25G玻璃体切割联合内界膜剥除术治疗不同分期特发性黄斑前膜的疗效
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摘要
目的观察采用25G玻璃体切割(pars plana vitrectomy,PPV)联合内界膜(internal limiting membrane,ILM)剥除治疗不同分期的特发性黄斑前膜(idiopathic macular epiretinal membrane,IEM)疗效并探讨手术前后视力和黄斑形态的相关性。方法回顾性非随机临床研究。经眼底检查、眼底照相、光学相干断层扫描(optical coherence tomography,OCT)确诊为ILM的患者59例59眼纳入研究。检查最小分辨角对数(logMAR)最佳矫正视力(best corrected visual acuity,BCVA);采用OCT检测EM分期、黄斑中心凹视网膜厚度(central macular thickness,CMT)。所有患者均接受标准经睫状体平坦部三通道25G PPV联合ILM剥除术。对比患眼术前及术后1周、1个月、3个月BCVA、CMT的变化情况,分析IEM分期与手术前后logMAR BCVA、CMT的相关性。结果患眼术后3个月BCVA为(0.61±0.31)logMAR,与术前[(0.83±0.43)logMAR]比较,差异有统计学意义(t=7.05,P=0.000)。患者术后3个月CMT为(288.36±64.61)μm,与术前[(419.83±126.51)μm]比较,差异有统计学意义(t=11.97,P=0.000)。IEM分期与术前BCVA、CMT呈正相关关系(r=0.65、0.66,均为P=0.000),IEM分期与术后3个月BCVA、CMT呈正相关关系(r=0.67、0.64,均为P=0.000)。在随访期间,所有患眼未见黄斑前膜复发。所有患者术前、术后未见明显眼部或全身不良反应。结论 25G PPV联合ILM剥除术治疗IEM可稳定提高患者的BCVA,促进黄斑结构的恢复,IEM分期与术前、术后BCVA、CMT明显相关。
Objective To evaluate the effectiveness 25 G pars plana vitrectomy(PPV) combined with internal limiting membrane(ILM) peeling for the treatment of idiopathic macular epiretinal membrane(IEM) with different stages and the correlation between visual acuity and foveal morphology before and after operation.Methods A retrospective non-randomized clinical study.Then,59 patients(59 eyes) were retrospectively reviewed,who were diagnosed as IEM through examination of the ocular fundus,fundus photography,optical coherence tomography(OCT).The logarithm of the minimum angle of resolution(logMAR) best corrected visual acuity(BCVA),the stages of IEM and central macular thickness(CMT) were assessed with OCT.All patients underwent 25 G microincision vitrectomy.The differences in logMAR BCVA,CMT before and 1 week,1 month,3 months after surgery were analyzed.The correlative analysis was performed to investigate the relationship between IEM stages and logMAR BCVA,CMT.Results At the 3 months after surgery,the BCVA was(0.61±0.31)logMAR,the difference was significant to preoperative(0.83±0.43) logMAR(t=7.05,P=0.00).The mean CMT was(288.36±64.61)μm,the difference was significant to preoperative(419.83±126.51)μm(t=11.97,P=0.00).The IEM stages was positively related to preoperative logMAR BCVA and CMT(r=0.65,0.66,both P=0.00).The stages was also positively related to postoperative 3-month logMAR BCVA and CMT(r=0.67,0.64,both P=0.00).No patient of ERM was recurrenced during in 3 months.There was no ocular or systemic adverse event observed in all patients.Conclusion 25 G PPV combined with ILM peeling is an efficient and safe treatment for IEM,and it can improve visual acuity,foveal morphology.Both visual acuity and CMT correlate with the IEM stages.
