Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema

BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.

Internal limiting membrane peeling with different dyes in the surgery of idiopathic macular hole: a systematic review of literature and network Meta-analysis

AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic macular hole(IMH). METHODS: A search was conducted using Pub Med, EMBASE, and CENTRAL(Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS: A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION: BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.

Displacement of the retina after idiopathic macular hole surgery with different internal limiting membrane peeling patterns

AIM:To explore retinal displacement after surgical treatment for idiopathic macular hole(IMH)with different internal limiting membrane(ILM)peeling patterns.METHODS:Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups,N-T group(11 eyes)and T-N group(11 eyes).For patients in N-T group,ILM was peeled off from nasal to temporal retina.For patients in T-N group,ILM was peeled off from temporal to nasal retina.Preoperative,postoperative 1,3,and 6 mo,autofluorescence fundus images were collected for manual measurement of distances of fixed nasal(N),temporal(T),superior(S),and inferior(I)retinal points(bifurcation or crossing of retinal vessels)around the macula to the optic disc(OD).These were respectively defined as N-OD,T-OD,S-OD,and I-OD.The retinal displacement,macular holeclosure rate,and best corrected visual acuity(BCVA)were compared between the two groups after surgery.RESULTS:At postoperative 1,3,and 6 mo,the macula slipped toward the OD,manifested by the decreased T-OD,N-OD,S-OD,and I-OD(P<0.05).No significant difference was found in the T-OD,N-OD,S-OD,and I-OD between N-T group and T-N group.IMH closure rate was 100%both in N-T group and T-N group.There was no significant difference in BCVA between two groups(P<0.05).CONCLUSION:The macula slips toward the OD after successful macular hole surgery.The two different ILM peeling pattern show similar visual outcome and retinal displacement,which means ILM peeling directions are not the influencing factor of postoperative retinal displacement.

Efficacy of Phacovitrectomy Combined with Internal Limiting Membrane Peeling for Macular Diseases

Purpose:To observe the efficacy of vitrectomy with internal limiting membrane.(ILM) peeling combined with phacoemulsification with intraocular lens.(IOL) implantation in the treatment of cataract with co-existing macular diseases.Methods:A total of 28 cataract patients (28 eyes) with coexisting macular diseases were admitted to Aier Eye Hospital between May 2008 and May 2011.The clinical characteristics were analyzed in this study.Subjects included 6 men and 22 women,aged from 56 to 77 years (mean 64 years),with duration of disease ranging from 2 to 36 months (mean 9.3 months).All patients underwent phacoemulsification with implantation of a hydrophobic acrylic IOL into the capsular bag and pars plana vitrectomy with ILM peeling.Results:Postoperatively,patients underwent 3-to 18-months of follow-up.(mean 7.2 months).Only one eye had macular hole failing to close.Normal macular structure was restored in the other 27 eyes.The presenting visual acuity and best corrected visual acuity.(BCVA) did not differ significantly (t =-1.724,P =0.096),with the BCVA in 27 eyes.(96.4%).improving by 2 lines or more.The improvement in minimum angle of resolution.(MAR).was > 0.3 in 21 eyes,≥0.1 in 6 eyes and<0.1 in 1 eye.The mean spherical equivalent.(SE) was-4.67±5.98D preoperatively and-0.38±0.69D postoperatively (t=4.157,P<0.005).Conclusion:Combined phacovitrectomy surgery is a reliable and safe procedure in the treatment of cataract complicated by macular disease.

A novel surgical technique of internal limiting membrane peeling for high myopic foveoschisis:a wide range of whole piece consecutive peeling without preservation of epi-fovea

AIM:To demonstrate an improved surgical technique of whole piece consecutive internal limiting membrane(ILM) peeling without preservation of the epi-fovea to treat high myopic foveoschisis(MF).METHODS:A 23-gauge 3-port pars plana vitrectomy was performed on 16 patients with high MF.A parallel arc line along the vascular arcades was scraped out with a curved membrane scraper DSP.Next,an ILM forceps was used to catch hold of the incisal edge of the ILM flap,and the action of releasing and separating was subsequently taken toward the direction of the macular fovea.Next,the ILM forceps was used to grasp the released area,and the whole area coherent ILM peeling covering the macular fovea was implemented thereafter.Finally,the ILM was folded backwards and peeled off in the arc direction.RESULTS:At the final visit,the average central macular thickness decreased remarkably from 423.76±177.67 to 178.24±66.21 μm.The mean logarithm of the minimum angle of resolution best-corrected visual acuity of 1.37±0.59 was significantly alleviated to 0.74±0.59.CONCLUSION:The wide range of whole piece consecutive ILM peeling without preservation of the epifovea is proven to be effective and significantly reduced the occurrence of retinal tear and macular hole.

