25G玻璃体切割联合臼内障超声乳化治疗特发牲黄斑前膜

25G vitrectomy combined with phacoemulsification for idiopathic macular epiretinal membrane

目的探讨25G玻璃体切割联合白内障超声乳化治疗特发性黄斑前膜的疗效。方法对2011年7月至2013年7月，在南昌大学第二附属医院眼科确诊为特发性黄斑前膜患者60例（60只眼），按手术方式不同分为两组，联合手术组及分期手术组。分期手术组30例30只眼，先行玻璃体手术，术后根据晶状体混浊程度再行白内障超声乳化及人工晶状体植入术。联合手术组30例30只眼，行白内障超声乳化联合25G玻璃体切割，并同期植入人工晶状体。术后对分期手术组白内障发展情况，两组术后最佳矫正视力、黄斑中心厚度及相关并发症等资料进行观察，随访时间为6个月至1年，平均8个月。结果（1）在分期手术组中，玻璃体切割术后晶体混浊加重者27只眼（占90％），其中因白内障明显影响视力行Ⅱ期白内障超声乳化术者21只眼（占70％）；（2）联合手术组术后最佳矫正视力提高i〉2行者24只眼（80％）与分期手术组术后最佳矫正视力提高≥2行者16只眼（53．3％），差异有统计学意义（r=4．92，P〈0．05）。（3）联合手术组及分期手术组术后黄斑中心凹厚度分别为185—511（287±65）μm，182～509（279±66）μm，较术前均明显减轻，但术后两组黄斑中心凹厚度之间比较差异无统计学意义（t=0．473，P〉0．05）。（4）两组手术相关并发症情况：两组患者均未出现玻璃体积血、视网膜脱离等并发症，而且两组植入的人工晶状体无并发症。结论25G玻璃体切割术联合超声乳化白内障吸出术治疗特发性黄斑前膜不仅可以改善视力，而且可以有效地避免二次手术，是安全可行的治疗方法。

Objective To explore the therapeutic efficacy of 25G vitrectomy combined with phacoemulsification for idiopathic macular epiretinal membrane. Methods From July 2011 to July 2013, 60 patients （60eyes） diagnosed as idiopathic macular epiretinal membrane was divided into two groups according to surgical methods, staging and joint operation group; 30 patients （30 eyes） of staging operation group underwent vitrectomy first, then underwent phacoemulsification according to the degree of the opacity of the lens. The other 30 patients （30 eyes） of joint operation group un- derwent 25G vitrectomy combined with phacoemulsification, implanted lenses concurrently. The cata- ract development in staging operation group, the therapeutic efficacy and complication between tow groups was observed postoperatively. Follow up for 6 months-12months, meanly 8 months. Results In staging groug, 27 eyes （90%） developed cataract after vitrectomy, 21 eyes （50%） underwent phaco- emulsification in stage II because of mature cataract. The ratio of best corrected visual acuity improv- ing ≥2 lines in joint group （80%） was higher than staging group （53.3%） postoperatively （Z2=4.92,P 〈0.05）. There was significant difference between tow groups. The central macular thickness was 185±511 （287±65）1am in joint operation group, 182-509 （279±66） μm in staging group postoperative- ly. There was no significant difference between two groups. No retina detachment and vitreous hem- orrahge occurred in two groups, no complication occurred in phackic lenses in two groups postopera- tively. Conclusions 25G vitrectomy with phaeoemulsification not only improve visual acuity, but al- so avoid secondary surgery for idiopathic macular epiretinal membrane. It is safe and possible ~reat- ment.