特发性黄斑区视网膜前膜对视力影响的临床观察

Clinical observation on vision effect of idiopathic macular epiretina membranes

目的探讨特发性黄斑区视网膜前膜（idiopathic macular epiretina membranes，IMEM）对视力的影响。方法经视力、直间接眼底镜及光相干断层成像（optical coherence tomography，OCT）检查确诊的IMEM患者75例共86只眼，分析不同IMEM形态与视力的关系。结果86只眼最佳矫正视力0．01～1．0（0．50±0．30），其中≤0．3为27只眼，占31．40％；0.3-0．7为38只眼，占44．19％；0．8～1．0为21只眼，占24．42％。OCT检查IMEM与视网膜的位置关系有两种：39只眼（45．35％）前膜与视网膜紧密粘连和47只眼（54．65％）部分粘连；视网膜神经上皮层表现为：50只眼（66．67％）黄斑中心凹出现囊腔，13只眼出现假性黄斑裂孔（15．1％）。86只眼黄斑区中心凹厚度为101～685（313．34±132．15）μm，对全部患眼视力与所对应的黄斑中心凹厚度进行相关分析显示二者存在负相关（r=-0．37，P=0．001〈0．05），即黄斑中心凹越厚视力越差。结论由IMEM牵拉引起的黄斑区水肿增厚与视力损害具有直接关系。

Objective To explore the effect of idiopathic macular epiretinal membranes （IMEM） on vision. Methods Seventy-five patients （86 eyes） in our hospital who were diagnosed as IMEM with visual acuity, direct and indirect ophthalmoscope and optical coherence tomography （OCT）. Then the relationship between the results above and vision were analyzed. Results Vision of 86 eyes ranged from 0.01 to 1.0, average 0.50±0.30, among which 27 eyes were equal or less than 0.3 （31.40%）, of 38 eyes ranged from 0.3 to 0.7 （44.19%）, of 21 eyes ranged from 0.8 to 1.0 （24.42%）. There were two types of position between IMEM and retina： 39 eyes （45.35%） were of tight eonglutination and 47 eyes （54.65%） were of partial conglutination. Retinal nerve fiber layer represented： 50 eyes （66.67%） had cystic cavity, 13 eyes （ 15. 1% ） had macula pseudoholes.The thickness of fovea ranged from 101p m to 685p m, average 313.34±132.15p m. There was negative correlation between all the vision and the thickness of fovea corresponding （r=-0.3 7, P=0.001〈0.05）, namely the thicker of the fovea, the worse of the vision. Conclusions Macular edema caused by IMEM distraction and thickening had a direct bearing on the visual impairment.