Internal limiting membrane flap technique in macular hole surgery

Vitrectomy combined with internal limiting membrane(ILM)peeling is popular for the treatment of macular hole(MH).However,the improvements of MH closure rate and postoperative visual acuity are not satisfactory especially in large and refractory MHs.Currently,the ILM flap technique has gradually been applied for the treatment of MH and achieved high MH closure rate.The ILM flap technique has many variations,including the difference of the size,shape,number,and manner in which the flaps put on the MHs.The ILM flap technique also has some auxiliary means including perfluoro-n-octane(PFO),dye,autologous blood and adhesive viscoelastics.There is controversy about the effects between several technique variations of ILM flap,and it needs to be explored in the future.

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.

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.

Retinal displacement after surgery for idiopathic macular hole

AIM:To review and summarize the mechanism hypothesis,influencing factors and possible consequences of macular retinal displacement after idiopathic macular hole(IMH)surgery.METHODS:PubMed and Web of Science database was searched for studies published before April 2023 on“Retinal displacement”,“Idiopathic macular holes”,and“Macular displacement”.RESULTS:Recently,more academics have begun to focus on retinal displacement following idiopathic macular holes.They found that internal limiting membrane(ILM)peeling was the main cause of inducing postoperative position shift in the macular region.Moreover,several studies have revealed that the macular hole itself,as well as ILM peeling method,will have an impact on the result.In addition,this phenomenon is related to postoperative changes in macular retinal thickness,cone outer segment tips line recovery,the occurrence of dissociated optic nerve fiber layer(DONFL)and the degree of metamorphopsia.CONCLUSION:As a subclinical phenomenon,the clinical significance of postoperative macular displacement cannot be underestimated as it may affect the recovery of anatomy and function.

内界膜剥除联合玻璃体腔注射曲安奈德治疗PDR硅油填充术后黄斑水肿的临床观察

目的硅油取出术中内界膜剥除联合玻璃体腔注射曲安奈德(TA)治疗PDR硅油填充眼合并黄斑水肿的疗效观察。方法回顾性分析2020年10月至2022年5月因PDR导致的玻璃体积血或合并牵拉性视网膜脱离于我院行微创玻璃体切割联合硅油填充术的患者17例(17眼),行硅油取出时合并黄斑水肿,术中联合内界膜剥除及玻璃体腔注射TA,观察术前、术后1周、1个月及3个月时最佳矫正视力(BCVA)及黄斑中心凹厚度的变化。结果术后BCVA较术前提高,黄斑水肿较术前减轻。结论对PDR硅油填充眼合并黄斑水肿的患者,硅油取出术中联合内界膜剥除及玻璃体腔注射TA可有效减轻黄斑水肿,提高患者最佳矫正视力,改善生活质量。

玻璃体切割手术对青年糖尿病患者黄斑水肿的治疗作用

目的研究分析玻璃体切割手术治疗青年糖尿病患者黄斑水肿的效果。方法回顾性病例对照研究。搜集北京市顺义区空港医院2017年1月至2021年6月期间就诊的45岁以下,因糖尿病视网膜病变行玻璃体切割手术且合并有糖尿病黄斑水肿的患者,根据玻璃体切割术中是否联合行内界膜剥除,分为单纯玻璃体切割组和联合内界膜剥除组,分析两组的视力预后,黄斑区视网膜厚度以及术后糖尿病黄斑水肿反复治疗需求情况。结果研究搜集34例患者(41只眼),均为2型糖尿病患者。单纯玻璃体切割组纳入18只眼,患者平均年龄(40.67±5.25)岁。联合内界膜剥除组纳入23只眼,患者平均年龄(42.48±4.01)岁。统计结果显示,两组患者术后3个月最佳矫正视力不具有统计学差异,黄斑厚度在术后第1个月(t=-2.603,P=0.013),第3个月(t=-2.463,P=0.018)具有显著差异,但术后6个月时两组不具有统计学差异(t=-1.881,P=0.067)。根据病情需要,两组在3个月、6个月再次需要玻璃体注药治疗的情况差异不具有统计学意义。结论玻璃体切割手术是青年糖尿病黄斑水肿的安全有效治疗措施,但并不必要对所有患者联合进行内界膜剥除操作。

