玻璃体手术治疗特发性黄斑前膜临床观察

Clinical observation of vitrectomy with surgical removal of idiopathic epimacular membrane

目的探讨玻璃体切除联合黄斑前膜剥离术治疗特发性黄斑前膜的手术效果及手术时机的选择。方法回顾性分析手术治疗的特发性黄斑前膜58例(59眼),所有病例均行三切口玻璃体切除及黄斑前膜剥除术,其中20眼同时进行了内界膜撕除术。32眼行气液交换。6眼联合行晶状体超声乳化及人工晶状体植入术。手术后随访1～24月,平均4.7月。对视力、黄斑结构及手术并发症等进行了临床观察。结果随访期末视力提高43眼,占72.88%(其中提高2行以上者29眼占49.15%);不变15眼,占25.42%;下降1眼,占1.70%。随访期内未见前膜复发。OCT显示所有患眼的前膜均已消除,黄斑水肿不同程度逐渐减轻。并发症:术中少许点状出血6眼;手术后11d发生玻璃体积血1眼;周边小牵引孔3眼(其中视网膜脱离1眼);术中中心凹处小牵引孔1眼;手术后1a并发性白内障2眼。结论玻璃体切除术联合膜剥离治疗特发性黄斑前膜的手术效果较好,但也可能出现一些较严重的并发症。在手术技巧比较娴熟的情况下,较早手术治疗可能有助于恢复较好视功能。

Objective To investigate the efficacy and suitable time of vitrectomy with removal of epiretinal membrane to treat idiopathic epimacular membrane （ IEM ）. Methods Fifty-eight patients（59 eyes）with IEM were retrospectively investigated. All the eyes were undergone a standard three port pars plana vitrectomy with removal of cpiretinal membrane, 20 eyes also with internal limiting membrane （ILM） peeling. 32 eyes underwent fluid-air exchange. Six eyes were combined with phacoemulsification and IOL implantation. Postoperative follow up was 1-24 months, mean 4.7 months. The visual acuity, complications of the surgery, foveal thickness and anatomical structural changes of macula were compared before and after surgery. Results The visual acuity Were improved in 43 patients （ 72.88% ） in the last follow-up, among which 29 eyes（49.15% ） improved by 2 or more lines, remained unchanged in 15（25.42% ） patients, and decreased in 1 （ 1.70% ） patient. No recurrent of IEM were seen during follow-up time. All IEM were disappeared on OCT after surgery and macular edema alleviated gradually. Six eyes complicated with small amount retinal hemorrhage during surgery, one vitreous hemorrhage occurred 11 days after surgery. Three eyes complicated with prepheral retinal hole, among which 1 eye developed retinal detachment, 1 with a small foveal hole. Two patients need phacoemulsification and IOL implantation because of complicating cataract after 1 year of surgery. Conclusion Vitrectomy accompanied with removal of epiretinal membrane in treating IEM may aid in improving visual function and reducing macular edema in most patients. Severe complications may occur in surgery. Earlier surgery may get better restoration of visual function.