除黃斑血管弓區域內ILM;ILM未剝除組患眼隻在麯安奈德染色輔助下剝除視網膜前膜.ILM剝除組、ILM未剝除組手術後平均隨訪時間分彆為(15.85±3.79)、(16.45±3.72)箇月.兩組患者間性彆、年齡、眼彆、最小分辨角對數(logMAR)矯正視力(BCVA)、黃斑中心凹厚度(CMT)、黃斑體積(TMV)及隨訪時間比較,差異均無統計學意義(P＞0.05).觀察兩組患眼手術中及手術後併髮癥的髮生情況.對比分析末次隨訪時兩組患眼BCVA、CMT及TMV的差異.同時對手術後BCVA與CMT、TMV的關繫進行相關性分析.結果 ILM剝除組與ILM未剝除組手術中及手術後均未髮生視網膜脫離、眼內炎等嚴重併髮癥,亦未見IMEM複髮.末次隨訪時,ILM剝除組、ILM未剝除組平均logMAR BCVA分彆為0.53±0.27、0.54±0.26,均較手術前明顯提高.ILM剝除組、ILM未剝除組手術前後logMAR BCVA比較,差異均有統計學意義(t=5.035、4.964,P＜0.05).兩組間手術後logMAR BCVA比較,差異無統計學意義(t=0.176,P＞0.05).ILM剝除組、ILM未剝除組平均CMT分彆為(343.55±48.74)、(311.70±42.48) μm,均較手術前明顯變薄.ILM剝除組、ILM未剝除組手術前後CMT比較,差異均有統計學意義(t=9.508、8.549,P＜0.05).ILM剝除組手術後CMT較ILM未剝除組更厚,差異有統計學意義(t=-2.203,P＜0.05).ILM剝除組、ILM未剝除組平均TMV分彆為(7.78±0.40)、(7.88±0.43) mm3,均較手術前明顯縮小.ILM剝除組、ILM未剝除組手術前後TMV比較,差異均有統計學意義(t=11.098、15.372,P＜0.05).兩組間手術後TMV比較,差異無統計學意義(t=0.755,P＞0.05).相關性分析髮現,ILM剝除組、ILM未剝除組手術後logMAR BCVA與CMT(r=0.244、0.266)、TMV(r=-0.096、0.157)之間均無相關性(P＞0.05).結論 23G玻璃體切割手術聯閤與不聯閤ILM剝除均能安全有效地治療IMEM.聯閤ILM剝除較不聯閤ILM剝除在改善視力方麵併未顯示齣更大優勢,且其手術後CMT更厚.
목적 대비분석23G파리체절할수술연합여불연합내계막(ILM)박제치료특발성황반전막(IMEM)적림상효과.방법 림상학진위IMEM병행23G경첩상체평탄부삼절구폐합식파리체절할수술치료적40례환자40지안납입연구.기중,연합ILM박제20지안(ILM박제조),불연합ILM박제20지안(ILM미박제조).ILM박제조환안재곡안내덕염색보조하박제시망막전막,연후재신타청록염색보조하박제황반혈관궁구역내ILM;ILM미박제조환안지재곡안내덕염색보조하박제시망막전막.ILM박제조、ILM미박제조수술후평균수방시간분별위(15.85±3.79)、(16.45±3.72)개월.량조환자간성별、년령、안별、최소분변각대수(logMAR)교정시력(BCVA)、황반중심요후도(CMT)、황반체적(TMV)급수방시간비교,차이균무통계학의의(P＞0.05).관찰량조환안수술중급수술후병발증적발생정황.대비분석말차수방시량조환안BCVA、CMT급TMV적차이.동시대수술후BCVA여CMT、TMV적관계진행상관성분석.결과 ILM박제조여ILM미박제조수술중급수술후균미발생시망막탈리、안내염등엄중병발증,역미견IMEM복발.말차수방시,ILM박제조、ILM미박제조평균logMAR BCVA분별위0.53±0.27、0.54±0.26,균교수술전명현제고.ILM박제조、ILM미박제조수술전후logMAR BCVA비교,차이균유통계학의의(t=5.035、4.964,P＜0.05).량조간수술후logMAR BCVA비교,차이무통계학의의(t=0.176,P＞0.05).ILM박제조、ILM미박제조평균CMT분별위(343.55±48.74)、(311.70±42.48) μm,균교수술전명현변박.ILM박제조、ILM미박제조수술전후CMT비교,차이균유통계학의의(t=9.508、8.549,P＜0.05).ILM박제조수술후CMT교ILM미박제조경후,차이유통계학의의(t=-2.203,P＜0.05).ILM박제조、ILM미박제조평균TMV분별위(7.78±0.40)、(7.88±0.43) mm3,균교수술전명현축소.ILM박제조、ILM미박제조수술전후TMV비교,차이균유통계학의의(t=11.098、15.372,P＜0.05).량조간수술후TMV비교,차이무통계학의의(t=0.755,P＞0.05).상관성분석발현,ILM박제조、ILM미박제조수술후logMAR BCVA여CMT(r=0.244、0.266)、TMV(r=-0.096、0.157)지간균무상관성(P＞0.05).결론 23G파리체절할수술연합여불연합ILM박제균능안전유효지치료IMEM.연합ILM박제교불연합ILM박제재개선시력방면병미현시출경대우세,차기수술후CMT경후.