玻璃体切除联合重水辅助内界膜填塞术治疗黄斑裂孔性视网膜脱离

目的观察玻璃体切除联合重水辅助内界膜填塞术治疗黄斑裂孔性视网膜脱离(MHRD)的疗效。方法回顾性病例对照研究。纳入2020年1月至2022年10月在我院诊断MHRD并行玻璃体切除(PPV)联合内界膜(ILM)填塞术的患者;其中,2020年1月至2021年4月20例(20只眼)MHRD患者归于对照组(内界膜直接填塞组),2021年5月至2022年10月20例(20只眼)MHRD患者归于实验组(重水辅助内界膜填塞组)。随访至术后6个月,观察记录患者的最佳矫正视力(BCVA)、黄斑裂孔愈合及网膜复位情况,有无术后并发症如高眼压等。以术后6个月的检查结果作为最终的疗效结果。结果末次随访结束,所有患者脱离的网膜均复位,MH均闭合,随访过程中未出现高眼压、眼内炎等并发症。末次随访结束,对照组黄斑裂孔I型闭合9只眼(其中U形愈合只眼,V形愈合4只眼),II型闭合11只眼;实验组黄斑裂孔I型闭合16只眼其中U形愈合13只眼,V形愈合3只眼,II型闭合4只眼;两组间MH不同类型愈合占比比较差异有统计学意义(P=0.022)。两组术前BCVA(log⁃MAR)差异无统计学意义(P=0.744);两组术后6个月BCVA(logMAR)较术前均有改善(P<0.001),两组间术后6个月BCVA(logMAR)比较,试验组(重水辅助内界膜填塞组)视力改善优于对照组(内界膜直接填塞组)(P<0.001)。结论PPV联合重水辅助内界膜填塞是一种有效安全的手术方式,可以提高裂孔的I型愈合率,一定程度上改善术后视力。

Comparison of anatomical and functional outcomes of different surgical techniques in myopic macular hole without retinal detachment

AIM:To define the anatomic and functional outcomes of pars plana vitrectomy(PPV)with internal limiting membrane(ILM)peeling,inverted ILM flap and free ILM patch graft technique for the treatment of myopic macular hole(MH)without retinal detachment.METHODS:Sixty-four eyes of 64 patients who underwent PPV for myopic MH were included.Group 1 consists of patients underwent ILM peeling(n=26),and Groups 2 and 3 consists of patient underwent free ILM patch graft(n=20)and inverted ILM flap procedure(n=18)respectively.Outcomes following surgery were MH closure and best corrected visual acuity(BCVA)in logMAR at 6mo.RESULTS:Closure of MH was obtained in 20 eyes(76.9%)of the Group 1,in 16 eyes(80%)of the Group 2 and in 16 eyes(88.9%)of the Group 3.The mean preoperative and postoperative BCVA was 1.60±0.53 logMAR and 1.27±0.58 logMAR,respectively(P<0.05).There was no significant difference in the postoperative BCVA and anatomical closure rates in the three groups.Although the anatomical closure rate did not differ significantly in the groups,closure of MH tended to be better in the inverted ILM flap technique group at 6mo.CONCLUSION:Different surgical techniques may provide favorable visual and anatomical results for myopic MH surgery.ILM flap techniques offer higher closure rates compared to ILM peeling technique.However,in terms of visual outcomes,the study reveals no difference in three surgical techniques.

23G微创玻璃体切割手术联合内界膜剥离术在黄斑裂孔性视网膜脱离中的应用效果

目的:探究23G微创玻璃体切割手术联合内界膜剥离术在黄斑裂孔性视网膜脱离中的应用效果。方法:回顾性分析2017年6月-2021年10月建湖建阳眼科医院接诊的82例黄斑裂孔性视网膜脱离患者的临床资料。根据治疗方式将患者分为单一手术组[41例(41眼),23G微创玻璃体切割手术]和联合手术组[41例(41眼),23G微创玻璃体切割手术联合内界膜剥离术]。比较两组手术时间、住院时间、治疗前后视力水平及术后并发症发生情况。结果:联合手术组手术时间、住院时间短于单一手术组,差异有统计学意义(P<0.05)。治疗1个月后,两组视力水平均高于治疗前,且联合手术组高于单一手术组,差异有统计学意义(P<0.05)。联合手术组并发症发生率为4.88%,低于单一手术组的21.95%,差异有统计学意义(P<0.05)。结论:23G微创玻璃体切割手术联合内界膜剥离术治疗黄斑裂孔性视网膜脱离患者,可缩短手术时间、住院时间,提高视力水平,降低并发症发生率。

