Epiretinal membrane following pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM: To determine the rate and possible contributors for post-pars plana vitrectomy(PPV) epiretinal membrane(ERM) in patients treated for rhegmatogenous retinal detachment(RRD). METHODS: This prospective, nonrandomized study comprised 47 consecutive patients(47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6 mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD. RESULTS: ERM developed postoperatively in 23 eyes(48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity(median log MAR 1.9 vs 0.3, respectively;P=0.003) rate of macula-off(69.6% vs 37.5%, respectively, P=0.028), and rate of ≥5 cryo-applications(55.6% and 18.8%, respectively, P=0.039). ERM developed mainly between the 1st and 3rd months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81(P=0.031). CONCLUSION: ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.

Correlation between choroidal thickness and intraocular pressure after 23-gauge vitrectomy for idiopathic epiretinal membrane

AIM： To determine the relationship between the subfoveal choroidal thickness（CT） and intraocular pressure（IOP） following idiopathic epiretinal membrane（ERM） surgery.METHODS： Retrospective observational case series of patients who had undergone 23-gauge vitrectomy for an ERM. The measurements of CT and IOP were done at the baseline and 1 d, 1 wk, 1, 3, 6, and 12 mo after the surgery.RESULTS： Forty-four eyes of 43 patients with a mean age of 69.8±9.5 y were studied. The CT was 200.8±86.3 μm at the baseline, 210.1±83.5 μm at 1 d, 213.2±85.4 μm at 1 wk, 203.1±84.0 μm at 1 mo, 197.5±85.5 μm at 3 mo, 197.7±84.0 μm at 6 mo, and 191.2±86.8 μm at 12 mo after surgery. The CT on day 1 and week 1 after the surgery was significantly thicker than that at the baseline CT（P=0.0023 and P〈0.0001）. The CT at 12 mo after surgery was significantly thinner than the baseline（P=0.0062）. The IOP on day 1 and week 1 were significantly lower than the baseline（P〈0.0001 and P=0.0042）. The IOP at 1, 3, 6, and 12 mo after surgery were significantly higher than the baseline IOP（P=0.0087, P=0.0023, P〈0.00051, and P〈0.0001）. The rates of changes in the CT between baseline and day 1 and week 1 were significantly and negatively correlated with the rates of change in the IOP（P〈0.0001 and P=0.046）. In the group with the IOP change rate of-30% or less at 1 d postoperatively, the change rate of CT was-21.1% to 31.2%（9.8%±12.4%） and in the group of-29% or more, it was-8.9% to 28.0%（2.6%±8.9%）. The change rate of CT in the group with the IOP change rate of-30% or less was significantly higher than the group of-29% or more（P=0.016）.CONCLUSION： CT increases soon after the ERM surgery which is probably due to the transient hypotony, showing that IOP may be a significant confounding factor for CT.

The impact of macular surgery in different grades of epiretinal membrane

AIM：To assess the impact of macular surgery on the functional and anatomic outcomes of the patients in different grades of epiretinal membrane（ERM）.METHODS：Seventy-one eyes of 71 patients who underwent 23-gauge transconjunctival sutureless pars plana vitrectomy for primary isolated ERM were evaluated in this study.RESULTS：There were 38 females（53.5%） and 33 males（46.5%）.The average age of the patients was 68.1 y（range 42-89 y）.Mean follow up period was 14 mo（range 6-26 mo）.The cases were divided into two subgroups of cellophane maculopathy（CM） and macular pucker（MP）.An improvement was observed in the postoperative best-corrected visual acuity（BCVA）,as well as a decrement in central foveal thickness（CFT） in both groups（both of these being statistically significant;P=0.001）.In comparison between two groups,it was found that there was a significant improvement on BCVA and CFT in CM group than MP group（P=0.01）.Furthermore,the postoperative fundus findings regarding RPE alterations and macular edema were significantly higher in MP group when compared to the CM group（P=0.01）.CONCLUSION：ERM and internal limiting membrane peeling surgery can lead to a significant reduction of CFT and visual improvements in idiopathic ERM.A long-term ERM persistence will cause unrecoverable retinal damage and visual loss.

