内界膜剥除术在复杂视网膜脱离手术中的应用

Clinical application of internal limiting membrane peeling for complex retinal detachment

目的 观察玻璃体手术中应用内界膜剥除术治疗视网膜脱离合并增生性玻璃体视网膜病变的效果.方法 回顾性分析视网膜脱离合并严重增生性玻璃体视网膜病变行玻璃体视网膜手术40例（40只眼）的临床资料.以术中是否联合内界膜剥除分为两组：剥膜组19例,未剥膜者为对照组21例.术毕均填充硅油.于玻璃体手术后3个月及硅油取出术后3个月应用OCT观察两组黄斑区视网膜水肿及视网膜前膜情况,并记录最终随访视力.结果 随访6 ～ 12个月.玻璃体切除术后3个月,OCT见黄斑视网膜前膜形成者剥膜组0眼,对照组6眼（28.57％）（Fisher确切概率法,P=0.021）;出现黄斑水肿者,剥膜组1眼（5.26％）,对照组5眼（23.81％） （x2=1.433,P =0.231）.硅油填充下视网膜复位率剥膜组为89.47％,对照组为90.48％ （x2 =0.011,P=0.916）.硅油取出术后3个月,两组病例均未再发生新的视网膜前膜;出现黄斑水肿者,剥膜组为5.3％,对照组为14.30％（x2=0.178,P=0.673）.最终随访视网膜均复位.两组患者术后视力均较术前视力明显提高,且两组间差异无统计学意义.结论 在玻璃体切除术中应用内界膜剥除术治疗视网膜脱离合并增生性玻璃体视网膜病变,可以降低术后黄斑前膜的发生率,对术后视力、黄斑水肿情况及视网膜复位成功率无明显影响.

Objective To investigate the clinical efficacy of vitrectomy combined with internal limiting membrane （ILM） peeling for the treatment of complex retinal detachment （ RD ） with proliferative vitreoretinopathy （PVR）. Methods Data of 40 eyes of 40 patients with RD and PVR who underwent vitreetomy were retrospectively analyzed. All the cases were divided into two groups： silicone oil tamponade with ILM peeling in 19 eyes （ILM-peeling group）and without ILM peeling in 21 eyes （control group）. Silicone oil were extracted 3 to 6 months after vitrectomy. The macular edema （ME） and epiretinal membrane （ERM） were studied by using OCT scan at 3 months after vitrectomy and silicone oil removal respectively. Visual acuity （VA） was recorded at final follow-up. Results The follow-up time was 6 to 12 months. Three months after vitrectomy, ERM was observed in no eyes of ILM-peeling group and in 6 eyes （28.57%）of control group who underwent ERM peeling later and ILM peeling during silicone oil removal （Fisher exact test, P = 0. 021 ）. ME was found in 1 eye （5.3%） of ILM-peeling group and in 5 eyes （23.8%） of control group （χ2 = 1. 433 ,P = 0. 231 ）. The percentages of retinal reattachment with silicone oil tamponade were 89.47% in ILM-peeling group and 90.48% in control group （χ2 = 0. 011 ,P = 0. 916）. Three months after silicone oil removal, no ERM were seen in both groups, but the incidences of ME were 5.3% in ILM-peeling group and 14.3% in control grouP（χ2 =0. 178,P =0. 673）. The retinas of all eyes were reattached at final follow-up. The postoperative VA of two groups were improved significantly compared with preoperative VA（ P 〈 0.001 ）, and there were no significant differences of preoperative VA and final VA between two groups （ P 〉 0.05 ）. Conclusion Vitrectomy combined with ILM peeling for complex retinal detachment may decrease epimacular membrane formation and has no effect on visual acuity, macular edema and success rate of retinal reattachment.