改良黄斑前膜手术早期疗效

Short Term Therapeutic Effect of Modified Epiretinal Membrane Surgery

目的:介绍一种改良的特发性黄斑前膜(IERM)手术方法并与传统手术方法进行临床对比观察。方法:前瞻性临床研究。选择2018年2-8月首次就诊于潍坊眼科医院的IERM患者30例(30眼),采用简单随机抽样法分为传统组和改良组,传统组(15眼)给予玻璃体切割+传统黄斑前膜撕除术,改良组(15眼)给予玻璃体切割+改良黄斑前膜钝性剥除术。测量术前,术后1周、1个月及3个月的最佳矫正视力、黄斑区神经节细胞内丛状层厚度(GCIPL)、视网膜黄斑中心凹厚度(CRT)、多焦视网膜电图(ERG)。定量资料采用t检验进行比较。结果:患者年龄为40~80岁。2组手术后3个月最佳矫正视力与手术前相比均有改善(传统组:t=4.176,P=0.001;改良组:t=6.187,P<0.001)。改良组手术后3个月视力优于传统组(t=2.219,P=0.035)。与手术前相比,2组CRT降低(传统组:t=5.666,P<0.001;改良组:t=13.905,P<0.001),术后3个月改良组CRT低于传统组,差异有统计学意义(t=2.144,P=0.041)。术前所有患眼黄斑区GCIPL厚度均有不同程度降低,2组间差异无统计学意义(t=0.451,P=0.366),与手术前相比,传统组术后黄斑区GCIPL无明显变化(t=-3.350,P=0.066),改良组黄斑区GCIPL厚度增加,差异有统计学意义(t=-14.148,P<0.001)。2组多焦ERG1环的P波峰值手术前差异无统计学意义(t=0.550,P=0.860),2组手术后3个月与手术前相比均有改善(传统组:t=-16.932,P<0.001;改良组:t=-29.701,P<0.001),且改良组优于传统组(t=-20.882,P<0.001)。结论:黄斑前膜钝性剥除术是一种实用、简便、安全的治疗方法。与传统黄斑前膜撕除术相比,在手术早期即可更快地恢复黄斑区形态结构,提高患者视力,改善黄斑功能。

Objective: To compare the early therapeutic effects of modified epiretinal membrane surgery to traditional epiretinal membrane surgery for idiopathic epiretinal membrane (IERM). Methods: From February to August 2018, 30 eyes of 30 IERM patients who had been treated in Weifang Eye Hospital were selected consecutively and received surgical treatment independently performed by the same physician in Weifang Eye Hospital. The patients were divided into a traditional group and modified group using a simple random method. All 15 eyes in the traditional group were treated with vitrectomy and traditional epiretinal membrane peeling, while all 15 eyes in the modified group were treated with vitrectomy and epiretinal membrane blunt peeling. All patients were reviewed at 1 week,1 month, and 3 months after surgery. The best corrected visual acuity (BCVA) before and after the operation, the central retina thickness (CRT)(μm) measured by Spectralis OCT, the ganglion cell inner plexiform layer (GCIPL)(μm) measured by ganglion cell analysis (GCA) with Cirrus HD-OCT, the changes in retinal morphology in the macular area, and the amplitude densities and latencies of the P1 waves from the multifocal electroretinogram (mERG). Data were analyzed using t test. Results: Postoperative BCVA increased in both groups compared with preoperative measurements and the differences were statistically significant (traditional group: t=4.176, P=0.001;modified group: t=6.187, P<0.001). The BCVA in the modified group was significantly better than that in the traditional group (t=2.219, P=0.035). Postoperative CRT decreased in both groups compared with preoperative CRT and the differences were statistically significant (traditional group: t=5.666, P<0.001;modified group: t=13.905, P<0.001). The CRT in the modified group was significantly lower than that in the traditional group (t=2.144, P=0. 041). GCIPL thickness: There was no significant difference between the two groups before and after surgery, and no significant change before and after surgery (t=-3.350, P=0.066) in the traditional group, but there was an increase after surgery in the modified group (t=-14.148, P<0.001). The P-wave peak of the mERG 1 ring: No significant differences were found between the two groups before surgery (t=0.550, P=0.860). In the two group, there was an increase after surgery (traditional group: t=16.932, P<0.001;modified group: t=-29.701, P<0.001), and the results of the modified group was better than that of the traditional group (t=-20.882, P<0.001). Conclusions: Blunt peeling of the anterior epiretinal membrane is a practical, simple and safe treatment method. It can effectively restore the morphological structure of the macular area, improve the patient's vision and improve macular function.