视网膜内界膜剥离手术治疗伴严重增生性玻璃体视网膜病变的孔源性视网膜脱离

Therapeutic effects of internal limiting membrane peeling on rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy

目的观察视网膜内界膜剥离与否对伴严重增生性玻璃体视网膜病变（PVR）的孔源性视网膜脱离玻璃体切割手术后并发黄斑前膜（MEM）以及视力的影响。方法伴有PVRC3～D2级的视网膜脱离患者62例纳入研究。患者随机分为A、B二组，其中，A组30例；B组32例。手术前最小视角对数（10gMAR）视力分别为1．47±0．38、1．44±0．33。两组间手术前视力比较，差异无统计学意义（F=0．089，P=0．766）。A组行单纯玻璃体切割手术，B组行玻璃体切割联合视网膜内界膜剥离手术。两组患者均行硅油填充。手术后随访9～12个月。其中，手术后3个月行硅油取出手术。对比观察手术前后视力、间接检眼镜和黄斑区光相干断层扫描（OCT）检查结果。结果OCT检查显示，A组7例患眼手术后发现MEM形成，占23．3％；B组患眼均未发现MEM形成。两组患眼手术后MEM发生率比较，差异有统计学意义（x2=8．42，P=0．004）。末次随访时A、B组患眼logMAR视力分别为0．70±0．22、0．57±0．17；与手术前logMAR视力比较，明显提高（t=16．881，17．887；P=0．000）。B组患眼手术后logMAR视力优于A组（t=2．497，P=0．015），但两组手术前后视力差值比较，差异没有统计学意义（F=2．084，P=0．153）。结论视网膜内界膜剥离手术可有效防止严重PVR孔源性视网膜脱离患者玻璃体切割手术后并发MEM，有助于提高视力。

Objective To evaluate the effects of vitrectomy with internal limiting membrane （ILM） peeling on epiretinal membrane and visual acuity of rhegmatogenous retinal detachment （RRD） with severe proliferative vitreoretinopathy （PVR）. Methods Sixty-two patients with RRD and PVR （C3 - D2） were enrolled in this study. The patients were divided into two groups： 30 patients in group A had undergone conventional vitrectomy; 32 patients in group B had undergone vitrectomy and ILM peeling. All patients had been tamponaded by silicone oil after the operation. The logarithm of minimal angle of resolution （logMAR） visual acuity in group A and B before the operation were 1.47 ± 0.38 and 1.44 ± 0.33 respectively, the difference between two groups was not statistically significant （F= 0. 089,P=0. 766）. The follow-up period was 9 - 12 months. The silicone oil was removed three months after the operation. LogMAR visual acuity, ocular fundus, and optical coherence tomography had been followed up. Results Epimacular membrane formation was found in seven eyes （23.3 %） in group A, but none in group B, the difference was significant （22=8.42, P=0. 004）. The logMAR visual acuity increased significantly both in group A （0.70±0.22） and B （0.57＋0.17） at the last visit （t=16.881, 17. 887; P=0.000）. The logMAR visual acuity in group B was better than that in group A （t=2. 497, P=0. 015）, the difference of vision improvement was not significant between those two groups （F=2. 084, P=0. 153）. Conclusion Vitrectomy with ILM peeling can significantly inhibit the epimacular membrane formation and improve the visual acuity in eyes with RRD and severe PVR.