特发性黄斑前膜手术前后黄斑厚度与功能的相关性研究  

A comparative study of macular thickness and function before and after idiopathic macular epiretinal membrane surgery

作　　者：周静[1] 刘武[1] 李倩[1] 李翔[1] 郝静[1] 王心蕾[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同t一眼科中心北京市眼科学与视觉科学重点实验室,100730

出　　处：《中华眼科杂志》2012年第2期119-123,共5页Chinese Journal of Ophthalmology

摘　　要：目的 探讨特发性黄斑前膜（ IEM）患者手术前后黄斑厚度变化与功能的相关性.方法 回顾性病例系列研究.回顾性分析37例（37只眼）IEM患者的临床资料.所有患者均采用标准三切口闭合式玻璃体切除术,剥除视网膜前膜.患者手术前后均先采用国际标准视力表检查最佳矫正视力（ BCVA）,再转换为最小分辨角的对数视力（logMAR）进行分析.应用相干光断层扫描（OCT）检测患者黄斑中心凹厚度（CFT）,应用MP-1微视野计检测患者黄斑中心10°区域视网膜平均光敏感度（MS）.患者手术前后BCVA比较,采用秩和检验；手术前后CFT、MS比较,采用配对资料t检验；对BCVA与CFT和MS的相关性进行分析,其中CFT和MS为计量资料,采用Pearson相关分析法；BCVA为等级资料,采用Spearman秩相关分析法.结果 37例（37只眼）患者术前BCVA 0.3 ～1.3,中位数0.7；术后BCVA为0.1 ～0.7,中位数0.4；术后BCVA较术前显著提高（Z=-4.97,P＜0.05）.患者术前CFT为199～ 641 μm,平均（482.2±101.8） μm；术后CFT为172 ～ 381 μm,平均（ 246.2±60.4）μm；术后CFT较术前显著减少（t=15.86,P＜0.05）；患者术前黄斑中心10°区域视网膜MS为5.5 ～19.9 dB,平均（14.1 ±3.4）dB；术后黄斑中心10°区域视网膜MS为11.6～20.0 dB,平均（18.6± 1.8）dB；术后MS较术前显著提高（t=-9.20,P＜0.05）.患者术前CFT值越高,则术前黄斑中心10°区域视网膜MS值越低（r=-0.82,P＜0.05）、术前BCVA水平越低（rs=0.91,P＜0.05）、术后BCVA水平也越低（rs=0.63,P＜0.05）.但患者术前CFT值越高,术后CFT值下降越明显（r=0.81,P＜0.05）、BCVA提高也越明显（rs =0.71；P＜0.05）.结论 玻璃体切除联合黄斑前膜剥除术可以有效促进IEM患者黄斑厚度及功能的恢复.观察分析IEM患者术前CFT、BCVA及黄斑区视网膜MS,有助于客观预测患者术后CFT及功能恢复水平.Objective To compare the thickness and functional changes of the macula after idiopathic macular epiretinal membrane （IEM） surgery. Methods A retrospective study. Thirty-seven patients （37 eyes） received surgical treatment of IEM.All patients received standard three-port vitrectomy as well as epiretinal membrane peeling.The best corrected visual acuity （BCVA,LogMAR） were recorded and optical coherence tomography （OCT） were used to evaluate central foveal thickness （CFT）.Microperimetry （MP）-1 was used for the mean sensitivity （MS） of central 10° macula area.SPSS13.0 was used for statistical analysis. Rank and testing methods were used to compare the preoperative and postoperative BCVA,paired t testing method was used to compare the preoperative and postoperative CFT and MS values. Correlation analysis was used to study the BCVA,CFT,and MS. Pearson correlation analysis was applied to analyze measurement data and Spearman rank correlation analysis was used to analyze rating data.Results Postoperatively,the BCVA （0.1-0.7,median 0.4） was significantly better （ Z =- 4.97,P 〈 0.05 ） than the preoperative one （ 0.3-1.3,median 0.7 ）.The CFT （ 246.2 ± 60.4 ） μm was significantly thinner （t =15.86,P 〈 0.05 ） than the preoperative one （482.2 ± 101.8 ） μm.The MS of central 10° macula area （ 18.6 ± 1.8 ） dB was significantly higher （ t =- 9.20,P 〈 0.05 ） than the preoperative one （ 14.1 ± 3.4） dB.Thicker preoperative CFT was associated with a lower preoperative BCVA （rs =0.91,P 〈0.05）,a lower MS of central 10° macula area （r =-0.82,P 〈0.05） and a lower postoperative BCVA level （rs =0.63,P 〈0.05 ）.But with a significant postoperative CFT reduce（ r =0.81,P 〈 0.05 ） and a significant postoperative BCVA increase （ rs =0.71,P 〈 0.05 ）.Conclusions Vitrectomy combined with macular epiretinal membrane removal can effectively promote the recovery of macular thickness and function in patients with IEM.Examinationand analysis of p

关 键 词：视网膜外膜 黄斑 体层摄影术 光学相干 视敏度 

分 类 号：R779.6[医药卫生—眼科]