微创玻璃体切除术治疗特发性黄斑表面膜

Transconjunctival sutureless vitrectomy for idiopathic epimacular membrane

目的评估经结膜无缝线微创玻璃体切除手术(TSV25G)治疗特发性黄斑表面膜(IEM)的手术效果。方法对7例(7眼)IEM患者TSV25G手术前后进行视力矫正、裂隙灯显微镜下Volk镜、眼底照相、荧光眼底血管造影(FFA)、相干光断层扫描(OCT)和多焦视网膜电图(mERG)等检查。结果所有患者加入随访,随访时间(173.2±125.3)d。术前视力0.18±0.16,术后视力0.64±0.18;IEM剥离情况:7眼中6眼一次性完整剥除膜组织,1眼分3次剥除,有5眼在剥离的视网膜表面有点状非持续性出血,未出现视网膜裂孔或视网膜脱离。IEM剥除后即可发现皱缩的视网膜松解,血管扭曲外观改善,但视网膜皱纹大多存在,视网膜颜色仍然呈灰黄水肿外观。术后第1天所有术眼的黄斑部视网膜颜色恢复正常,视网膜皱纹在术后3 d内均消失。OCT显示正常的黄斑解剖地形,mERG提示P波反应密度增加。结论TSV25G适合用于IEM手术,创伤轻,并发症少,恢复快。

Objective To evaluate the safety and efficacy of transconjunctival sutureless vitrectomy （TSV25G） for idiopathic epimacular membrane （IEM）. Methods The records on visual acuity, fundus photography, Volk lens biomicroscopy, fundus fluorescein angiography（ FFA）, optical coherence tomography（OCT） and multifocal-electroretinogram （mERG） before and after operation of 7 eyes of 7 patients undergoing TSV25G for IEM were retrospectively reviewed. Results All the patients were followed up for （173.2 ± 125.3） d. The visual acuity was 0.18 ±0.16 pre-operation and 0.64±0.18 post-operation. IEMs of 6 eyes were completely removed by primary surgical procedure and 1 eye by three- peeling. There was minor hemorrhage on inner retinal surface in five eyes and no clinically significant complications were encountered. The retinal color in macular area of all eyes was normal on postoperative day 1, and the retinal wrinkle disappeared within three days postoperation. A normal macular topography was revealed under OCT and the P waves were increased in mERG testing, Conclusion TSV25G is a preferred surgical procedure for the repair of ERM with less invasion and fewer complications.