Objective To evaluate the clinical outcomes of idiopathic macular epiretinal membrane (IMEM) by 23G vitrectomy with or without internal limiting membrane peeling.Methods A total of 40 eyes in 40 patients diagnosed as IMEM underwent 23G pars plana thre-port vitrectomy (23G PPV).The macular ERM alone was removed in 20 eyes (non-ILM peeling group).Both ERM and ILM peeling were performed in another 20 eyes (ILM peeling group).All patients underwent removal of ERM with assistance of triamcinolone acetonide.For patients who underwent ILM peeling,indocyanine green dye was used to stain the ILM.ILM was peeled off up to the marginal of macular vessels arch.The patients in ILM peeling group and non-ILM peeling group had postsurgical follow-up for (15.85±3.79) months and (16.45±3.72) months respectively.There were no significant differences in gender,age,OD/OS,preoperative bestcorrected visual acuity (BCVA),preoperative central macular thickness (CMT),preoperative total macular volume (TMV) and follow-up time between the two groups (P＞0.05).Intraoperative or postoperative complication was recorded during the follow-up period.At the final visit,the differences in BCVA,CMT and TMV between the two groups were analyzed,so did the correlations between BCVA and CMT or TMV in each group at the same time.Results There was no recurrence of an ERM or severe complications,such as retinal detachment and endophthalmitis in either group.The mean BCVA of ILM peeling group and nonILM peeling group was 0.53 ± 0.27 and 0.54 ± 0.26 respectively at the final visit.Postoperative BCVA improved significantly in both groups with significant difference (t=5.035,4.964; P＜0.05).The was no difference of postoperative BCVA between two groups (t =0.176,P＞ 0.05).The mean CMT was (343.55 ± 48.74) μm and (311.70±42.48) μm,and the mean TMV was (7.78±0.40) mm3 and (7.88±0.43) mm3.CMT (t=9.508,8.549) and TMV (t =11.098、15.372) revealed a significant decrease in both groups with significant difference (P ＜ 0.05).The postoperative CMT in the ILM peeling group was significantly higher than that in the non-ILM peeling group (t=-2.203,P＜0.05).No difference was found between the two groups in terms of TMV (t =0.755,P＞0.05).Furthermore,no correlation was observed between postoperative BCVA and CMT (r =0.244,0.266 ; P ＞ 0.05) or TMV (r =-0.096,0.157; P＞0.05).Conclusions 23G PPV combined with or without ILM peeling is an efficient and safe treatment for IMEM.ILM peeling appears to have similar effect on the long-term visual outcomes comparing with non-ILM peeling,combined with much thicker postoperative CMT.