Surgical Management of Macular Epiretinal Membranes

Purpose: To evaluate the effects of surgical treatment on macular epiretinal membranes.Methods: Vitrectomy and membrane removal were undergone for idopathic or secondary macular epiretinal membrane.Results: Fourteen eyes of 15 patients (93%) had vision improvement after operation in which 8 eyes (57%) increased 3 or more Senellen lines. Only one case suffered from paracentral scotoma. No other complications were noted. Conclusion: Surgical management of macular epiretinal membrane is safe and effective with good visual outcome and few complications. Eye Science 1996; 12:140 -144.

Anatomic and functional results of idiopathic macular epiretinal membrane surgery

AIM: To assess the impact of macular surgery on the functional and anatomic outcomes in patients with grade 2 epiretinal membrane(ERM), and the effect of internal limiting membrane(ILM) peeling on visual acuity and to analyze the long-term effect of pars plana vitrectomy(PPV) on intraocular pressure(IOP).METHODS: Pseudophakic eyes(62 eyes) diagnosed as idiopathic grade 2 ERM with at least 6 mo postoperative follow-up were included in this retrospective study. The fellow eye was nonvitrectomized. Patients were divided into two groups: group 1(29 eyes) treated with ERM and ILM peeling and group 2(33 eyes) with only ERM peeling. Preoperative and postoperative best corrected visual acuity(BCVA), slit-lamp, and a dilated fundus examination was performed. IOP was measured with Goldman applanation tonometer before, day 1 and first week and each visit after surgery. The incidence of significant IOP elevation was compared between vitrectomized eyes and nonvitrectomized fellow eyes.RESULTS: Visual improvement was statistically significant and similar in both groups(P=0.008 in group 1, P=0.002 in group 2, P=0.09 inter-group). The amount of decrease in central macular thickness was statistically significant and similar in both groups(P=0.005 group 1, P=0.008 group 2, P=0.37 intergroup). At the final follow-up(14.1±9.6 mo) the incidence of significant IOP elevation was 4% in vitrectomized eyes(three eyes) and 3%(two eyes) in the nonvitrectomized fellow eyes(P=0.12). Four eyes(12.1%) had recurrent ERM after a mean follow-up of 8.6±1.1 mo in group 2, there was no recurrence in group 1(P=0.01).CONCLUSION: Recurrence of ERM may be decreased by ILM peeling during ERM surgery. However, it seems that ILM peeling do not affect the functional outcome and 23-gauge PPV alone do not have a significant effect on IOP.

Epiretinal membrane related vascular changes in diabetic eyes evaluated with optical coherence tomography angiography

AIM:To evaluate the retinochoroidal microvascular circulation and anatomical structure of diabetic and nondiabetic patients with epiretinal membrane(ERM)with the help of optical coherence tomography angiography(OCT-A)and compare them with healthy control subjects.METHODS:In this prospective,cross-sectional study,a total of 165 eyes were evaluated,including 50 eyes of patients with diabetic ERM,54 eyes of idiopathic ERM(iERM)patients,and 61 eyes of healthy controls.Macula and disc angiography was performed by OCT-A.Macular vessel density(VD)ratio was evaluated by dividing the VD of the foveal region by the VD of the parafoveal region.Statistical calculations were evaluated at the 95%confidence interval.RESULTS:Macula superficial VD values of ERM cases were lower than that in the control group,while foveal VD was higher in ERM cases.Macula deep VD values of ERM cases were lower in all quadrants,except the fovea.The width of the foveal avascular zone(FAZ)area was significantly lower in the ERM groups,and the FAZ width was lowest in iERM group.Macula superficial VD ratio was significantly higher in the ERM groups,but there was no significant difference between ERM groups.Macula deep VD ratio was significantly higher in the iERM group than in the control group.CONCLUSION:Diabetic and idiopathic ERMs differ in their mechanism of formation and clinical presentation,as well as their effect on retinal vascular structures.If the relationship of increase of retinal thickness with vascular integrity can be demonstrated with OCT-A,then,OCT-A can be used as a guide for ERM prognosis.

