中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2015年
1期
66-69
,共4页
计算机体层成像%光学相干断层扫描%视力%预后%特发性黄斑前膜%玻璃体切割术
計算機體層成像%光學相榦斷層掃描%視力%預後%特髮性黃斑前膜%玻璃體切割術
계산궤체층성상%광학상간단층소묘%시력%예후%특발성황반전막%파리체절할술
Computerized tomography%Optical coherence tomography%Visual outcome%Prognosis%Idiopathic macular epiretinal membranes%Vitrectomy
背景 特发性黄斑前膜(IMEM)发病率高,严重影响患眼的视功能,玻璃体切割术是其治疗的主要方法,但关于其术后视力预测的研究较少. 目的 对IMEM进行玻璃体切割联合膜剥除手术患眼的临床资料进行分析,评价IMEM患者手术前后光学相干断层扫描(OCT)测量的黄斑中心凹厚度(CFT)变化与术后视力改善的关系.方法 采用回顾性研究方法,收集2009年3月至2013年5月在北京大学人民医院确诊为IMEM且行玻璃体切割手术、并完成随访的病例48例49眼的临床资料.患者依据术前OCT图像中视网膜色素上皮(RPE)层、视网膜光感受器内节/外节(IS/OS)及外界膜(ELM)层反光条带是否完整分为完整组(17例18眼)及不完整组(31例31眼),记录患眼手术前OCT测量的CFT值和LogMAR视力,并与术后12周的结果进行比较,分析术眼手术前后CFT值变化与视力改善程度的关系,评价术前OCT测量的CFT值在预测术眼术后视力改善程度方面的应用价值. 结果 术后12周,完整组18眼的OCT图像显示RPE层、IS/OS层及ELM层均仍完整,而不完整组OCT图像RPE层反光条带不连续者由术前的6眼减少到1眼,IS/OS层反光条带不连续者由术前的29眼减少到19眼,ELM层反光条带不连续者由术前的27眼减少到15眼(各层的不连续眼数有重复).术眼视力的增加值随着CFT值的减少而增加,二者间呈显著负相关(R2 =0.298,B=0.001,P=0.000),CFT每减少100 μm,术后LogMAR视力提高1行.完整组患眼术前平均LogMAR最佳矫正视力(BCVA)为0.4±0.19,术后为0.36±0.21,差异无统计学意义(t=0.876,P=0.393).不完整组术前平均logMAR BCVA为0.82±0.41,术后为0.46±0.26,差异有统计学意义(t=6.206,P=0.000).不完整组患眼术后视力的改善程度为0.3,优于完整组的0.0. 结论 IMEM术眼手术前后OCT测量视网膜外层结构的连续性及CFT的变化均与患眼视力改善的程度明显相关,术前视网膜外层结构连续者术后预后较好,而术前视网膜外节结构不连续者术后多数可以得到明显改善,包括结构和视力.术前OCT检查在评价IMEM患者术后视力预后方面有一定价值.
揹景 特髮性黃斑前膜(IMEM)髮病率高,嚴重影響患眼的視功能,玻璃體切割術是其治療的主要方法,但關于其術後視力預測的研究較少. 目的 對IMEM進行玻璃體切割聯閤膜剝除手術患眼的臨床資料進行分析,評價IMEM患者手術前後光學相榦斷層掃描(OCT)測量的黃斑中心凹厚度(CFT)變化與術後視力改善的關繫.方法 採用迴顧性研究方法,收集2009年3月至2013年5月在北京大學人民醫院確診為IMEM且行玻璃體切割手術、併完成隨訪的病例48例49眼的臨床資料.患者依據術前OCT圖像中視網膜色素上皮(RPE)層、視網膜光感受器內節/外節(IS/OS)及外界膜(ELM)層反光條帶是否完整分為完整組(17例18眼)及不完整組(31例31眼),記錄患眼手術前OCT測量的CFT值和LogMAR視力,併與術後12週的結果進行比較,分析術眼手術前後CFT值變化與視力改善程度的關繫,評價術前OCT測量的CFT值在預測術眼術後視力改善程度方麵的應用價值. 結果 術後12週,完整組18眼的OCT圖像顯示RPE層、IS/OS層及ELM層均仍完整,而不完整組OCT圖像RPE層反光條帶不連續者由術前的6眼減少到1眼,IS/OS層反光條帶不連續者由術前的29眼減少到19眼,ELM層反光條帶不連續者由術前的27眼減少到15眼(各層的不連續眼數有重複).術眼視力的增加值隨著CFT值的減少而增加,二者間呈顯著負相關(R2 =0.298,B=0.001,P=0.000),CFT每減少100 μm,術後LogMAR視力提高1行.完整組患眼術前平均LogMAR最佳矯正視力(BCVA)為0.4±0.19,術後為0.36±0.21,差異無統計學意義(t=0.876,P=0.393).不完整組術前平均logMAR BCVA為0.82±0.41,術後為0.46±0.26,差異有統計學意義(t=6.206,P=0.000).不完整組患眼術後視力的改善程度為0.3,優于完整組的0.0. 結論 IMEM術眼手術前後OCT測量視網膜外層結構的連續性及CFT的變化均與患眼視力改善的程度明顯相關,術前視網膜外層結構連續者術後預後較好,而術前視網膜外節結構不連續者術後多數可以得到明顯改善,包括結構和視力.術前OCT檢查在評價IMEM患者術後視力預後方麵有一定價值.
