手术治疗特发性黄斑视网膜前膜后内界膜的存在和完整性分析
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摘要
目的探讨手术治疗特发性黄斑视网膜前膜(IMEM)后内界膜(ILM)的存在和完整性分析。方法分析2016年2月至2018年2月于我院因IMEM行手术治疗的83例(83只眼)患者,所有的患者随机分配到观察组(n=42)或对照组(n=41),所有的患者均予以玻璃体切除联合台盼蓝染色下黄斑视网膜前膜(MEM)剥除术,而观察组患者额外予以亮蓝G染色下ILM剥除术。术后所有的标本均行组织病理学检验。结果术后末次随访时两组患者的最佳矫正视力(BCVA)及黄斑中心凹视网膜厚度(FMT)相比较并无显著统计学差异(P> 0. 05),但观察组的IMEM的复发率明显低于对照组(χ2=4. 623,P=0. 032)。术中经染色剂染色证实76例标本存在ILM的完整性受损,术中应用台盼蓝染色证实MEM存在的敏感度为95. 1%,而术中应用亮蓝G证实ILM存在的敏感度为97. 5%。结论手术过程中单纯剥除MEM而保留ILM的完整性是相对困难的,但剥除ILM后IMEM的复发率明显降低,而应用染色剂证实ILM的存在和完整性与组织病理学结果存在良好的一致性。
Objective To investigate the existence and integrity of the internal limiting membrane( ILM) after surgical treatment of idiopathic macular epiretinal membrane( IMEM). Methods Eighty-three patients( 83 eyes) who underwent surgery for the IMEM in our hospital from February 2016 to February 2018 were enrolled. All patients were randomly assigned to the observation group( n = 42) or the control group( n = 41). All patients underwent vitrectomy combined with trypan blue assisted macular epiretinal membrane( MEM) peeling,while patients in the observation group were additionally treated with brilliant blue G assisted ILM peeling. All specimens were examined by histopathology post-surgically. Results There was no significant difference in best-corrected visual acuity or FMT between the two groups at the last follow-up( p > 0. 05),but the recurrence rate of IMEM in the observation group was significantly lower than that in the control group( χ~2= 4. 623,P = 0. 032). Intraoperative staining confirmed that the integrity of ILM was impaired in 76 specimens. The sensitivity of intraoperative trypan blue staining for MEM existence was 95. 1%,and the sensitivity of brilliant blue G was 97. 5%. Conclusions It is relatively difficult to solely remove MEM and preserve the integrity of ILM during surgery. However,the recurrence rate of IMEM is significantly reduced after ILM peeling. The use of stains shows good agreement with histopathological findings for the demonstration of the existence and integrity of ILM.
Objective To investigate the existence and integrity of the internal limiting membrane( ILM) after surgical treatment of idiopathic macular epiretinal membrane( IMEM). Methods Eighty-three patients( 83 eyes) who underwent surgery for the IMEM in our hospital from February 2016 to February 2018 were enrolled. All patients were randomly assigned to the observation group( n = 42) or the control group( n = 41). All patients underwent vitrectomy combined with trypan blue assisted macular epiretinal membrane( MEM) peeling,while patients in the observation group were additionally treated with brilliant blue G assisted ILM peeling. All specimens were examined by histopathology post-surgically. Results There was no significant difference in best-corrected visual acuity or FMT between the two groups at the last follow-up( p > 0. 05),but the recurrence rate of IMEM in the observation group was significantly lower than that in the control group( χ~2= 4. 623,P = 0. 032). Intraoperative staining confirmed that the integrity of ILM was impaired in 76 specimens. The sensitivity of intraoperative trypan blue staining for MEM existence was 95. 1%,and the sensitivity of brilliant blue G was 97. 5%. Conclusions It is relatively difficult to solely remove MEM and preserve the integrity of ILM during surgery. However,the recurrence rate of IMEM is significantly reduced after ILM peeling. The use of stains shows good agreement with histopathological findings for the demonstration of the existence and integrity of ILM.
引文
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[8]Tian T,Chen C,Jin H,et al.Morphologic and postoperative fixation characteristics of the macular epiretinal membrane in young patients undergoing surgery[J].Ophthalmic Surg Lasers Imaging Retina,2017,48(8):655-662.
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[12]Lee SM,Pak KY,Kwon HJ,et al.Association between tangential contraction and early vision loss in idiopathic epiretinal membrane[J].Retina,2018,38(3):541-549.
[13]Vila SD,Nienow C,Jürgens I.Assessment of the internal limiting membrane status when a macular epiretinal membrane is removed in a prosoective study[J].Retina,2017,37(12):2310-2316.
[14]Shahzadi B,Rizvi SF,Latif K,et al.Visual and anatomical outcomes following idiopathic macular epiretinal membrane surgery[J].J Coll Physicians Surg Pak,2016,26(12):971-974.
