特发性黄斑前膜手术前后OCT图像的临床观察

Characters of idiopathic epiretinal macular membrane pre-and post-operation under optical coherence tomography

目的:通过分析特发性黄斑区视网膜前膜(idiopathic epiretinal macular membrane,IERMM)的光学相干断层扫描(optical coherence tomography,OCT)图像特征,探讨其对手术效果评估的意义。方法:38例(38眼)黄斑前膜患者,行玻璃体切割联合黄斑前膜剥离手术,观察患者手术前后的视力、眼底彩色照相以及OCT检查的情况,并进行统计学分析。结果:术前黄斑部视网膜前膜的OCT图像表现为视网膜内表面厚薄不一的高反光带,或紧贴于黄斑表面,或与其部分相连。绝大多数黄斑中心凹厚度增加,患眼视力不同程度下降。术后视网膜表面异常反光条带均消失,即黄斑区视网膜前膜消失,黄斑中心凹曲线恢复或接近正常状态,术后视力不同程度提高。部分病例黄斑区色素上皮损害或黄斑部水肿。结论:通过OCT可以了解前膜牵拉黄斑区组织结构形态的改变关系,从而为黄斑前膜的临床鉴别诊断、手术指征评估及手术效果评价,提供比以往更加准确可靠的信息。

Objective：To analysis the characters of idiopathic epiretinal macular membrane （IERMM） pre- and post-operation by optical coherence tomography （OCT） and investigate the evaluation of OCT on surgery efficacy. Methods： 38 eyes of 38 cases of IERMM patients were performed vitrectomy combined with epimacular membrane peeling. The visual acuity, fundus color photograph and OCT images were noted pre- and post- operatively. Results： Preoperatively, the OCT characters of epiretinal membrane displayed as high-reflex strip in the inner surface of retina, varied in thickness and tightly adhered or partly bound to the surface or macula. The macular foveola got thickened in most patients and vision decreased. After operation, the abnormal reflex strip in the surface of retina disappeared, and the normal curve of macula recovered to normal or almost recovered to norreal, with improvement in vision. In some cases, the macula were still edematous or damaged in pigment epithelium. Conclusion：The morphological characters of macular along with membrane could be disclosed by OCT so as to providing dependable messages for differential diagnosis, surgical indication and efficacy evaluation to IERMM.