玻璃体手术治疗特发性黄斑前膜的临床观察

Vitrectomy in treating idiopathic macular epiretinal membrane

目的探讨玻璃体切除联合膜剥离术及玻璃体腔注射曲安奈德（TA）治疗特发性黄斑前膜（IMEM）的手术疗效。方法选取进行玻璃体切割手术剥离特发性黄斑前膜（IMEM）患者27例27眼。所有患者均行标准三切口玻璃体切割术，采用自制钩针将前膜组织钩离视网膜表面后用眼内镊撕除前膜，手术结束时玻璃体腔内注入4mgTA。患者治疗前后均进行视力、眼底彩色照相、光相干断层扫描（OCT）检查。视力采用5分纪录，眼底彩色照相、OCT检查按常规方法进行。手术前患眼平均视力为（4．15±0．32），黄斑平均厚度为（498±132）μm。手术后随访3—20个月，平均随访时间（10±7）个月。结果手术后14眼视力提高，约占51．85％；9眼视力不变，约占33．33％；4眼视力下降，约占14．81％。末次随访平均视力提高到（4．52±0．29），与手术前患眼平均视力（4．15±O．32）比较，差异有统计学意义（t=3．28，P〈0．05）。13眼视物变形消失，10眼视物变形减轻，4眼视物变形加重。黄斑平均厚度降低到（296±114）μm，与手术前黄斑平均厚度（498±132）μm比较，差异有统计学意义（t=6．468，P〈0．01）。黄斑前膜均经手术成功剥除，随访期内未见黄斑前膜复发和眼内炎发生。并发症：6眼手术中黄斑区视网膜浅层点片状出血，约占22．22％；7眼手术后白内障加重，约占25．92％；4眼手术后高眼压，约占14．81％。结论玻璃体切割联合膜剥离和玻璃体腔注射TA能够提高视功能，是治疗特发性黄斑前膜确切有效的方法。

Objective To evaluate the effect of pars plana vitrectomy with inner limiting membrane （ILM） peeling and intravitreal triamcinolone acetonide （TA） injection in treatment of idiopathic macular epiretinal membrane （IMEM）. Methods Patients were recruited from ophthalmic center from January 2011 to March 2013. Totally, 27 eyes （27 con- secutive patients ） with IMEM who underwent standard three-port pars plana vitrectomy and epiretinal membrane peeling were observed. Each patient received 4 mg TA intravitreal injection at the end of the surgery. All the patients were ex- amined by visual acuity （VA）, fundus color photography, and optical coherence tomography （OCT） before and after the treatment. VA was adopted 5 points record; fundus color photography and OCT were taken as usual way. The mean of VA was（4.15 ±0.32） and the mean of macular thickness was（498 ± 132） μm before the treatment. All the patients were followed-up 3 to 20 months （ mean （ 10 ± 7 ） months ）. Results VA improvement was achieved in 14 eyes （51.85%）, meanwhile, 9 eyes（33.33% ） were stable and 4 eyes （ 14.81% ） were worse. The mean VA increased from （4.15 ± 0.32 ） to （4.52 ± 0.29 ） post-operatively, the difference was statistically significant （ t = 3.28, P 〈 0.05 ）. Simultaneously, metamorphopsia of 13 eyes disappeared, of 10 eyes alleviated and of 4 eyes aggravated. Mean macular thickness decreased from（498 ± 132） μm to（296 ± 114 ） μm post-operatively, the difference was statistically significant （ t =6. 468, P 〈0.01 ）. The OCT and fundus photography showed that all the MEM had disappeared. No MEM recur- rence and endoephthalmitis were observed during the follow-up periods. 6 eyes （22.22%）had retinal hemorrhage intra- operatively. 7 eyes （25.92%） had cataract improvement and 4 eyes （14.81% ） had secondary higher intraocular pres- sure post-operatively. Conclusion Pars plana vitrectomy with inner limiting membrane （ILM） peeling and intravitreal TA injection is successful in treating IMEM.