Increased risk of postsurgical macular edema in high stage idiopathic epiretinal membranes

Purpose:To assess the rate of occurrence and the risk factors of postsurgical macular edema(PSME)in eyes with idiopathic epiretinal membrane(iERM)or full-thickness macular hole(FTMH).Methods:Retrospective longitudinal analysis of all subjects scheduled for vitrectomy with or without combined cataract surgery over a 6-month period.Electronic medical charts and imaging data were analyzed preoperatively and at 1,3 and 6 months after surgery.Results:From 101 patients diagnosed with iERM or FTMH,71 patients were eligible for the study.Forty-nine eyes with iERM(69.0%)and 22 eyes with FTMH(31.0%)underwent vitrectomy either isolated(31.0%)or combined with cataract extraction(69.0%).The overall rate of PSME was 26.7%,without differences between the two groups(P=0.9479).Combined cataract extraction did not affect the overall occurrence of PSME rate in both groups(P=0.9255 in FTMH and P=0.8658 in iERM).If grouped by stage,eyes with stage 4 iERM though disclosed an increased rate of PSME(57.1%)compared to lower(1 to 3)stages(14.3%,P=0.0021),particularly when combined with cataract surgery(71.4%vs.15.4%in stages≤3,P=0.0021).The PSME odds ratio for a stage 4 iERM is 8(95%CI:1.933-33.1;P=0.0041)compared to stages 3 and below.Conclusions:PSME remains a clinically relevant and frequent event after surgery for iERM and FTMH.Patients with stage 4 iERM have an 8-fold higher likelihood of developing PSME in a 6-month postsurgical period compared to iERM in 1-3 stages,especially when combined with cataract extraction.

Post-operative visual outcomes based on morphological staging of idiopathic epiretinal membranes on OCT

AIM:To evaluate the recently described optical coherence tomography(OCT)based classification of epiretinal membrane(ERM)and its usefulness in predicting the functional outcome.METHODS:A retrospective observational review of OCT scans of patients with the diagnosis of idiopathic ERM was carried out from January 2016 to June 2021.All consecutive images diagnosed with any stage of idiopathic ERM and fulfilled the eligibility criteria were included in the analysis.ERM was identified on OCT scans as a thin hyperreflective layer over the inner layers of retina.OCT scans of patients with ERM who underwent vitrectomy,were independently staged as per the new classification by two independent retinal surgeons to form a consensus on stage.Best corrected visual acuity(BCVA)in logMAR scale and central subfield thickness(CST)on pre-and post-operative spectral domain OCT scans were the variables noted for all patients at the time of diagnosis and at 6 and 12 mo follow up visit after undergoing intervention.Partial correlation coefficient was computed between BCVA(logMAR)and CST by ERM stage adjusting by baseline measures.RESULTS:Clinical charts of 74 patients with idiopathic ERM were assessed.Clinically significant improvement in BCVA overtime was observed with significant difference in median visual acuity of patients with StageⅡ-ⅣERM with P<0.001.The median CST of all patients with stageⅡ-ⅣERM showed similar consistent improvement with P<0.001 from baseline to 12^(th)month.Our results showed not only gain in visual acuity but also shift from baseline to anatomical normalization of CST in stageⅡ.We found a decrease in CST with difference of 166μm and 151μm in stageⅢand stageⅣrespectively.Our results remained consistent with the hypothesis of improved visual outcomes with all stages of ERM with adjusted moderate linear correlation between visual acuity and CST in stageⅡ-Ⅳ(r>0.3).CONCLUSION:Equally significant visual outcomes of patients with ERM stagedⅡ-Ⅳand therefore can be counselled for improved visual acuity after surgical removal of ERM with improvement up to 5 lines on Snellen's chart from the baseline.

