玻璃体切除术治疗伴有板层黄斑裂孔相关视网膜前增生膜的全层黄斑裂孔

Effect of vitrectomy on full-thickness macular hole with lamellar hole-associated epiretinal proliferation

摘要:

目的：观察伴有板层黄斑裂孔相关视网膜前增生膜(LHEP)的全层黄斑裂孔(FTMH)患者玻璃体切除术后的视力改善和解剖学闭合情况。方法：回顾性临床病例研究。纳入2018-01/2022-01本院确诊为FTMH患者28例28眼，根据是否有LHEP分为有LHEP组12例12眼，无LHEP组16例16眼。两组患者均行玻璃体切除术治疗。比较两组患者术前、术后1a最佳矫正视力(BCVA)、裂孔愈合情况、椭圆体带和外界膜(ELM)连续性、眼压、术后并发症情况。结果：术前BCVA(LogMAR)有LHEP组为0.80±0.17，无LHEP组为0.92±0.27(t=1.406，P=0.172)； 术后1a有LHEP组为0.54±0.14，无LHEP组为0.39±0.10(t=3.399，P=0.002)。两组患者术后1a BCVA较术前均显著改善(t有LHEP组=4.029，P有LHEP组=0.001； t无LHEP组=7.445，P无LHEP组=0.001)； 两组患者手术前后BCVA(LogMAR)差值有LHEP组为0.27±0.16，无LHEP组为0.52±0.26(t=3.153，P=0.002)。术后1a两组患者裂孔均愈合，愈合率均为100%。有LHEP组20%(2/12)患者椭圆体带闭合，无LHEP组56%(9/16)(P椭圆体带=0.04)； 有LHEP组25%(3/12)患者ELM闭合，无LHEP组69%(11/16)(PELM=0.027)。有LHEP组2眼术后发生一过性的眼压升高，无LHEP组3眼。两组患者玻璃体切除术后均未并发显著白内障及严重并发症。结论：与无LHEP的FTMH患者比较，有LHEP的FTMH患者玻璃体切除术后BCVA提高较小，尽管裂孔愈合，但椭圆体带和ELM闭合率较低，连续性中断持续时间较长，预后需进一步明确。

Abstract:

AIM: To observe the visual improvement and anatomical closure of patients with full-thickness macular hole(FTMH)accompanied by lamellar hole-associated epiretinal proliferation(LHEP)after vitrectomy.METHODS: A retrospective study of clinical cases. A total of 28 cases(28 eyes)of patients diagnosed with FTMH in our hospital between January 2018 and January 2022 were included, and they were divided into 12 cases(12 eyes)in the LHEP group and 16 cases(16 eyes)in the non-LHEP group according to the presence or absence of LHEP. All subjects had undergone vitrectomy. The best corrected visual acuity(BCVA)before and 1a after operation, hole closure, continuity of ellipsoid zone and external limiting membrane(ELM), intraocular pressure(IOP), and postoperative complications were compared between the two groups.RESULTS: Preoperative BCVA(LogMAR)was 0.80±0.17 in the LHEP group and 0.92±0.27 in the non-LHEP group(t=1.406, P=0.172); BCVA at 1a after operation was 0.54±0.14 in the LHEP group and 0.39±0.10 in the non-LHEP group(t=3.399, P=0.002). BCVA at 1a after operation was significantly improved in both groups compared with that before operation(tLHEP group=4.029; PLHEP group=0.001; tnon-LHEP group=7.445, Pnon-LHEP group=0.001); the difference in BCVA(LogMAR)before and after the operation was 0.27±0.16 in the LHEP group and 0.52±0.26 in the non-LHEP group(t=3.153, P=0.002). The hole closed in both groups 1a after the operation, and the closure rate was 100%. The ellipsoid zone closed in 20%(2/12)of patients in the LHEP group and 56%(9/16)in the non-LHEP group(Pellipsoid zone=0.04); the ELM closed in 25%(3/12)of patients in the LHEP group and 69%(11/16)in the non-LHEP group(PELM=0.027). A postoperative transient IOP elevation occurred in 2 eyes of the LHEP group and 3 eyes of the non-LHEP group, respectively. There were no significant cataract or serious complications after the vitrectomy in either group.CONCLUSIONS: Compared with FTMH patients without LHEP, the BCVA improvement after vitrectomy was less in FTMH patients with LHEP. Although their macular hole was closed, the closure rates of ellipsoid zone and ELM were lower, and the duration of continuity interruption was longer, so the prognosis requires further clarification.