部分玻璃体切除术治疗特发性黄斑前膜的长期疗效观察

Long-term effect of partial vitrectomy on idiopathic epiretinal membrane

目的观察部分玻璃体切除术治疗特发性黄斑前膜的长期临床疗效,并与常规手术方法比较。设计回顾性比较性病例系列。研究对象在南京鼓楼医院眼科手术的特发性黄斑前膜患者68例(68眼)。方法根据手术方法不同分为保留前部玻璃体的部分玻璃体切除术联合黄斑前膜及内界膜剥除者34例(34眼)为部分切除组(2019年9月至2022年8月),常规玻璃体切除术联合黄斑前膜及内界膜剥除者34例(34眼)为常规切除组(2017年9月至2019年8月)作为对照。术后部分切除组随访16.0(12.0,23.8)个月,常规切除组随访15.5(13.0,20.5)个月。比较两组手术时间、术前和术后BCVA、眼压及中央视网膜厚度(CRT),并观察术中和术后并发症的发生情况。主要指标手术时间、BCVA、眼压、CRT及术中、术后并发症。结果部分切除组术后末次随访LogMAR BCVA为0.3(0.2,0.4),较术前的0.8(0.68,1.00)明显提高(Z=-5.121,P=0.001)。末次随访CRT为(374.35±128.69)μm,较术前(513.79±148.49)μm明显降低(t=7.221,P=0.001)。术后各时间随访眼压较术前均无明显差异(P均>0.05)。术中有3眼(8.82%)视网膜轻度出血,术后18个月有1眼(2.94%)黄斑前膜复发。部分切除组平均手术时间(36.12±2.49)分钟,比常规切除组的(42.08±2.36)分钟明显缩短(t=-10.124,P=0.001)。术后1天常规切除组眼压(12.21±3.12)mmHg,低于部分切除组的(14.79±2.17)mmHg(t=3.969,P=0.001)。两组术前及术后BCVA、CRT比较,差异均无统计学意义(P均>0.05)。常规切除组术中有2眼(5.88%)视网膜轻度出血,1眼(2.94%)发生医源性视网膜裂孔。术后14个月有1眼(2.94%)黄斑前膜复发,1眼(2.94%)上血管弓下视网膜局部萎缩。结论部分玻璃体切除术治疗特发性黄斑前膜效果与常规手术方法相同,但手术时间缩短,术后眼压波动小,并发症较少,是治疗特发性黄斑前膜安全有效的方法。

Objective To observe the long-term clinical effect of partial vitrectomy on idiopathic epiretinal membrane(IERM),and compared with conventional vitrectomy.Design Retrospective comparative case series.Participants 68 Cases(68 eyes)of IERM surgery at Nanjing Drum Tower Hospital.Methods According to different surgical methods,34 cases(34 eyes)of partial vitrectomy with preservation of the anterior vitreous body combined with removal of the IERM and inner limiting membrane were selected as the partial resection group(from September 2019 to August 2022),while 34 cases(34 eyes)of conventional vitrectomy combined with removal of the IERM and inner limiting membrane were selected as the conventional resection group(from September 2017 to August 2019).The median follow-up time was 16.0(12.0,23.8)months in the partial resection group and 15.5(13.0,20.5)months in the conventional resection group,compare the operation time,the best corrected visual acuity(BCVA),intraocular pressure(IOP),and central retinal thickness(CRT)between the two groups before and after operation,and observe the occurrence of intraoperative and postoperative complications.Main Outcome Measures Operation time,BCVA,IOP,CRT and the occurrence of intraoperative and postoperative complications.Results In the partial resection group,LogMAR BCVA at the last follow-up after surgery was 0.3(0.2,0.4),which was significantly higher than that before surgery 0.8(0.68,1.00)(Z=-5.121,P=0.001).The CRT at the last follow-up was(374.35±128.69)μm,which was significantly lower than that before surgery(513.79±148.49)μm(t=7.221,P=0.001).There was no significant difference in IOP between postoperative follow-up at all time and preoperative(all P>0.05).3 eyes(8.82%)had mild retinal hemorrhage.The epiretinal membrane recurred in 1 eye(2.94%)18 months after surgery.The mean operation time in the partial resection group(36.12±2.49)minutes,it was significantly shorter than that in the conventional resection group(42.08±2.36)minutes(t=-10.124,P=0.001).The IOP(12.21±3.12)mmHg in the conventional resection group was lower than that in the partial resection group(14.79±2.17)mmHg one day after surgery(t=3.969,P=0.001).There was no significant difference in BCVA and CRT between the two groups before and after operation(all P>0.05).In the conventional resection group,mild retinal hemorrhage occurred in 2 eyes(5.88%)and iatrogenic retinal hole occurred in 1 eye(2.94%).Fourteen months after surgery,the epiretinal membrane recurred in 1 eye(2.94%),and the retinal atrophy under the upper vascular arch in 1 eye(2.94%).Conclusion Partial vitrectomy is a safe and effective method for IERM,with the same effect as conventional vitrectomy,but shorter surgical time,less postoperative intraocular pressure fluctuations,and fewer complications.