Reflectivity and thickness analysis of epiretinal membranes using spectral-domain optical coherence tomography

AIM：To compare thickness and reflectivity spectral domain optical coherence tomography（SD-OCT）findings in patients with idiopathic epiretinal membranes（ERMs）,before and after ERM peeling surgery,with normal controls.·METHODS：A retrospective study analyzing SD-OCTs of eyes with ERMs undergoing ERM peeling surgery by one surgeon from 2008 to 2010 and normal control eyes.SD-OCTs were analyzed using a customized algorithm to measure reflectivity and thickness.The relationship between the SD-OCT findings and best corrected visual acuity（BCVA）outcomes was also studied.·RESULTS：Thirty-four ERM eyes and 12 normal eyes were identified.Preoperative eyes had high reflectivity and thickness of the group of layers from the internal limiting membrane（ILM）to the retinal pigment epithelium（RPE）and the group of layers from the ILM to the external limiting membrane（ELM）.The values of reflectivity of these two groups of layers decreased postoperatively,but were still higher than normal eyes.In contrast,preoperative eyes had lower reflectivity of two10×15 pixel regions of interest（ROIs）incorporating：1）ELM＋outer nuclear layer（ONL）and 2）photoreceptor layer（PRL）＋RPE,compared to controls.The values of reflectivity of these ROIs increased postoperatively,but were still lower than normal controls.A larger improvement in BCVA postoperatively was correlated with a greater degree of abnormal preoperative reflectivity and thickness findings.·C ONCLUSION：Quantitative differences in reflectivity and thickness between preoperative,postoperative,and normal SD-OCTs allow assessment of changes in the retina secondary to ERM.Our study identified hyperreflective inner retina changes and hyporeflective outer retina changes in patients with ERMs.SD-OCT quantitative measures of reflectivity and/or thickness of specific groups of retinal layers and/or ROIs correlate with improvement in BCVA.

25G+与27G+玻璃体切割术治疗特发性视网膜前膜疗效比较

目的比较25G+与27G+玻璃体切割术(PPV)治疗特发性视网膜前膜的临床效果。方法选择2019年12月至2022年8月新乡医学院第三附属医院收治的特发性视网膜前膜患者50例(50眼)为研究对象,根据手术方式不同将患者分为对照组和观察组,每组25例25眼。对照组患者采用25G+PPV治疗,观察组患者采用27G+PPV治疗。比较2组患者玻璃体内手术时间、术后1 d手术切口结膜下出血及水肿范围;分别于术前及术后1 d、1周、1个月、3个月,应用光学相干断层扫描(OCT)检查2组患者的黄斑中心凹厚度(CMT),早期治疗糖尿病视网膜病变研究组(ETDRS)视力表标准检查流程测2组患者的视力,Callon型非接触眼压计测2组患者的眼压;观察2组患者术中黄斑损伤、视网膜裂孔及术后脉络膜脱离、视网膜出血、视网膜脱离、眼内感染等并发症发生情况。结果观察组患者的玻璃体内手术时间显著短于对照组(t=2.314,P<0.05)。观察组结膜下出血及水肿范围显著小于对照组(t=13.706,P<0.01)。对照组和观察组患者术后1 d、1周、1个月和3个月的ETDRS视力显著高于术前(P<0.05)。术后1 d、1周、1个月和3个月,2组患者的ETDRS视力比较差异无统计学意义(P>0.05)。术后1 d,观察组患者的眼压高于对照组(P<0.05);术后1周、1个月和3个月,对照组与观察组患者的眼压比较差异无统计学意义(P>0.05)。对照组2例患者术后1 d出现一过性低眼压,观察组患者均未出现一过性低眼压。术前,2组患者均有视网膜神经上皮层牵拉伴不同程度视网膜水肿增厚及血管扭曲;术后1 d,2组患者视网膜前膜均解除牵拉,视网膜黄斑区解剖结构较术前有大幅改善。术后1 d、1周、1个月、3个月,2组患者的CMT均显著小于术前(P<0.05);术后1 d、1周、1个月、3个月,2组患者的CMT比较差异无统计学意义(P>0.05)。对照组患者18眼(72.0%)因穿刺口渗漏而缝合巩膜穿刺口,观察组患者均未行穿刺口缝合。2组患者均顺利完成手术,术中未出现黄斑损伤、视网膜裂孔等并发症。随访3个月,2组患者均未发现脉络膜脱离、视网膜出血、视网膜脱离、眼内感染等术后并发症。结论27G+PPV与25G+PPV治疗特发性视网膜前膜均有较好临床效果,且手术安全性高。与25G+PPV相比较,27G+PPV可缩短手术时间,更好地维持术后眼压稳定,缩小结膜下出血及水肿范围。

