非玻璃体切割手术治疗特发性黄斑前膜的疗效观察

Clinical effect of non-vitrectomy in the treatment of idiopathic macular epiretinal membranes

目的观察非玻璃体切割手术(NVS)治疗特发性黄斑前膜(IMEM)的疗效。方法随机对照临床研究。2017年12月至2018年12月于潍坊眼科医院检查确诊的IMEM患者60例60只眼纳入研究。所有患者均行BCVA、眼压、OCT检查。采用国际标准视力表行BCVA检查,统计时换算为logMAR视力。采用OCT仪测量黄斑中心凹厚度(CMT)。根据手术方式,将患者分为NVS组和对照组,每组均为30例30只眼。两组患者年龄(t=1.723)、logMAR BCVA(t=1.703)、CMT(t=-0.956)、眼压(t=-1.434)比较,差异均无统计学意义(P=0.090、0.094、0.343、0.157)。所有患眼均采用23G玻璃体切割系统进行手术。NVS组患眼NVS条件下剥除黄斑前膜;对照组患眼玻璃体切割条件下剥除黄斑前膜。手术后1周及1、3、6个月采用手术前相同设备和方法行相关检查。对比观察两组患眼有效手术时间以及手术后BCVA、CMT变化和手术后并发症发生情况。两组患眼手术后BCVA、CMT、眼压比较行重复测量的方差分析,视力改善程度行两独立样本的Wilcoxon秩和检验;手术后并发症发生率比较行χ2检验。结果手术后6个月,NVS组30只眼中,BCVA提高24只眼(80.0%),不变6只眼(20.0%);与手术前BCVA比较,差异有统计学意义(P<0.05)。对照组30只眼中,BCVA提高25只眼(83.4%),不变4只眼(13.3%),下降1只眼(3.3%);与手术前BCVA比较,差异有统计学意义(P<0.05)。两组间视力改善程度比较,差异无统计学意义(Z=-0.26,P=0.792)。手术后6个月,两组患眼平均logMAR BCVA与手术前比较,差异均有统计学意义(PNVS组=0.002、0.005,P对照组=0.004、<0.001)。NVS组、对照组患眼视力稳定时间分别发生于手术后1、3个月;CMT开始降低时间分别为手术后1周、1个月。NVS组、对照组有效手术时间分别为(4.50±1.41)、(15.50±2.33)min;两组有效手术时间比较,差异有统计学意义(t=-22.12,P<0.05)。NVS组手术后未见明显并发症;对照组手术中出现黄斑裂孔1只眼,手术后出现低眼压3只眼。结论NVS和玻璃体切割治疗IMEM具有相似疗效。NVS有效手术时间短,手术后恢复更快且未出现明显并发症。

Objective To observe the effect of non-vitrectomy in the treatment of idiopathic macular epiretinal membranes(IMEM).Methods This study is a randomized controlled trial.From December 2017 to December 2018,60 IMEM patients(60 eyes)diagnosed in Weifang Eye Hospital were included in the study.BCVA,intraocular pressure(IOP)and OCT were performed in all patients.The BCVA examination was performed using the international standard visual acuity chart,which was converted to logMAR.The CMT was measured by OCT.According to the surgical methods,the patients were divided into non-vitrectomy group and control group,30 patients(30 eyes)in each group.The age(t=1.723),logMAR BCVA(t=1.703),CMT(t=-0.956),IOP(t=-1.434)were not significantly different between the two groups(P=0.090,0.094,0.343,0.157).23G vitreous cutting system was used in all eyes.The macular epiretinal membranes was removed by non-vitrectomy in the non-vitrectomy group and by vitrectomy in the control group.The relevant examination with the same equipment and methods before the operation at 1 week and 1,3,6 months after operation.The time of surgery,the changes of BCVA,CMT and postoperative complications in the two groups were observed comparatively.Variance analysis of repeated measurements was performed for the comparison of BCVA,CMT and IOP after surgery in the two groups.Wilcoxon rank sum test of two independent samples was performed for the degree of vision improvement.The incidence of postoperative complications was compared byχ2 test.Results At 6 months after operation,BCVA increased in 24 eyes(80%)and unchanged in 6 eyes(20%)in the non-vitrectomy group.Compared with preoperative BCVA,the difference was statistically significant(P<0.05).BCVA increased in 25 eyes(83.4%),unchanged in 4 eyes(13.3%)and decreased in 1 eye(3.3%)in the control group.Compared with preoperative BCVA,the difference was statistically significant(P<0.05).There was no significant difference between the two groups in BCVA improvement degree after operation(Z=-0.26,P>0.05).At 6 months after operation,the average logMAR BCVA was statistically significant compared with the preoperative in the non-vitrectomy group(P=0.002,0.005)and control group(P=0.004,<0.001).Visual stability occurred 1 month after operation in the non-vitrectomy group and 3 months after operation in the control group.The effective operative time of the non-vitrectomy group and control group was 4.50±1.41 and 15.50±2.33 min,respectively.The difference of effective operation time between the two groups was statistically significant(t=-22.12,P<0.05).After surgery,no significant complications were found in the non-vitrectomy group.In the control group,there were 3 eyes with low IOP and 1 eye with macular hole during operation.Conclusions Non-vitrectomy and vitrectomy have similar effects on IMEM.Non-vitrectomy has short effective operation time,faster recovery after surgery and no obvious complications.