25G微创玻璃体切除联合黄斑前膜剥除术治疗特发性黄斑前膜视力恢复及影响因素研究

Visual acuity recovery in patients with idiopathic macular epiretinal membrane undergoing 25G minimally invasive vitrectomy combined with macular epiretinal membrane dissection and its influencing factors

目的探讨特发性黄斑前膜患者行25G微创玻璃体切除联合黄斑前膜剥除术后视力恢复的影响因素。方法回顾性分析2015年1月-2018年6月解放军总医院第一医学中心眼科确诊为特发性黄斑前膜并接受手术治疗的患者17例(17眼),其中男性3例,女性14例,年龄45~73岁。17眼术式均为25G微创玻璃体切除联合黄斑前膜剥除术,其中3例剥除内界膜。比较手术前后3个月最佳矫正视力、黄斑中心凹厚度等临床数据。视力提升的相关因素分析采用Pearson及Spearman相关分析法。结果17眼术前平均最佳矫正视力(0.57±0.37)logMAR,术后3个月平均最佳矫正视力(0.34±0.29)logMAR,术后最佳矫正视力较术前有显著提升(P=0.009);术前平均黄斑中心凹厚度(412.56±132.02)μm,术后3个月平均黄斑中心凹厚度(266.29±80.84)μm,显著变薄(P<0.001)。相关分析结果显示:患者术后视力提升程度与术前最佳矫正视力(logMAR)显著负相关(r=-0.61,P=0.01);术后3个月最佳矫正视力(logMAR)与术前最佳矫正视力(logMAR)呈正相关(r=0.53,P=0.03),与病程呈正相关(r=0.51,P=0.004);两者与年龄、术前黄斑中心凹厚度无显著相关性。结论玻璃体切除联合黄斑前膜剥除术对特发性黄斑前膜患者的视力改善有显著的效果。患者术后最佳矫正视力的提升幅度与术前最佳矫正视力呈负相关,与术前黄斑中心凹厚度、年龄、病程无关。

Objective To investigate the effect of 25G minimally invasive vitrectomy combined with macular epiretinal membrane dissection on idiopathic macular epiretinal membrane and its influencing factors.Methods A retrospective analysis was performed in 17 patients(17 eyes)with idiopathic macular epiretinal membrane diagnosed in our department from January 2015 to June 2018.All the 17 eyes were treated with 25G minimally invasive vitrectomy combined with macular epiretinal membrane dissection.In addition,3 cases underwent removal of inner limiting membranes.Clinical data including age,disease course,best corrected visual acuity,preoperative macular fovea thickness,best corrected visual acuity,and macular fovea thickness at 3 months after operation were collected.Results Compared to pre-operation,the best corrected visual acuity[(0.57±0.37)logMAR vs(0.34±0.29)logMAR,P=0.009],and the thickness of macular fovea[(412.56±132.02)μm vs(266.29±80.84)μm,P<0.001]decreased significantly at 3 months after operation.The results of correlation analysis showed that the degree of postoperative visual acuity improvement was negatively correlated with preoperative best corrected visual acuity(logMAR)(r=-0.61,P=0.01);The best corrected visual acuity(logMAR)at 3 months after operation was positively correlated with preoperative best corrected visual acuity(logMAR)(r=0.53,P=0.03),and it was also positively correlated with the course of disease(r=0.51,P=0.04).Conclusion 25G vitrectomy combined with anterior macular membrane exudation has significant effect on visual acuity improvement in patients with idiopathic macular epiretinal membrane.The improvement of postoperative best corrected visual acuity is negatively correlated with preoperative best corrected visual acuity,but not with the thickness of macular fovea,age and disease course before operation.