Ozurdex植入联合内界膜剥除治疗特发性黄斑前膜的效果观察

目的观察地塞米松玻璃体内植入剂(Ozurdex)植入联合内界膜(ILM)剥除术治疗特发性黄斑前膜(IEM)的有效性和安全性。方法回顾性分析2020年1月至2023年2月佛山市第二人民医院共21例(21眼)3~4期IEM患者均接受25G经睫状体平坦部玻璃体切除术(PPV)联合IEM及ILM剥除及Ozurdex植入术治疗的效果。主要观察指标为术后1、3、6、12个月时最佳矫正视力(BCVA)和黄斑视网膜厚度(CMT)。结果术后1、3、6、12个月患者BCVA均比术前改善,差异有统计学意义(P<0.05),分别较术前改善了0.30 logMAR、0.40 logMAR、0.40 logMAR、0.50 logMAR。术后1、3、6、12个月患者CMT均比术前组改善,差异有统计学意义(P<0.05),分别较术前下降了185.41、214.05、233.82、230.02μm。患者高眼压发生率为28.57%,PPV术后白内障手术率为46.15%,行白内障摘除术时间间隔为(6.50±1.40)个月。结论Ozurdex植入联合ILM剥除治疗IEM,可促进黄斑水肿消退、有效提高视力,但需注意白内障进展及高眼压症。

玻璃体切除术联合地塞米松玻璃体内植入剂治疗特发性黄斑前膜

目的:研究玻璃体切除术联合地塞米松玻璃体内植入剂治疗特发性黄斑前膜(IMEM)的疗效。方法:回顾性分析2019-01/2023-01在西安市人民医院诊断为IMEM患者72例72眼,按照不同治疗方式分为A组和B组,A组36眼接受玻璃体切除、黄斑前膜(ERM)剥除术联合地塞米松玻璃体内植入剂治疗;B组36眼仅接受玻璃体切除、ERM剥除术治疗。随访12 mo。比较术前及术后1、3、6、12 mo最佳矫正视力(BCVA)、眼压、黄斑中心凹视网膜厚度(CMT)、黄斑视网膜结构变化。结果:术后1、3、6 mo两组间BCVA比较有差异(均P<0.05),A组视力提高较明显;术后12 mo两组间BCVA比较无差异(P=0.056)。术后1、3、6 mo两组间CMT比较有差异(均P<0.05),A组患者术后CMT降低较B组明显;术后12 mo两组间CMT比较无差异(P=0.165)。两组手术前后各时间眼压比较有差异(F时间=2.763,P时间<0.05;F组间=26.800,P组间<0.05;F交互=5.091,P交互<0.05)。A组术后黄斑视网膜结构变化明显。结论:玻璃体手术联合地塞米松玻璃体内植入剂治疗晚期IMEM,能够在术后6 mo内迅速改善黄斑形态并帮助视功能恢复。

