老年人特发性黄斑前膜手术前后OCT图像的临床观察与比较

Optical coherence tomogram of idiopathic epiretinal macular membrane in the aged before and after operation

目的通过分析老年人特发性黄斑前膜(IERMM)的光学相干断层扫描(OCT)图像特征,探讨其对手术效果评估的意义。方法30例(30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 analyze the characters of optical coherence tomogram（OCT） of idiopathic epiretinal macular membrane （IERMM） in the aged before and after operation and investigate the significance of OCT for evaluation of surgery efficacy. Methods Thirty eyes of 30 cases of IERMM underwent vitrectomy combined with epimacular membrane peeling. The visual acuity, fundus color photograph and OCT images were examined pre- and post- operatively. Results Preoperatively, the OCT characters of macula region of epiretinal membrane manifested as a highly reflective strip in the inner surface of retina, which varied in thickness and tightly adhered or partly bound to the surface of macula. The macular foveola got thickened in most patients and vision decreased. Post-operatively, the abnormal reflective strip in the surface of retina disappeared, and the normal curve of macula recovered to normal or almost to normal, with increase in vision. In some cases, the macula was still edematous or damaged in pigment epithelium. Conclusions The morphological characters of macula along with membrane could be disclosed by OCT so as to provide dependable information for differential diagnosis, surgical indication of IERMM and efficacy evaluation of the operation.