玻璃体切割联合内界膜剥离术治疗IMEM不同眼内填充物的临床观察

Vitrectomy and internal limiting membrane peeling with different vitreous tamponade for idiopathic macular epiretinal membrane

目的:探讨玻璃体切割联合视网膜内界膜剥离手术治疗特发性黄斑前膜(idiopathic macular epiretinal membrane,IMEM)术不同眼内填充物术后疗效及并发症的观察。方法:回顾性分析特发性黄斑前膜患者44例44眼。患者随机分成A、B两组,其中A组20例;B组24例,两组患者均行玻璃体切割联合视网膜内界膜剥离手术,A组玻璃体腔内行平衡盐溶液(BSS)填充,B组行气体填充(13眼填充滤过空气,11眼填充100mL/LC3F8),术后随访12～16(平均13)mo。术前、术后1,3,6,12mo检查最佳矫正视力(BCVA),光学相干断层扫描(OCT)测量黄斑中心凹厚度(CFT),术后1,7d;1,3mo行眼压(IOP)检查,对比观察手术前后视力,间接检眼镜,CFT,IOP检查结果。结果:末次随访时两组患眼BCVA较术前显著提高,提高0.2logMAR及以上者29眼(66%)。两组间logMARBCVA的差异手术前(0.53±0.18vs0.52±0.14)及末次随访时(0.31±0.14vs0.28±0.09)均无统计学意义(P>0.05)。末次随访时A、B组患眼CFT较术前明显降低,从407.82±97.00μm下降到285.25±70.07μm(Z=4.29,P<0.05)。两组间CFT的差异术前(409.45±108.40μmvs406.46±88.76μm)及末次随访时(287.60±66.94μmvs283.29±73.95μm)均无统计学意义(P>0.05)。术后1d,A组眼压(14.25±3.06mmHg)低于B组(17.71±3.20mmHg),差异有统计学意义(Z=3.12,P<0.05),但两组眼压均值均未超过正常范围(10～21mmHg)。术前、术后7d;1,3mo两组间眼压差异均无统计学意义(P>0.05)。A组患者术后无需俯卧位,B组患者填充滤过空气者术后俯卧位1～3d,填充100mL/LC3F8者俯卧位至少7d。结论:玻璃体切割联合视网膜内界膜剥离手术治疗特发性黄斑前膜手术末填充BSS或气体均能显著提高视力、降低黄斑中心凹厚度,两者的临床疗效无显著差异,但填充BSS可避免术后俯卧位,减轻患者术后身体及精神负担,同时手术更加快捷、安全。

AIM： To compare visual outcomes, central foveal thickness （ CFT）, and postoperative complications after vitrectomy and internal limiting membrane （ ILM ） peeling, with balanced salt solution （BSS） or gas tamponade, for the treatment of idiopathic macular epiretinal membrane（IMEM）. METHODS ： Retrospective clinical study. 44 patients with IMEM were included in this study. All patients had undergone vitrectomy and ILM peeling. Eyes were divided into two groups： 20 eyes in group A with BSS tamponade. 24 patients in group B with gas tamponade 411 eyes were injected with filtered air and 13 eyes with perfluoropropane,100mL/L C3Fs）. The follow-up period was 12-16（ mean 13） months. The following parameters were collected and compared： best- corrected visual acuity（BCVA） and CFT （at baseline and 1, 3, 6 and 12 months postoperatively）, intraocular pressure （lOP） （ at baseline and on the 1th ,7th day, 1,3 months postoperatively. RESULTS： BCVA significantly improved, and 29 of 44 eyes （65. 9%） achieved visual recovery ≥ 0.2 IogMAR. There were no significant differences between group A and group B in mean baseline IogMAR BCVA （0.53±0.18 vs0.52±0.14; P〉0.05） and final IogMAR BCVA（0. 31±0.14 vs 0. 28±0.09 ; P〉0.05 ）. With respect to OCT parameters, the mean CFT at 12 months （285. 25±70. 07μm） wassignificantly decreased from that of the baseline （407.82± 97.00μm）, （Z= 4.29, P〈 0.05）. There were no significant differences between group A and group B in mean baseline CFT （409.45±108.40μn vs 406.46±88. 76μm; P〉 0.05） and final CFT （287.60±66.94μm vs 283.29±73.95μ m ; P〉0.05）. With respect to lOP, there were no significant differences between group A and group B at mean baseline and on the 7^th day, 1, 3 months postoperatively （P〉0.05）. The lOP in group A was significant lower at 1th postoperative day compared with group B （Z=3.12, P〈 0.05）, but the mean lOP of both groups were within normal range （10-21mmHg）. Patients in group B with filtered air tamponade were instructed to maintain a prone position for 1 to 3 days and with perfluoropropane tamponade instructed to maintain a prone position for at least 1 week, however, patients in group A were not. CONCLUSION- Vitrectomy and ILM peeling can significantly improve the visual acuity and decrease the CFT no matter with gas or with BSS tamponade, there were no significant differences in clinical outcomes, but it is neither necessary for patients with BSS tamponade to maintain a prone position nor have physically and psychological burden compared to who with gas, which makes surgery more efficient and safe.