玻璃体切除联合内界膜剥除术与曲安奈德球内注射治疗特发性黄斑前膜的效果

目的探讨玻璃体切除+内界膜剥除术联合曲安奈德球内注射在特发性黄斑前膜中的治疗效果。方法回顾性将2021年5月至2023年5月南阳市眼科医院收治的特发性黄斑前膜患者(107例)根据不同治疗方法分为对照组53例和观察组54例。对照组施以23 G玻璃体切除联合内界膜剥除术,观察组在对照组基础上加以曲安奈德球内注射。比较2组术前与术后1周及术后1、3、6个月时的视力水平和黄斑中心视网膜厚度,术前与术后1、3、6个月时的黄斑中心凹厚度,以及并发症发生情况。结果与术前比较,对照组患者术后1、3、6个月时的视力均提升,观察组术后1周与1、3、6个月的视力均有提升,且较对照组提升更大;对照组术后3、6个月与观察组术后1周及1、3、6个月的黄斑中心视网膜厚度均有增加,观察组术后1周时增幅更大;2组术后1、3、6个月黄斑中心凹厚度均降低,术后1个月观察组降幅更大;相较于对照组,观察组并发症发生率明显更低(P<0.05)。结论玻璃体切除+内界膜剥除术联合曲安奈德球内注射应用于特发性黄斑前膜中的疗效确切,可提升患者视力,减轻患者黄斑水肿,可做进一步推广。

特发性黄斑前膜术后视力与黄斑区形态结构和血流密度的相关性

目的:利用光学相干断层扫描血管成像(OCTA)观察特发性黄斑前膜(IMEM)患者术后黄斑区形态结构及血流密度的变化,分析其与视力的相关性。方法:前瞻性研究。连续收集2020-01/2021-07就诊于我院的IMEM患者45例45眼,观察术前、术后1wk,1、3、6mo最佳矫正视力(BCVA)、中央黄斑区厚度(CMT)、中心凹无血管区(FAZ)面积、中心凹视网膜浅层毛细血管丛(SCP)血流密度的变化。结果:与术前比较,纳入患者术后1wk BCVA无明显变化(P>0.05),术后1、3、6mo均明显改善(P<0.05);术后1wk CMT明显增厚(P<0.05),术后1、3、6mo均明显降低(P<0.05);术后1wk,1mo FAZ面积无明显变化(P>0.05),术后3、6mo明显扩大(P<0.05);术后1wk,1、3mo SCP血流密度均无明显变化(P>0.05),术后6mo明显减少(P<0.05)。术后3、6mo纳入患者BCVA与CMT呈正相关(r=0.457、0.615,P=0.032、0.012)。结论:特发性黄斑前膜手术后1mo内视力恢复快,之后趋于平稳,而中心凹形态及血流分布的恢复滞后于视力恢复,且与视力无明显相关性。

地塞米松玻璃体内植入剂在特发性黄斑前膜玻璃体手术中的应用

目的比较特发性黄斑前膜患者玻璃体手术联合与不联合玻璃体腔地塞米松玻璃体内植入剂注药术后视网膜黄斑区超微结构与视功能变化。方法收集2019年1月至2022年12月接受手术治疗的特发性黄斑前膜患者94例(94只眼)。按术毕时是否联合玻璃体腔内注射地塞米松玻璃体内植入剂将患者分为注药组59例(59只眼)和对照组35例(35只眼)。2组患者行玻璃体切除术剥除黄斑前膜及内界膜,术后随访>12个月。观察2组患者手术前后最佳矫正视力(BCVA)、黄斑中心凹厚度、异常中心凹内层厚度的变化情况。结果患者术前及术后1、3、6、12个月最佳矫正视力(LogMAR)分别为0.71±0.14、0.62±0.15、0.51±0.16、0.48±0.29、0.36±0.20,注药组和对照组术后最佳矫正视力LogMAR视力均较术前明显提高(Waldχ^(2)=3428.83,P<0.001;Waldχ^(2)=445.67,P<0.001)。在术后3、6、12个月,2组间最佳矫正视力差异有统计学意义(Waldχ^(2)=8.31,P=0.004;Waldχ^(2)=11.31,P=0.001;Waldχ^(2)=22.54,P<0.001)。黄斑中心凹视网膜厚度分别为(472.64±69.69)、(423.68±83.56)、(380.08±104.98)、(319.55±95.83)、(294.55±104.88)μm,差异有统计学意义(Waldχ^(2)=1322.92,P<0.001)。在术后3、6、12个月,2组间黄斑中心凹厚度差异有统计学意义(Waldχ^(2)=12.47,P<0.001;Waldχ^(2)=21.15,P<0.001;Waldχ^(2)=28.88,P<0.001)。异常中心凹内层厚度分别为(189.87±38.22)、(164.05±40.17)、(142.08±47.80)、(112.51±52.87)、(91.49±53.25)μm,差异有统计学意义(Waldχ^(2)=969.82,P<0.001)。在术后3、6、12个月,2组间异常中心凹内层厚度差异有统计学意义(Waldχ^(2)=11.25,P=0.001;Waldχ^(2)=15.93,P<0.001;Waldχ^(2)=11.98,P=0.001)。结论特发性黄斑前膜患者术毕时玻璃体腔注射地塞米松玻璃体内植入剂可以辅助于黄斑超微结构和视功能的恢复。

