内界膜剥除术治疗伴黄斑脱离的增生性糖尿病视网膜病变的效果

Efficacy of vitrectomy combined with internal limiting membrane peeling for proliferative diabetic retinopathy with macular detachment

目的评估玻璃体切除联合内界膜剥除对伴黄斑脱离的增生性糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)的疗效。设计回顾性比较性病例系列。研究对象行玻璃体切除手术治疗,且术前或术中经相干光断层扫描(OCT)检查确诊伴有黄斑脱离的PDR患者39例(45眼)。方法21例(24眼)术中联合内界膜剥除为联合组,18例(21眼)仅接受玻璃体切除手术治疗者作为对照组。所有手术均由同一医师主刀完成。术后1周、1、3、6个月随访时复查OCT。主要指标黄斑中心厚度(CMT)、黄斑区视网膜下液高度(SFH)和最佳矫正视力(BCVA)。结果联合组和对照组BCVA(LogMAR)在术后1周、1、3、6个月均较术前有提高(F=17.63、16.94;P均<0.001)。术后3个月时,联合组BCVA(0.71±0.65)优于对照组(1.02±0.53)(t=2.73;P=0.009)。两组患者的SFH在术后1周、1、3、6个月时均较术前有显著性降低(F=17.63,16.94;P均<0.001)。术后6个月时,联合组CMT(218.56±49.51μm)低于对照组(289.32±65.34μm)(t=2.84,P=0.006)。两组患者SFH在术后1周、1、3、6个月时均较术前有显著性降低(F=17.63、16.94,P均<0.05);术后3个月时,联合组SFH(15.07±12.01μm)低于对照组(42.67±30.21μm)(t=2.24,P=0.003)。结论采用玻璃体切除联合内界膜剥除术治疗伴黄斑脱离的PDR有助于术后早期黄斑区脱离视网膜复位及视网膜下液吸收,能安全有效地提高患者视力及降低黄斑中心区厚度。(眼科,2021,30:222-226)

Objective To observe the clinical efficacy of vitrectomy combined with inner limiting membrane(ILM)peeling in the treatment of proliferative diabetic retinopathy(PDR)with macular detachment.Design Retrospective comparative case series.Participants 39 cases(45 eyes)diagnosed as PDR with macular detachment in Tongren Eye Center.Methods Vitrectomy and ILM peeling were performed in the ILM-removed group,in which there were 21 patients(24 eyes);vitrectomy only were performed in the control group,in which there were 21 eyes of 18 patients.All the surgeries were performed by the same surgeon.Best corrected visual acuity(BCVA,LogMAR),complications,and the center macular thickness(CMT)and subretinal fluid height(SFH)were examined before the surgery and during follow-up at one week,one month,three month and six month postoperative.Main Outcome Measures BCVA,SFH,and CME.Results The BCVA of the combined group and the control group were significantly higher at 1 week,1 month,3 months and 6 months after operation than before operation(F=17.63,16.94;P<0.001).The BCVA in the ILM-removed group(0.71±0.65)was higher than the control group(1.02±0.53)at three month after operation(t=2.73,P=0.009).The SFH of the two groups at 1 week,1 month,3 months and 6 months after operation was significantly lower than that before operation(F=17.63,16.94;P<0.001).The CMT in the ILM-removed group(218.56±49.51μm)was thinner than in the control group(289.32±65.34μm)at six month after operation(t=2.84,P=0.006).The SFH of the two groups decreased significantly at 1 week,1 month,3 months and 6 months after operation(F=17.63,16.94,P<0.05).The SFH in the ILM-removed group(15.07±12.01μm)was lower than in the control group(42.67±30.21μm)at three month after operation(t=2.24,P=0.003).Conclusion In the treatment of PDR with macular detachment,vitrectomy combined with ILM peeling can effectively and safely improve visual acuity,reduce the thickness of macular center area and promote SRF absorption.(Ophthalmol CHN,2021,30:222-226)