[15]Schechet SA,De Vience E,Thompson JT.The effect of internal limiting membrane peeling on idiopathic epiretinal membrane surgery,with a review of the literature[J].Retina,2017,37(5):873-880.
[16]Modi A,Giridhar A,Gopalakrishnan M.Comparative analysis of outcomes with variable diameter internal limiting membrane peeling in surgery for idiopathic macular hole repair[J].Retina,2017,37(2):265-273.
[17]Schenkel EJ,Ciesla R,Shanga GM.Effects of nasal dilator strips on subjective measures of sleep in subjects with chronic nocturnal nasal congestion:a randomized,placebo-controlled trial[J].Allergy Asthma Clin Immunol,2018,14:34.
[18]Zhang YP,Liao WJ,Xia WG.Effect of acupuncture cooperated with low-frequency repetitive transcranial magnetic stimulation on chronic insomnia:A randomized clinical trial[J].Curr Med Sci,2018,38(3):491-498.
[2]HechtI,YeshurunI,BartovE,etal.Retinal layers thickness changes following epiretinal membrane surgery[J].Eye(London),2018,32(3):555-562.
[3]樊冬生,李红霞.玻璃体切割联合内界膜剥离治疗高度近视眼黄斑裂孔性视网膜脱离疗效观察[J].实用防盲技术,2015,10(4):162-165.
[4]Faria MY,Ferreira NP,Mano S,et al.Internal retinal layer thickness and macular migration after internal limiting membrane peeling in macular hole surgery[J].Eur J Ophthalmol,2018,28(3):311-316.
[5]Díaz-Valverde A,Wu L.To peel or not to peel the internal limiting membrane in idiopathic epiretinal membranes[J].Retina,2018,38Suppl 1S5-5S11.
[6]Lee JH,Park SP,Kim YK.Correlation between uncorrected visual acuity and macular distortion in idiopathic epiretinal membrane patients[J].Korean J Ophthalmol,2017,31(6):508-513.
[7]Hamoudi H,Correll CU,La Cour M.Epiretinal membrane surgery:an analysis of 2-step sequential-or combined phacovitrectomy surgery on refraction and macular anatomy in a prospective trial[J].Acta Ophthalmol,2018,96(3):243-250.
[8]Tian T,Chen C,Jin H,et al.Morphologic and postoperative fixation characteristics of the macular epiretinal membrane in young patients undergoing surgery[J].Ophthalmic Surg Lasers Imaging Retina,2017,48(8):655-662.
[9]Li HH,Liao X,Xie CL,et al.Intraoperative risk factors associated with visual acuity outcomes of pars planavitrectomy in idiopathic epiretinal membrane〗[J].Chin J Ophthalmol,2017,53(5):344-351.
[10]Nelis P,Alten F,Clemens CR,et al.Quantification of changes in foveal capillary architecture caused by idiopathic epiretinal membrane using OCT angiography[J].Graefes Arch Clin Exp Ophthalmol,2017,255(7):1319-1324.
[11]Azuma K,Ueta T,Eguchi S,et al.Effects of internal limiting membrane peeling combind with removal of idiopathic epiretinal membrane:A systematic review of literature and Meta-analysis[J].Retina,2017,37(10):1813-1819.
[12]Lee SM,Pak KY,Kwon HJ,et al.Association between tangential contraction and early vision loss in idiopathic epiretinal membrane[J].Retina,2018,38(3):541-549.
[13]Vila SD,Nienow C,Jürgens I.Assessment of the internal limiting membrane status when a macular epiretinal membrane is removed in a prosoective study[J].Retina,2017,37(12):2310-2316.
[14]Shahzadi B,Rizvi SF,Latif K,et al.Visual and anatomical outcomes following idiopathic macular epiretinal membrane surgery[J].J Coll Physicians Surg Pak,2016,26(12):971-974.
[15]Schechet SA,De Vience E,Thompson JT.The effect of internal limiting membrane peeling on idiopathic epiretinal membrane surgery,with a review of the literature[J].Retina,2017,37(5):873-880.
[16]Modi A,Giridhar A,Gopalakrishnan M.Comparative analysis of outcomes with variable diameter internal limiting membrane peeling in surgery for idiopathic macular hole repair[J].Retina,2017,37(2):265-273.
[17]Schenkel EJ,Ciesla R,Shanga GM.Effects of nasal dilator strips on subjective measures of sleep in subjects with chronic nocturnal nasal congestion:a randomized,placebo-controlled trial[J].Allergy Asthma Clin Immunol,2018,14:34.
[18]Zhang YP,Liao WJ,Xia WG.Effect of acupuncture cooperated with low-frequency repetitive transcranial magnetic stimulation on chronic insomnia:A randomized clinical trial[J].Curr Med Sci,2018,38(3):491-498.