배경 특발성황반전막(IMEM)발병솔고,엄중영향환안적시공능,파리체절할술시기치료적주요방법,단관우기술후시력예측적연구교소. 목적 대IMEM진행파리체절할연합막박제수술환안적림상자료진행분석,평개IMEM환자수술전후광학상간단층소묘(OCT)측량적황반중심요후도(CFT)변화여술후시력개선적관계.방법 채용회고성연구방법,수집2009년3월지2013년5월재북경대학인민의원학진위IMEM차행파리체절할수술、병완성수방적병례48례49안적림상자료.환자의거술전OCT도상중시망막색소상피(RPE)층、시망막광감수기내절/외절(IS/OS)급외계막(ELM)층반광조대시부완정분위완정조(17례18안)급불완정조(31례31안),기록환안수술전OCT측량적CFT치화LogMAR시력,병여술후12주적결과진행비교,분석술안수술전후CFT치변화여시력개선정도적관계,평개술전OCT측량적CFT치재예측술안술후시력개선정도방면적응용개치. 결과 술후12주,완정조18안적OCT도상현시RPE층、IS/OS층급ELM층균잉완정,이불완정조OCT도상RPE층반광조대불련속자유술전적6안감소도1안,IS/OS층반광조대불련속자유술전적29안감소도19안,ELM층반광조대불련속자유술전적27안감소도15안(각층적불련속안수유중복).술안시력적증가치수착CFT치적감소이증가,이자간정현저부상관(R2 =0.298,B=0.001,P=0.000),CFT매감소100 μm,술후LogMAR시력제고1행.완정조환안술전평균LogMAR최가교정시력(BCVA)위0.4±0.19,술후위0.36±0.21,차이무통계학의의(t=0.876,P=0.393).불완정조술전평균logMAR BCVA위0.82±0.41,술후위0.46±0.26,차이유통계학의의(t=6.206,P=0.000).불완정조환안술후시력적개선정도위0.3,우우완정조적0.0. 결론 IMEM술안수술전후OCT측량시망막외층결구적련속성급CFT적변화균여환안시력개선적정도명현상관,술전시망막외층결구련속자술후예후교호,이술전시망막외절결구불련속자술후다수가이득도명현개선,포괄결구화시력.술전OCT검사재평개IMEM환자술후시력예후방면유일정개치.
Background Idiopathic macular epiretinal membrane (IMEM) shows a high incidence and affects visual function of patients.The primary management of IMEM is vitrectomy,but the study on prediction of visual acuity after operation by optical coherence tomography (OCT) is seldom.Objective This study was to evaluate the predicting ability of OCT for preoperative visual outcome for IMEM patients who received vitrectomy.Methods The clinical data of IMEM patients with vitrectomy from March 2009 to May 2013 were retrospectively analyzed in People's Hospital Peking University.Forty-nine eyes of 48 cases were divided into continuous group (19 eyes of 18 cases) and discontinuous group (31 eyes of 31 cases) based on whether the extraretinal layers were intact on OCT,including retinal pigment epithelium (RPE),inner and outer segment of photoreceptors (IS/OS) and external limiting membrane (ELM).Central foveal thickness (CFT) by high-resolution spectral-domain OCT and best corrected visual acuity (BCVA) (LogMAR) before surgery and 12 weeks after surgery were recorded and compared between the two groups,and the correlations of shift of CFT with the shift of LogMAR vision was analyzed by unitary linear regression to evaluate the value of OCT in predicting postoperative vision.Writen informed consent was obtained from each patient prior to any medical operation.Written informed consent was obtained from each patient before surgery.Results In 12 weeks after operation,reflective strips of RPE layer,IS/OS and ELM layer were intact in 18 eyes of the continuous group after vitrectomy.The number of eyes with discontinuous strip in RPE layer decreased to 1 eye after operation from 6 eyes before operation,and the number of eyes with IS/OS reflective strip discontinue decreased to 19 eyes after operation from 29 eyes before operation,and that with ELM layer discontinue decreased to 15 eyes after operation from before operation in the discontinuous group.The improvement of LogMAR BCVA was increased with the decline of CFT values with a negative correlation between them (R2 =0.298,B =0.001,P =0.000),and postoperative LogMAR visual acuity improved 1 line whenever CFT reduced by 100 μm.LogMAR BCVA was 0.4±0.19 before surgery and 0.36±0.21after surgery in the continuous group,showing a insignificant difference between them (t =0.876,P=0.393).In the discontinuous group,the postoperative IogMAR BCVA was significantly higher after operation (0.46±0.26) than 0.82 ±0.41 after operation (t =6.206,P =0.000).The increase value of LogMAR after vitrectomy was 0.3 in the discontinuous group,which was superior to 0.0 of the continuous group.Conclusions The continuity of extraretinal layers and CFT by OCT are closely associated with the improvement of vision after vitrectomy in the eyes with IMEM.Postoperative vision is better in IMEM eye with continuous retinal reflective strips before operation,and majority of IMEM eyes can improve vision after operation.Preoperative OCT seems to be an important diagnostic tool for the selection of patients who benefit or not from surgery to certain extent.
