特发性黄斑前膜行玻璃体切割术后黄斑视网膜厚度及视力的变化

Vitrectomy results of macular retinal thickness and vision acuity for idiopathic epiretinal membranes

目的:应用光学相干断层成像术(OCT)评价特发性黄斑前膜(ERM)行23G玻璃体切割术前和术后最佳矫正视力(BCVA)与黄斑视网膜厚度变化的关系。方法:本研究回顾性分析了78例经23G平坦部玻璃体切除术联合内界膜(ILM)及ERM剥离治疗的特发性ERM患者82眼,所有患者均行完整的眼科检查,包括BCVA、裂隙灯检查、眼压、OCT、眼底照相。随访时间为3个月,通过黄斑OCT特征评估BCVA与黄斑视网膜厚度之间的关系。结果:特发性ERM患者行玻璃体切割术前和术后3个月,BCVA由0.26±0.16提高至0.36±0.16(t=9.843,P<0.0001),黄斑中心凹视网膜平均厚度由(506.41±112.67)µm降低至(442.39±82.10)µm(t=5.526,P<0.0001),黄斑中心凹旁视网膜厚度由(453.66±79.36)µm降低至(409.95±61.63)µm(t=6.164,P<0.0001),术前黄斑中心凹周围视网膜厚度(365.93±50.84)µm和术后黄斑中心凹周围视网膜厚度(356.76±54.20)µm差异无统计学意义(P>0.05)。术前BCVA与术前黄斑中心凹厚度具有相关性(r=-0.4437,P=0.0041),术后BCVA与术后黄斑中心凹厚度也具有相关性(r=-0.3345,P=0.0349)。术前BCVA与术前黄斑中心凹旁厚度相关(r=-0.4160,P=0.0076),术后BCVA与术后黄斑中心凹旁厚度也具有相关性(r=-0.3758,P=0.0169)。结论:特发性ERM患者行玻璃体切割除联合ILM和视ERM剥离治疗可提高患者BCVA,改善黄斑中心凹形态,但术后多数患者黄斑中心凹形态并未恢复至正常。

Objective:To evaluate the relationship between best corrected vision acuity(BCVA)and the changes of macular retinal thickness before and after 23G vitrectomy to idiopathic epiretinal mem‑branes(ERM)by using optical coherence tomography(OCT).Methods:In this retrospective study,we examined 82 eyes of 78 patients who were confirmed as idiopathic ERM and accepted pars plana vitrectomy combined with internal limiting membrane(ILM)and ERM peeling.All patients under‑went complete ophthalmologic examination,including BCVA,slit‑lamp examination,intraocular pressure,OCT,and fundus photography.Patients were followed for three months.The relationships between the BCVA features and retinal thickness were evaluated by OCT.Results:The BCVA im‑proved from 0.26±0.16 to 0.36±0.16(t=9.843,P<0.0001),the mean foveomacular retinal thickness decreased from(506.41±112.67)µm to(442.39±82.10)µm(t=5.526,P<0.0001)af‑ter vitrectomy for idiopathic ERM patients.The parafovea macular retinal thickness decreased from(453.66±79.36)µm to(409.95±61.63)µm(t=6.164,P<0.0001)postoperatively.No statistical‑ly significant difference was found in perifovea thickness after operation as(365.93±50.84)µm ver‑sus(356.76±54.20)µm,P>0.05.Visual acuity was correlated with fovea thickness preoperatively(r=-0.4437,P=0.0041)and postoperatively(r=-0.3345,P=0.0349),and it was also corre‑lated with parafovea thickness preoperatively(r=-0.4160,P=0.0076)and postoperatively(r=-0.3758,P=0.0169).Conclusion:Vitrectomy combined with ILM and ERM peeling can en‑hance the vision acuity and improve macula morphology in the treatment of idiopathic ERM,while most of patients did not recover foveal depression after surgery.