特发性黄斑前膜玻璃体切割手术后视力与黄斑结构的变化

Changes of Vision and Macular Structure after Idiopathic Macular Epiretinal Membrane Vitrectomy

目的:探讨特发性黄斑前膜(idiopathic macular epiretinal membrane,IMEM)玻璃体切割手术后视力与黄斑结构的变化。方法:回顾性分析2014年5月-2016年5月于本院行玻璃体切割手术治疗的IMEM患者40例(40只眼)的临床资料,根据椭圆体区(ellipsoid zone,EZ)的完整性将病例分为完整组(n=26)和不完整组(n=14)。随访12个月,观察EZ结构修复、黄斑中心凹厚度(central fovea thickness,CFT)及最佳矫正视力(best corrected visual acuity,BCVA)情况。分析CFT与BCVA的相关性,比较两组手术前后CFT及BCVA。结果:术后12个月,不完整组中10例EZ结构得到修复,4例EZ结构仍不完整。术后12个月,40例患者术后CFT为(306.30±136.82)μm明显低于术前(471.93±149.01)μm(P<0.05);40例患者中37例(92.5%)术后BCVA提高,术后最小分辨角对数视力(logMAR)为(0.44±0.17)优于术前(0.85±0.36),差异有统计学意义(P<0.05),BCVA与CFT无相关性(r=0.594,P=0.445)。术后12个月,两组的CFT比较,差异无统计学意义(P>0.05),而完整组的logMAR(0.39±0.14)优于不完整组的(0.53±0.18),差异有统计学意义(P<0.05)。结论:IMEM玻璃体切割术后CFT降低,视力得到改善,EZ完整性影响视力恢复。

Objective:To investigate the visual acuity and macular structure changes after idiopathic macular epiretinal membrane (IMEM) vitrectomy.Method:The clinical data of 40 IMEM patients (40 eyes) underwent vitrectomy in our hospital from May 2014 to May 2016 were retrospectively analyzed.According to the completeness of the ellipsoid zone (EZ),they were divided into complete group (n=26) and incomplete group (n=14).Follow-up of 12 months,EZ structure repair,central fovea thickness (CFT) and best corrected visual acuity (BCVA) were observed.The correlation between CFT and BCVA was analyzed,and CFT and BCVA before and after surgery were compared between the two groups.Result:After surgery 12 months,EZ structures of 10 cases in the incomplete group were repaired,while 4 cases EZ structures were still incomplete.12 months after surgery,the CFT of 40 patients was (306.30±136.82) μm significantly lower than (471.93±149.01) μm before the surgery,the difference was statistically significant (P<0.05).Among the 40 patients,37 cases (92.5%) had improved postoperative BCVA.12 months after surgery,minimum resolution logarithmic visual acuity (logMAR) of 40 patients was (0.44±0.17) better than (0.85±0.36) before surgery,the difference was statistically significant (P<0.05).BCVA was not correlated with CFT (r=0.594,P=0.445).12 months after surgery,there was no significant difference in CFT between the two groups (P>0.05),while logMAR (0.39±0.14) in the complete group was better than (0.53±0.18) in the incomplete group,the difference was statistically significant (P<0.05).Conclusion:The CFT is reduced and the visual acuity is improved in IMEM patients after vitrectomy,and the integrity of the EZ affects visual acuity recovery.