不同手术方法治疗继发性黄斑前膜的效果观察

The efficacy of different surgical methods for secondary macular epiretinal membrane

目的观察不同手术方法治疗继发性黄斑前膜的效果。方法回顾性分析继发性黄斑前膜手术52例（52眼）的临床资料。A组（26眼）行经睫状体平坦部的三切口玻璃体切除＋黄斑前膜剥除＋玻璃体内注药（雷珠单抗0．5mg／0．05ml）术，B组（26眼）行经睫状体平坦部的三切口玻璃体切除＋黄斑前膜剥除＋气液交换＋C3F8（20％）注入术，对手术前后最佳矫正视力（BCVA）、黄斑形态及手术并发症等进行了临床观察。结果随访4～14个月。随访期末A组BCVA提高20眼，视力不变5眼，下降1眼，术后BCVA与术前相比，差异有统计学意义（t=4．125，P=0．00035）。随访期末B组BCVA提高18眼，视力不变6眼，下降2眼。术后BCVA与术前相比，差异有统计学意义（t：3．817，P=0．00052）。两组相比手术后视力改善程度差异无统计学意义（z=0．661，P=0．24），两组手术前后黄斑中心神经上皮层厚度（CMT）差异均有统计学意义。但A组术后CMT改善较快。并发症：A组术中视网膜少许出血6眼，手术后发生玻璃体积血1眼；周边牵引性小裂孔3眼，激光治疗后恢复1眼，再次手术2眼。B组术中少许视网膜出血8眼，手术后发生玻璃体积血4眼；周边牵引性小裂孔3眼，均采用激光治疗。随访期内B组复发前膜2眼，均发生于玻璃体积血吸收以后。结论两种手术方式均可有效治疗继发性黄斑前膜。A组手术方式可较快改善CMT，较少发生术后玻璃体积血，减少黄斑前膜复发。B组手术方式对于术后发生的牵引性裂孔可以更有效治疗。

Objective To observe the efficacy of different surgical methods for secondary macular epiretinal membrane （SEM）. Methods Clinical data of 52 eyes of 52 cases with SEM who underwent surgical treatment were retrospectively analysed. Patients in group A （26 eyes） underwent pars plana vitrectomy ＋ membrane peeling ＋ intravitreal injection of luncentis（0.5 mg/0.05 ml） . Patients in group B （26 eyes） underwent pars plana vitrectomy ＋ membrane peeling ＋ fluid-air exchange ＋ C3Fs （20%） gas tamponade. Postoperative changes in best corrected visual acuity （BCVA）, macular morphology and the complications were observed. Results The follow-up time was 4-14 months. In group A, the BCVA improved in 20 eyes after the operation, it was unchanged in 5 eyes and decreased in 1 eye, the post- operative BCVA improved comparing with the preoperative one （t = 4. 125,P = 0. 00035）. In group B, the BCVA improved in 18 eyes after the operation, unchanged in 6 eyes and decreased in 2 eyes, the post- operative BCVA improved comparing with the preoperative one（ t = 3. 817, P = 0. 00052）. The difference in vision improvement between the two groups was not statistically significant （ z = 0. 661, P = 0.24 ）. The thickness of neuroepithelium in the central macular area （CMT） was statistically improved after the surgery in both the two groups. But the improvement of CMT was faster in group A. In group A, small amount of retinal hemorrhage happened in 6 eyes during the surgery, and vitreous hemorrhage occurred in 1 eye after the surgery. Prepheral retinal hole occurred in 3 eyes , in which one eye was cured by laser treatment, and the other two eyes needed secondary surgery. In group B, small amount of retinal hemorrhage happened in 8 eyes during the surgery, and vitreous hemorrhage occurred in 4 eyes after the surgery. Prepheral retinal hole occurred in 3 eyes, and were cured in all 3 eyes by laser treatment. Epiretinal membrane（EM） was seen in 2 eyes during follow-up time in group B, which ocurred after vitreous hemorrhage absorption. Conclusion Both the two kinds of operation can cure SEM effectively. The surgical method of group A can improve the CMT faster, reduce the risk of vitreous hemorrhage and epiretinal membrane recurrence. The surgical method of group B can cure the tractional retinal hole effectively.