内界膜剥除在过去三十年间是如何革新黄斑手术的

内界膜剥除术是过去30a间黄斑手术的重大创新。经过各种改良,现已成为黄斑手术的标准操作。但剥除黄斑部作为视网膜和玻璃体之间结构界面的Müller细胞基底膜,怎样获得最佳疗效和避免不良后果,仍是需要探索的问题。鉴于本刊共同主编Peter Wiedemann教授在视网膜外科领域长期的卓越贡献、以及他们团队近年来在中心凹再生方面取得的重要进展,我们特别邀请他撰写本篇述评。他欣然在2wk内完成了这篇纵览全局、提纲挈领、深刻洞见、简明有据、闪耀着智慧光芒的文章。其中概括了内界膜剥除的历史、理由、技术与适应证、范围大小、不良后果,以及难治性黄斑裂孔的手术。既有对目前认知的肯定,也提出了存在的问题,值得我们细读思考。为了方便一些同道的阅读,特此全文译出。

玻璃体切割联合内界膜(ILM)剥除术与玻璃体切割联合ILM瓣覆盖术治疗不同直径特发性黄斑裂孔的疗效和安全性对比分析

目的比较玻璃体切割联合内界膜(inner limiting membrane,ILM)剥除术和玻璃体切割联合ILM瓣覆盖术治疗不同直径特发性黄斑裂孔(idiopathic macular hole,IMH)的疗效和安全性。方法采用玻璃体切割联合ILM剥除或ILM覆盖的方法治疗IMH共127例127眼,根据IMH的最小直径分为小裂孔(63眼,直径≤500μm)和大裂孔(64眼,直径>500μm);依据不同的手术方法进行分组:剥除1组(小裂孔32眼)和剥除2组(大裂孔33眼)采取玻璃体切割联合ILM剥除术;覆盖1组(小裂孔31眼)和覆盖2组(大裂孔31眼)采取玻璃体切割联合ILM瓣覆盖术。对患者术前、术后最佳矫正视力和黄斑裂孔愈合情况进行检查随访。结果术后12个月时各组最佳矫正视力分别与术前相比,均有不同程度提高;术后剥除1组和覆盖1组(t=0.112 2,P>0.05),剥除2组和覆盖2组(t=0.750 8,P>0.05)相比,最佳矫正视力差异均无统计学意义。剥除1组和覆盖1组在术后6个月时闭合率均为100.00%,两组差异无统计学意义(P>0.05);剥除2组和覆盖2组在术后6个月闭合率分别为84.85%和100.00%,差异有统计学意义(P<0.05)。术前剥除2组和覆盖2组内外节交界面连接带缺损直径差异无统计学意义(P>0.05);剥除2组和覆盖2组术后1个月时,内外节交界面连接带缺损直径差异无统计学意义(P>0.05);术后3个月、6个月、12个月时差异均有统计学意义(均为P<0.05),覆盖2组的内外节交界面连接带缺损直径比剥除2组小。各时间点剥除1组和覆盖1组内外节交界面连接带缺损直径差异均无统计学意义(均为P>0.05)。结论相对于传统的ILM剥除,ILM瓣覆盖术有助于直径大于500μm裂孔愈合,对于小裂孔愈合两种术式疗效无明显差异。

内界膜翻瓣术治疗黄斑裂孔的配对研究

目的用配对研究的方法评价内界膜翻瓣术治疗黄斑裂孔(macular hole,MH)的临床疗效。方法收集2014年10月至2015年6月在天津市眼科医院行玻璃体切割手术的MH患者34例(34眼),将情况相近的患者进行配对,分为两组,A组术中行内界膜翻瓣术、B组术中行内界膜剥除术。术后随访6个月,观察记录术后最佳矫正视力(best-corrected visual acuity,BCVA)、裂孔闭合率、MH闭合形态及椭圆体区闭合率等指标。结果A组术后BCVA为(0.50±0.07)log MAR,明显好于B组(0.91±0.12)log MAR,差异有统计学意义(t=-3.786,P=0.002);A组裂孔闭合率为94.1%(16/17),B组闭合率为70.6%(12/17),差异无统计学意义(P=0.175);A组U型闭合8例,V型闭合7例,W型闭合1例;B组U型闭合4例,V型闭合8例,W型闭合0例;A组椭圆体区闭合率为29.4%,B组椭圆体区闭合率为0,差异有统计学意义(P=0.044)。结论玻璃体切割联合内界膜翻瓣术可提高MH患者术后BCVA和裂孔闭合率,使U型闭合增加,提高椭圆体区术后闭合率,是治疗MH的一种安全、有效的方法。

