视网膜內界膜剥离治疗糖尿病黄斑水肿的研究

A Clinical Study on Effects of Peeling of Retinal Internal Limiting Membrane with Triamcinolone Acetonide(TA) on Diabetic Macular Edema

目的:观察视网膜內界膜(ILM)剥离对糖尿病黄斑水肿的疗效,视力和黄斑中心凹厚度的变化以及对眼压的影响。探讨曲安奈德(TA)在玻璃体切割及ILM剥离术中的作用。方法:选取糖尿病视网膜病变(IV,V期)引起的黄斑水肿患者60例(60眼)。分成观察组和对照组各30眼。观察组行玻璃体切割手术,术中应用TA标记残留玻璃体后皮质、机化膜及ILM,剥离后极部ILM;对照组行单纯玻璃体切割手术,术中应用TA标记玻璃体后皮质及机化膜。观察:2组术前视力与术后(4个月)视力的变化以及2组之间视力的变化;2组术前、术后2周内、术后4个月眼压的变化,以及2组之间眼压的对照;术后4个月黄斑中心凹OCT值与术前对照及两组之间黄斑中心凹OCT值对照。结果:(1)视力:观察组术后4个月时视力与术前对照P<0.01,具有统计学意义;对照组术后视力与术前对照P<0.05具有统计学意义;观察组30眼中有25眼(84.6%)视力有提高,对照组30眼中有17眼(56.7%)有提高,2组之间对照P<0.05具有统计学意义。(2)黄斑中心凹OCT值:观察组术后4个月黄斑中心凹OCT值与术前对照P<0.01具有统计学意义;对照组术后黄斑中心凹OCT值与术前对照P<0.01具有统计学意义;观察组30眼中黄斑水肿消退28眼,有效率92.3%,对照组30眼中有20眼明显消退,有效率66.7%,2组之间对照P<0.05,具有统计学意义。(3)眼压:观察组术后14天内眼压与术前眼相对照P<0.05,具有统计学意义,术后4个月时眼压P>0.05,无统计学意义;对照组,术后14天内眼压与术前对照P<0.05,具有统计学意义,术后4个月眼压P>0.05,无统计学意义;术后14天内,观察组有8例眼压超过21mmHg,对照组有7例眼压超过21mmHg,2组之间对照,P>0.05无统计学意义。结论:单纯玻璃体切割手术对黄斑水肿有效,ILM剥离能明显提高手术疗效;TA的标记作用使玻璃体切割及ILM剥离更加安全确切。

s Objective ：To evaluate the effects of peeling of retinal internal limiting membrane with TA in diabetic macular edema by observing changes of visual acuity,thickness of central fovea of macula,and intraocular pressure.Methods：We selected 60 eyes with diabetic macular edema.They were divided into two groups：study group（30 eyes）and control group（30 eyes）.In the study group,30 eyes underwent pars plana vitrectomy with TA marker,in the end of operation,4mg TA were injected into the vitreous cavity.The control group,all eyes received simple pars plana vitrectomy.We compared the preoperative and postoperative（4 months）visual acuity of two groups,and observed difference between two groups.We also observed intraocular pressure of preoperative,postoperative on 14 days and 4 months,and difference between the two groups.Results：1.Visual acuity：In the study group,postoperative（4months）were significantly higher than preoperative（p0.01）;And in the control group,postoperative visual acuity were significantly higher than preoperative（p0.05）;In the study group,there were 25 eyes（84.6%）got visual acuity improved;while in the control group,there were 17 eyes（56.%）improved.There were significant difference between the two groups（p0.05）.2.The thickness of central fovea of macular（OCT）：In the study group,the thickness of central fovea of macular of 4 months after operation were less than preoperative（p0.01）.The control group got the similar result.In the study group,there were 28 eyes got macular edema subsided（92.3%）.While in the control group,there were 20 eyes got macular edema subsided（66.7%）.There was significant difference between the two groups（p0.05）.3.Intraocular pressure：In the study group,the intraocular pressure on 14 days after operation were higher than preoperative（p0.05）;While there was no difference between 4 months later and preoperative（p0.05）.In the control group,the intraocular pressure on 14 days after operation were higher than preoperative（p0.05）,while there was no difference between 4 months later and preoperative（p0.05）.In the study group,on 14 days after operation there were 8 eyes got their intraocular pressure over 21 mmHg,and in the control group,there were 7 eyes over 21mmHg.There was no difference between the two groups（p0.05）.Conclusion：Simple pars plana vitrectomy was effective for diabetic macular edema;peeling of internal limiting membrane can improve the effect of operation.TA＇ marker assisted with vitrectomy and peeling of ILM can make the surgery more safe and exactly.