Objective To evaluate the effectiveness 25 G pars plana vitrectomy(PPV) combined with internal limiting membrane(ILM) peeling for the treatment of idiopathic macular epiretinal membrane(IEM) with different stages and the correlation between visual acuity and foveal morphology before and after operation.Methods A retrospective non-randomized clinical study.Then,59 patients(59 eyes) were retrospectively reviewed,who were diagnosed as IEM through examination of the ocular fundus,fundus photography,optical coherence tomography(OCT).The logarithm of the minimum angle of resolution(logMAR) best corrected visual acuity(BCVA),the stages of IEM and central macular thickness(CMT) were assessed with OCT.All patients underwent 25 G microincision vitrectomy.The differences in logMAR BCVA,CMT before and 1 week,1 month,3 months after surgery were analyzed.The correlative analysis was performed to investigate the relationship between IEM stages and logMAR BCVA,CMT.Results At the 3 months after surgery,the BCVA was(0.61±0.31)logMAR,the difference was significant to preoperative(0.83±0.43) logMAR(t=7.05,P=0.00).The mean CMT was(288.36±64.61)μm,the difference was significant to preoperative(419.83±126.51)μm(t=11.97,P=0.00).The IEM stages was positively related to preoperative logMAR BCVA and CMT(r=0.65,0.66,both P=0.00).The stages was also positively related to postoperative 3-month logMAR BCVA and CMT(r=0.67,0.64,both P=0.00).No patient of ERM was recurrenced during in 3 months.There was no ocular or systemic adverse event observed in all patients.Conclusion 25 G PPV combined with ILM peeling is an efficient and safe treatment for IEM,and it can improve visual acuity,foveal morphology.Both visual acuity and CMT correlate with the IEM stages.
引文
[1] BU S C,KUIJER R,LI X R,HOOYMANS J M,LOS L I.Idiopathic epiretinal membrane[J].Retina,2014,34(12):2317-2335.
[2] MITCHELL P,SMITH W,CHEY T,WANG J J,CHANG A.Prevalence and associa-tions of epiretinal membranes.The blue mountain eye study[J].Aust Ophthalmol,1997,104(6):1033-1040.
[3] DONATI G,KAPETANIOS A D,POURNARAS C J.Complications of surgery for epiretinal membranes[J].Graefes Arch Clin Exp Ophthalmol,1998,236(10):739-746.
[4] AZUMA K,UETA T,EGUCHI S,AIHARA M.Effects of internal limiting membrane peeling combined with removal of idiopathic epiretinal membrane:A systematic review of literature and meta-analysis[J].Retina,2017,37(10):1813-1819.
[5] YOON Y H,JOE S G,HWANG J U,YANG H S.Insights into epiretinal membranes:presence of ectopic inner foveal layers and a new optical coherence tomography staging scheme[J].Am J Ophthalmol,2017,177(3):226-227.
[6] BAE J H,SONG S J,LEE M Y.Five-year incidence and risk factors for idiopathic epiretinal membranes[J].Retina,2017,28(11):1-8.
[7] MARIOTTI C,NICOLAI M,LONGO A,VITI F,BAMBINA E,SAITTA A,et al.Peripapillary retinal nerve fiber thickness changes after vitrectomy for epiretinal membrane in eyes with and without vitreous detachment[J].Retina,2017,37(12):2304-2309.
[8] CLARK A,BALDUCCI N,PICHI F,VERONESE C,MORARA M,TORRAZZA C,et al.Swelling of the arcuate nerve fiber layer after internal limiting membrane peeling[J].Retina,2012,32(8):1608-1613.
[9] BAE S H,KIM D,PARK T K,HAN J R,KIM H,NAM W.Preferential hyperacuity perimeter and prognostic factors for metamorphopsia after idiopathic epiretinal membrane surgery[J].Am J Ophthalmol,2013,155(1):109-117.
[10] CHO K H,PARK S J,WOO S J,PARK K H.Correlation between inner-retinal changes and outer-retinal damage in patients with idiopathic epiretinal membrane[J].Retina,2018,38(12):2327-2335.
[11] NIWA T,TERASAKI H,KONDO M,PIAO C H,SUZUKI T,MIYAKE Y.Function and morphology of macula before and after removal of idiopathic epiretinal membrane[J].Invest Ophthalmol Vis Sci,2003,44(4):1652-1656.
[12] LIU W,TANG S B,HUANG S Y,ZHANG P,LIANG Z Y,LI J Q,et al.Histopathological examination of scleral perforation prolapse during vitreous surgery[J].Chin J Ocul Fundus Dis,2001,17(2):99-101.刘文,唐仕波,黄素英,张平,梁忠英,李加青,等.玻璃体手术中巩膜穿刺孔脱出物的组织病理学检查[J].中华眼底病杂志,2001,17(2):99-101.
[13] YOU C Y,XIE L X.The application status of 25G vitreous surgery system without suture and perfusion in the treatment of infantile cataract[J].Chin J Ophthalmol,2009,45(8):762-765.由彩云,谢立信.无缝线无灌注 25G 玻璃体手术系统治疗婴幼儿白内障的应用研究现状[J].中华眼科杂志,2009,45(8):762-765.
