黄斑区微结构形态与糖尿病玻璃体积血患者微创玻璃体手术后视力的关系  

Macular microstructure and relation with visual prognosis of micro-invasive vitrectomy for diabetic vitreoushemorrhage

作　　者：孙吉君[1] 柯治生[1] 胡志翔[1] 宋宗明[1] 

机构地区：[1]温州医学院附属眼视光医院,325027

出　　处：《中华眼底病杂志》2013年第1期21-25,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察黄斑区微结构形态与糖尿病玻璃体积血患者微创玻璃体手术后视力的关系。方法回顾性病例系列研究。确诊为糖尿病玻璃体积血并接受微创玻璃体切割手术治疗的45例患者53只眼纳入研究。手术前后行最佳矫正视力（BCVA），手术后同时行频域光相干断层扫描（OCT）检查，检测患眼黄斑区中心凹厚度（CFT）。所有患者随访时间6～36个月，平均随访时间（12．8l±8．22）个月。根据末次随访频域OCT检查所见，以发现黄斑水肿（ME）、视网膜前膜（ERM）及光感受器细胞内外节连接（IS／OS）、外界膜（ELM）中断为黄斑部异常，反之为黄斑部正常。并将其分为ME组、非ME组，ERM组、非ERM组，IS／OS中断组、IS／OS连续组及ELM中断组、ELM连续组。对比分析各组手术后BCVA的差异及黄斑区微结构形态与手术后BCVA的关系。结果末次随访时，患眼CFT为103．00～498．00μm，平均CFT为（251．12±90．23）μm。53只患眼中，黄斑部异常37只眼，占69．8％；黄斑部正常16只眼，占30．2％。黄斑部异常的37只眼中，ME者20只眼，占37．7％；ERM者12只眼，占22．6％；IS／OS中断33只眼，占62．3％；ELM中断20只眼，占37．7％。ME组BCVA较非ME组差，差异有统计学意义（t=-2．09，P〈0．05）；ERM组与非ERM组BCVA间差异无统计学意义（t=-1．10，P〉0．05）；IS／OS中断组BCVA较IS／OS连续组差，差异有统计学意义（t=-4．33，P〈0．05）；ELM中断组BCVA较ELM连续组差，差异有统计学意义（t=-2．58，P〈0．05）。广义线性模型分析结果显示，末次随访时BCVA与IS／OS连续性、是否发生ME及CFT相关（r=9．82、4．99、8．21，P〈0．05）；与ELM连续性、是否发生ERM无明显相关性（r=0．01、0．82，P〉O．05）。结论糖尿病玻璃体积血患者微创玻璃体手术后视力与IS／OS连续性、是否发生ME及CFT相关，与ELM连续性、是Objective To investigate the relationship of macular microstructure and visual prognosis of micro-invasive vitrectomy for diabetic vitreous hemorrhage. Methods Fifty three patients （53 eyes） with diabetic vitreous hemorrhage who underwent micro-invasive vitrectomy were enrolled in this retrospective study. The preoperative and postoperative best-corrected visual acuities （BCVA） were recorded. The central foveal thicknesses （CFT） were measured after surgery by spectral domain-optical coherence tomography （SDOCT）. The median follow-up time was （12. 81 ±8. 22） months, ranging from six to 36 months. According to the results of SD-OCT at last follow-up time, macular edema （ME）, epiretinal membrane （ERM）, interrupted inside and outside section （IS/OS） and interrupted external limiting membrane （ELM） were macular abnormalities were observed. The preoperative and postoperative BCVA of different maeular abnormalities were comparatively analyzed. The correlation between BCVA and macular microstrueture were analyzed. Results The CFT was ranged from 103.00 μm to 498.00 μm, with the mean of（251.12±90.23） μm. Macular abnormalities were observed in 37 eyes （69.8%）, and normal macula in 16 eyes （30.20%）. Among 37 eyes with macular abnormalities, there were 20 eyes （37.7%） with ME, 12 eyes （22.6%） with ERM, 33 eyes （62.3%） with interrupted IS/OS, and 20 eyes （37.7%） with interrupted ELM. The BCVA of ME eyes decreased significantly than that in non-ME eyes （t= -2.09,P〈0.05）. The difference of BCVA in ERM and non-ERM eyes was not statistically significant （t=--1.10, P〉0.05）. The BCVA of interrupted IS/OS eyes decreased significantly more than that in continuous IS/OS eyes （t=--4.33, P〈0.05）. The BCVA of interrupted ELM eyes decreased significantly more than that in continuous ELMeyes （t =2.58, P〈0.05）. The postoperative BCVA correlated positively with integrity of the IS/OS junction, CFT, and whether ME or not （r 7.65, 8.21, 4.99; P〈0.0

关 键 词：糖尿病视网膜病变 并发症 玻璃体出血 外科学 体层摄影术 光学相干 

分 类 号：R77[医药卫生—眼科] R587[医药卫生—临床医学]