特发性黄斑裂孔的临床研究进展

特发性黄斑裂孔(idiopathic macular hole,IMH)主要是指无明确诱因引起的黄斑区域的视网膜神经上皮层局限性全层缺损,是比较重要的眼底黄斑病变之一。根据不同的原因及其病变的解剖部位则有不同的分类,其病因较多且病机复杂,但随着眼科检查仪器的不断更新及手术技术的不断提高,IMH的治疗手段也随之多样化并且治疗效果更加明显。不仅如此,对于IHM的预防性治疗在临床也逐渐得到运用。现本文将从IMH的发病机制、相关检查、治疗及预后评估等方面的进展作一综述。

特发性黄斑裂孔的发病机制及治疗进展

特发性黄斑裂孔(IMH)是指无明显病因发生于黄斑区视网膜神经上皮层的全层组织缺损。目前,随着对IMH认识的逐渐深入及其治疗方式的不断创新和改进,其治疗技术也呈现成熟化及多样化。研究表明,早期直径较小的IMH可以进行观察随访;奥克纤溶酶(Ocriplasmin)已被批准用于中小型黄斑裂孔和黄斑粘连(VMA)的患者;内界膜(ILM)剥除可提高解剖闭合率。然而,对于直径<250μm的IMH,尚不确定是否总是需要剥除ILM。本文讨论了IMH的发病机制、分期、分类及当前的治疗方案。基于IMH的特点和患者的差异性,拟提出一种基于循证医学的方法来为个体患者选择最佳和最实际的治疗方案。

内界膜剥除对孔源性视网膜脱离玻璃体切割术后黄斑前膜形成及视力预后的影响

目的研究累及黄斑的孔源性视网膜脱离(RRD)玻璃体切割联合内界膜(ILM)剥除对预防黄斑前膜(ERM)形成和视力预后的影响。方法采用队列研究方法,纳入2015年1月至2018年1月就诊于保定市第一中心医院累及黄斑的RRD患者74例74眼。所有患者均接受玻璃体切割术及硅油眼内填充,且术后视网膜均成功复位。根据玻璃体切割术中是否行ILM剥除,将患者分为ILM未剥除组36例36眼和ILM剥除组38例38眼;所有受检者均于玻璃体切割术后3~5个月行硅油取出术。分别于术前及硅油取出术后1、6和12个月行最佳矫正视力(BCVA)、裂隙灯显微镜、间接检眼镜、彩色眼底照相、光相干断层扫描(OCT)检查。结果术后1个月,2个组患眼中均未发现ERM;术后6个月,ILM未剥除组中3眼形成ERM,占8.33%,ILM剥除组2眼出现ERM,占5.26%,2个组ERM发生率比较差异无统计学意义(P=0.067);术后12个月,ILM未剥除组中共9眼出现ERM,占25.00%,ILM剥除组中共4眼出现ERM,占10.53%,2个组ERM的发生率比较差异无统计学意义(χ^(2)=2.674,P=0.102)。2个组患者手术前后不同时间点间BCVA总体比较差异有统计学意义(F_(时间)=31.692,P<0.001);各组内术后1、6、12个月BCVA均明显优于术前值,差异均有统计学意义(均P<0.05)。2个组间BCVA总体比较差异无统计学意义(F_(组别)=0.117,P=0.773)。OCT结果显示,术后12个月时ILM未剥除组中椭圆体带完整者25眼,占77.78%,ILM剥除组椭圆体带完整者30眼,占78.95%,2个组间椭圆体带完整眼数比较差异无统计学意义(χ^(2)=0.875,P=0.350)。结论与单纯玻璃体切割术比较,累及黄斑的RRD患者玻璃体切割术中联合ILM剥除不能预防术后ERM的发生,对患者的视力预后无明显影响。