[14] LI S N,TANG S B,LI J Q,LAI M Y,BAI N Y,GAO Y.Preliminary clinical application of 25G transconjunctival suture free vitrectomy system[J].Chin J Ophthalmol,2004,40(6):419-421.李双农,唐仕波,李加青,赖铭莹,白宁艳,高艺.25G 经结膜无缝线玻璃体切除手术系统的初步临床应用效果[J].中华眼科杂志,2004,40(6):419-421.
[2] MITCHELL P,SMITH W,CHEY T,WANG J J,CHANG A.Prevalence and associa-tions of epiretinal membranes.The blue mountain eye study[J].Aust Ophthalmol,1997,104(6):1033-1040.
[3] DONATI G,KAPETANIOS A D,POURNARAS C J.Complications of surgery for epiretinal membranes[J].Graefes Arch Clin Exp Ophthalmol,1998,236(10):739-746.
[4] AZUMA K,UETA T,EGUCHI S,AIHARA M.Effects of internal limiting membrane peeling combined with removal of idiopathic epiretinal membrane:A systematic review of literature and meta-analysis[J].Retina,2017,37(10):1813-1819.
[5] YOON Y H,JOE S G,HWANG J U,YANG H S.Insights into epiretinal membranes:presence of ectopic inner foveal layers and a new optical coherence tomography staging scheme[J].Am J Ophthalmol,2017,177(3):226-227.
[6] BAE J H,SONG S J,LEE M Y.Five-year incidence and risk factors for idiopathic epiretinal membranes[J].Retina,2017,28(11):1-8.
[7] MARIOTTI C,NICOLAI M,LONGO A,VITI F,BAMBINA E,SAITTA A,et al.Peripapillary retinal nerve fiber thickness changes after vitrectomy for epiretinal membrane in eyes with and without vitreous detachment[J].Retina,2017,37(12):2304-2309.
[8] CLARK A,BALDUCCI N,PICHI F,VERONESE C,MORARA M,TORRAZZA C,et al.Swelling of the arcuate nerve fiber layer after internal limiting membrane peeling[J].Retina,2012,32(8):1608-1613.
[9] BAE S H,KIM D,PARK T K,HAN J R,KIM H,NAM W.Preferential hyperacuity perimeter and prognostic factors for metamorphopsia after idiopathic epiretinal membrane surgery[J].Am J Ophthalmol,2013,155(1):109-117.
[10] CHO K H,PARK S J,WOO S J,PARK K H.Correlation between inner-retinal changes and outer-retinal damage in patients with idiopathic epiretinal membrane[J].Retina,2018,38(12):2327-2335.
[11] NIWA T,TERASAKI H,KONDO M,PIAO C H,SUZUKI T,MIYAKE Y.Function and morphology of macula before and after removal of idiopathic epiretinal membrane[J].Invest Ophthalmol Vis Sci,2003,44(4):1652-1656.
[12] LIU W,TANG S B,HUANG S Y,ZHANG P,LIANG Z Y,LI J Q,et al.Histopathological examination of scleral perforation prolapse during vitreous surgery[J].Chin J Ocul Fundus Dis,2001,17(2):99-101.刘文,唐仕波,黄素英,张平,梁忠英,李加青,等.玻璃体手术中巩膜穿刺孔脱出物的组织病理学检查[J].中华眼底病杂志,2001,17(2):99-101.
[13] YOU C Y,XIE L X.The application status of 25G vitreous surgery system without suture and perfusion in the treatment of infantile cataract[J].Chin J Ophthalmol,2009,45(8):762-765.由彩云,谢立信.无缝线无灌注 25G 玻璃体手术系统治疗婴幼儿白内障的应用研究现状[J].中华眼科杂志,2009,45(8):762-765.
[14] LI S N,TANG S B,LI J Q,LAI M Y,BAI N Y,GAO Y.Preliminary clinical application of 25G transconjunctival suture free vitrectomy system[J].Chin J Ophthalmol,2004,40(6):419-421.李双农,唐仕波,李加青,赖铭莹,白宁艳,高艺.25G 经结膜无缝线玻璃体切除手术系统的初步临床应用效果[J].中华眼科杂志,2004,40(6):419-421.