基于OCT不同分期的特发性黄斑前膜患者手术前后视力及黄斑区微结构变化

目的观察基于OCT不同分期的特发性黄斑前膜(IMEM)手术前后视力及黄斑微结构的改变。方法选取2021年10月至2023年1月于沧州爱尔眼科医院确诊为IMEM的患者82眼纳入研究,所有患者行25G经睫状体扁平部玻璃体切除联合黄斑前膜及内界膜(ILM)剥除、空气填充,其中59眼联合白内障超声乳化摘除、人工晶体植入术。依据2017年IMEM分期标准分为A组21眼(2期),B组39眼(3期),C组22眼(4期)。分别于术前及术后3个月行最佳矫正视力(BCVA)、光学相干断层成像(OCT)检查。结果3组术后BCVA(LogMAR)较术前均降低(P均<0.05)。术前3组比较BCVA(LogMAR)差异无统计学意义(P>0.05);术后3组BCVA(LogMAR)比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05)。A组术后黄斑中心凹厚度(CMT)较术前差异无统计学意义(P=0.393);B组和C组术后CMT较术前均降低(P均<0.01)。术前3组CMT比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P均<0.05);术后3组CMT比较差异有统计学意义(P<0.01),A组和B组、A组和C组比较差异均有统计学意义(P均<0.01),B组和C组比较差异无统计学意义(P>0.05)。82眼术后BCVA(LogMAR)与术前BCVA(LogMAR)、术前CMT、术后CMT均呈正相关(P均<0.01)。En face OCT发现7眼黄斑区可见同心圆状改变,B扫描呈柱状或锯齿状改变。结论特发性黄斑前膜患者OCT分期越早,术后视力及黄斑微结构恢复越好。应用OCT进行分期可以为手术时机选择及预后判断提供重要的依据。

23-G微创玻璃体切割术治疗特发性黄斑前膜的临床观察

目的:观察23-G微创玻璃体切割术治疗特发性黄斑前膜的临床效果。方法:选取2010-01/2012-12在我院治疗特发黄斑视网膜前膜患者30例30眼,采用23-G玻璃体切割系统,行玻璃体切割、剥膜及气体填充。对患者行2～13mo的术后随访观察,进行疗效评价与分析。结果:23-G微创玻璃体切割术治疗特发黄斑视网膜前膜30例30眼,1眼黄斑前膜复发,29眼黄斑视网膜前膜消失,视力较术前有不同程度的提高,视物变形消失或减轻,OCT提示黄斑前膜消失。结论:23-G微创玻璃体切割术是治疗黄斑视网膜前膜的一种安全有效的方法,在患者的视功能未造成严重的损害前,在早期进行手术治疗,可以提高患者的视觉质量和生活质量。

