特发性黄斑前膜术后黄斑区形态结构及视功能的研究

Structure and function of the visual area forms of idiopathic macular epiretinal membrane surgery

目的观察特发性黄斑前膜（idiopathic epiretinal membrane，IERM）手术治疗后黄斑结构和视功能的变化，评价黄斑结构与视功能预后的关系。方法回顾性研究。收集2013年1月至2014年12月于西南医院眼科就诊的38例（38只眼）行手术治疗的特发性黄斑前膜患者资料，术后随访1年。测量患者术前术后最佳矫正视力（BCVA）、黄斑中心凹厚度（CFT）、黄斑区视网膜平均厚度，分析BCVA与CFT、黄斑区视网膜平均厚度之间的相关性。根据椭圆体区（EZ）是否缺损将患者分为两组，测量EZ缺损长度，比较两组之间的BCVA、CFT和黄斑区视网膜平均厚度的差异。结果患者术后黄斑区水肿减轻，BCVA提高至（0.45±0.26）losMAR，CFT减少至（334.5±69.5）μm。术前BCVA与术前黄斑区平均厚度相关（r=0.433，P=0.007）。术后BCVA与术后CFT相关（r=0.363，P=0.025）。术后黄斑中心凹厚度、黄斑区平均厚度减少值与术后视力提升值呈正相关（r=0.459，P=0.04；r=0.445，P=0.005）。椭圆体区连续组术后BCVA（0.35±0.25）优于椭圆体区不连续组（0.59±0.23，P=0.005）。结论术后CFT测定可用于评价术后视力恢复情况，患者应在椭圆体区出现缺损前进行手术治疗。

ObjectiveTo investigate the relationship between macularstructure and visual acuity in patients with idiopathic macular membrane surgery.MethodsA retrospective trail analyzed the data of 38 patients （38eyes）. The best corrected visual acuity（BCVA）, central foveal thickness（CFT）, average macular thickness were measured and the correlations between BCVA, CFT and average macular thickness were investigated using Pearson correlation analysis. Patients were divided into two groups based on whether the Ellipsoid Zone （EZ） was irregular. The BCVA, CFT and average macular thickness of each group were also analyzed.ResultsThe mean BCVA was improved to0.45 （SD 0.26） and the mean CFT regressed to 334.5um （SD 69.5）.The preoperative BCVA was significantly correlated with preoperative average macular thickness and the final BCVA was correlated with final CFT. A linear relationship between the reduction of central foveal thickness and improvement of visual acuity was confirmed. The final BCVA of EZ intact group was better than EZ disrupted group.ConclusionsCFT could be a useful prognostic factor after ERM surgery. It might be better to schedule surgery while the EZ remain intact.