玻璃体切割联合双层膜剥除治疗特发性黄斑前膜

Vitrectomy combine with double membranes peeling for idiopathic epiretinal membrane

摘要:

目的：对比分析玻璃体切割术行黄斑前膜剥除联合黄斑区内界膜剥除与单纯黄斑前膜剥除治疗特发性黄斑前膜(IERM)的疗效及安全性。

方法：回顾性病例对照研究。将2015-01/12在我院行手术治疗的IERM患者53例53眼纳入研究，根据手术方式不同分为单纯黄斑前膜剥除组(ERM组，21例21眼)和黄斑前膜剥除联合内界膜剥除组(ERM+ILM组，32例32眼)，随访24mo，分别记录两组术前、术后1、3、12、24mo的最佳矫正视力(BCVA，LogMAR)、黄斑中心凹厚度(CMT)、术后并发症及复发情况，并进行统计学分析，比较两组结果差异有无统计学意义。

结果：ERM组术前及术后1、3、12、24mo BCVA分别为0.676±0.137、0.576±0.099、0.551±0.085、0.514±0.077、0.506±0.032； ERM+ILM组分别为0.659±0.132、0.582±0.111、0.578±0.101、0.523±0.062、0.511±0.081； 术后1、3、12、24mo 两组BCVA与术前比较均有不同程度改善(P<0.05)； 术后1、3、12、24mo两组间比较，无显著差异(P>0.05)。ERM组术前及术后1、3、12、24mo CMT分别为461.14±13.477、402.36±11.346、368.52±13.216、325.24±8.246、273.29±8.973μm； ERM+ILM组分别为462.47±14.287、414.72±9.237、373.44±8.328、328.94±6.923、274.28±8.340μm； 术后1、3、12、24mo 两组CMT与术前比较均有不同程度下降(P<0.05)； 术后1、3、12、24mo两组间比较，差异均无统计学意义(P>0.05)。患者53例53眼术后有3例3眼出现视网膜点状出血，其中ERM组1例1眼(5%)、ERM+ILM组2例2眼(6%)，两组比较差异无统计学意义(P=1.000)。在随访的24mo内ERM组复发4例4眼(19%)，ERM+ILM组无复发患者，两组比较差异有统计学意义(P=0.020)。

结论：玻璃体切割术行黄斑前膜剥除联合黄斑区内界膜剥除治疗IERM安全有效，能降低IERM复发率。

Abstract:

AIM: To explore the efficacy and safety of vitrectomy combine with internal limiting membrane peeling and epiretinal membranes peeling in the treatment of idiopathic epiretinal membrane(IERM).

METHODS: In this retrospective study, 53 patients(53 eyes)who underwent vitrectomy for IERM from January 2015 to December 2015 were evaluated, with 24-month follow-up. Only removal of the epiretinal membrane(ERM group)was performed in 21 patients, while 32 had removal of the epiretinal membrane associated with internal limiting membrane peeling(ERM+ILM group). The best corrected visual acuity(BCVA), central macular thickness(CMT)and the complications were observed and analyzed before operation, 1, 3, 12, 24mo after operation.

RESULTS: Both groups showed significant improvement of BCVA when compared to preoperative BCVA(P<0.05). In ERM group the BCVA before and 1, 3, 12 and 24mo after operation were 0.676±0.137,0.576±0.099, 0.551±0.085, 0.514±0.077, 0.506±0.032, and in ERM+ILM group were 0.659±0.132, 0.582±0.111, 0.578±0.101, 0.523±0.062, 0.511±0.081. The comparison between the two groups at 1, 3,12 and 24mo after surgery were no significant differences(P>0.05). After operation, statistically significant CMT reduction occurred in both groups(P<0.05). In ERM group the preoperative and postoperative CMT were 461.14±13.477μm, 402.36±11.346μm, 368.52±13.216μm, 325.24±8.246μm, 273.29±8.973μm, and in ERM+ILM group were 462.47±14.287μm, 414.72±9.237μm, 373.44±8.328μm, 328.94±6.923μm, 274.28±8.340μm. There were no significant difference between the two groups at 1, 3, 12 and 24 after operation(P>0.05). There were 3 cases(3 eyes)had retinal punctate hemorrhage after operation, of which 1(5%)was from the ERM group and 2(6%)were from the ERM+ILM group. No significant difference was observed between the groups(P=1.000). At the end of follow-up, 4 cases(19%)presented with recurrence of the epiretinal membrane all from the ERM group, and there no recurrence was found in ERM+ILM group, and the difference was statistically significant(P=0.020).

CONCLUSION: Vitrectomy with ILM peeling and epiretinal membranes peeling for the treatment of epiretinal membrane is the efficacy and safety, and it may reduce the recurrence.