玻璃体切除黄斑前膜剥除联合内界膜剥除对特发性黄斑前膜患者疗效的影响

目的:分析玻璃体切除黄斑前膜剥除术联合与不联合内界膜(ILM)剥除对特发性黄斑前膜(IMEM)患者脉络膜厚度、视力和视物变形的影响。方法:前瞻性研究。收集2016-01/2020-01在本院诊治的IMEM患者88例88眼,按随机数字表法分两组:观察组44眼接受玻璃体切除黄斑前膜剥除术联合内界膜剥除治疗,对照组44眼仅接受玻璃体切除黄斑前膜剥除术治疗。比较两组患者手术前后脉络膜厚度、视力和视物变形、黄斑中心凹厚度(CMT)、椭圆体区连续性(EZ)及并发症。结果:与术前比较,两组患者术后3、6mo时的黄斑中心凹脉络膜厚度(SFCT)、距黄斑中心凹鼻侧1000μm处脉络膜厚度(NFCT)及距黄斑中心凹颞侧1000μm处脉络膜厚度(TFCT)均明显下降(P<0.05),但两组间比较无差异(P>0.05);与术前比较,两组患者最佳矫正视力(BCVA)改善,光敏感度(MS)上升,观察组患者黄斑暗点数(SP)上升,对照组患者SP下降,观察组术后1、3、6mo时的MS明显低于对照组,SP高于对照组(均P<0.05);与术前比较,两组患者术后3、6mo时的水平和平均M评分较术前均明显下降(均P<0.05),但组间无差异(P>0.05);两组术后1、3、6mo时的CMT较术前均明显下降,观察组术后3、6mo时的CMT均高于对照组(均P<0.05),EZ连续比例及并发症发生率组间比较均无差异(P>0.05)。结论:玻璃体切除黄斑前膜剥除治疗IMEM时,无论是否联合ILM剥除均可取得良好的视力并改善视物变形,且对脉络膜厚度的影响及安全性相当;但联合ILM剥除具更低的光敏感度和更高的暗点数,术后CMT更厚,并未体现出显著优越性。

不同类型黄斑前膜术后视力相关因素分析

目的探讨不同类型黄斑前膜手术疗效及对术后视力的影响因素。方法对2004年9月～2006年10月21例行手术治疗的黄斑前膜患者的临床资料进行回顾性分析,所有患者均行玻璃体切割及黄斑前膜剥除手术,术前及术后行眼科检查,随访1年。结果21例(22眼)黄斑前膜病例中,病程最短1个月,最长4年。包括特发性黄斑前膜13例(13眼),继发性黄斑前膜8例(9眼),其中巩膜扣带术后2眼,伴随孔源性视网膜脱离2眼,继发于视网膜静脉阻塞5眼。所有病例术前均行光学相干断层扫描仪检查,发现合并玻璃体牵拉2眼。术前特发性黄斑前膜组黄斑中心凹平均视网膜厚度为386μm,继发性黄斑前膜组黄斑中心凹平均视网膜厚度为364μm。两组术后视力均有不同程度提高,其中提高2行及以上者特发性黄斑前膜组为9眼,继发黄斑前膜组为2眼。对于两种类型黄斑前膜,特发性黄斑前膜术后视力改善较继发性黄斑前膜明显(P=0.0365)。结论对于两种类型黄斑前膜,特发性黄斑前膜术后视力改善明显。术前黄斑中心凹视网膜厚度与术前视力成负相关,与术后视力无相关性。

复方血栓通胶囊治疗黄斑区视网膜前膜剥膜术后黄斑囊样水肿的疗效观察

目的观察复方血栓通胶囊对黄斑区视网膜前膜剥膜术后黄斑囊样水肿的疗效及安全性。方法对14例(16只眼)明确诊断黄斑前膜及黄斑水肿行手术剥膜患者,于术后次日开始服用复方血栓通胶囊,观察视力、相干光断层扫描(OCT)的变化。结果服药3个月后,视力明显提高,黄斑水肿显著减轻,服药6个月后较3个月后视力及黄斑厚度无统计学差异。结论复方血栓通胶囊短期内有助于黄斑区视网膜前膜剥膜术后黄斑囊样水肿的治疗,但长期疗效有待于进一步的研究。