特发性黄斑前膜患眼黄斑中心凹形态对手术预后的影响  

Foveal contour as a significant predictor of surgical outcome in idiopathic epiretinal membrane

作　　者：毛剑波[1] 许维馨 陈亦棋[1] 张赟[1] 祝晨婷 陶继伟[1] 沈丽君[1] 

机构地区：[1]温州医科大学附属眼视光医院杭州院区,310020

出　　处：《中华眼底病杂志》2016年第5期486-490,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：十二五国家科技支撑计划项目（2012BA108802）;浙江省医药卫生平台项目（2016RCB012）

摘　　要：目的观察黄斑中心凹形态对特发性黄斑前膜（iERM）患眼手术预后的影响。方法回顾性研究。临床确诊为iERM并行玻璃体切割联合黄斑前膜及内界膜剥除手术治疗的52例患者53只眼纳入研究。所有患者均行最佳矫正视力（BCVA）及光相干断层扫描（OCT）检查。BCVA检查采用国际标准对数视力表进行，并将结果转换为最小分辨角对数（logMAR）视力记录。OCT水平径向扫描图像上测量黄斑中心凹厚度（CMT）和距其1mm处的视网膜厚度，根据两者比值对iERM的黄斑中心凹形态进行定量分级。0级：凹陷型；1级：平坦型；2级：隆起型。53只眼中，1级（1级组）28只眼，2级（2级组）25只眼。1、2级组患眼平均logMARBCVA分别为0．40±0．26、0．60±0．27；平均CMT分别为（433．52±133．05）、（571．70±85．40）μm。两组患眼平均logMARBCVA、CMT比较，差异有统计学意义（t=-2．825、-4．512，P〈0．05）。手术后1、3个月重复行BCVA及OCT检查。对比观察患眼手术前后黄斑中心凹形态分级、logMARBCVA及CMT变化情况。分析手术前黄斑中心凹形态与手术早期预后的关系。结果手术后3个月，黄斑中心凹形态分级为0级15只眼，1级21只眼，2级17只眼。手术前后黄斑中心凹形态分级分布情况比较，差异有统计学意义（Z=-3．588，P〈0．05）。1级组患眼手术后3个月黄斑中心凹形态分级为0、1、2级各有12、10、6只眼；2级组患眼手术后3个月黄斑中心凹形态分级为0、1、2级各有3、11、11只眼。1、2级组患眼手术后3个月黄斑中心凹形态分级分布情况比较，差异有统计学意义（Z=-2．466，P〈0．05）。手术后1、3个月，1（t=-3．226、-5．439）、2级（t=-4．137、-5．919）组患眼平均logMARBCVA均较手术前明显提高，差异有统计学意义（P〈0．05）。1、2级组患眼手术后1、3个月平均logMARBCVA比较，差异有统计学意义（t=-2．Objective To observe the foveal contour characteristic of idiopathic epiretinal membrane （iERM）. Methods A total of 53 eyes in 52 patients with iERM who underwent pars plana vitrectomy with epiretinal membrane and inner limiting membrane peeling were enrolled in this retrospective study. All eyes received the examination of optical coherence tomography （OCT） and minimum resolution angle in logarithmic （logMAR） best corrected visual acuity （BCVA）. Foveal contour grading was according to the ratio of central macular thickness （CMT） to the thickness of the retina 1 mm away on OCT line scan： Grade 0, depressed; Grade 1, flat; Grade 2, elevated. Baseline foveal contour grade was as follows： 28 eyes with Grade 1 （Group 1）, and 25 eyes with Grade 2 （Group 2）. The mean logMAR BCVA was 0.40±0.26 in Group 1, and 0. 60±0. 27 in Group 2 respectively. The mean CMT was （433.52±133.05） μm and （571.70± 85.40） μm respectively. The logMAR BCVA and CMT both demonstrated significant difference between the two groups （t= -2. 825, -4. 512; P〈0.05）. OCT images and BCVA at 1, 3 months after surgery were collected and analyzed. The change in foveal contour, BCVA and CMT were evaluated. The relationship between surgical outcome and different preoperative grading was analyzed. Results Foveal contour grade at 3 months after surgery was as follows： 15 eyes with Grade 0, 21 eyes with Grade 1, and 17 eyes with Grade 2, demonstrating significant difference compared with baseline （Z=- 3. 588, P〈0.05）. In Group 1, there were 12 eyes with Grade 0, 10 eyes with Grade 1, and 6 eyes with Grade 2 postoperatively. In Group 2, there were 3 eyes with Grade 0, 11 eyes with Grade 1, and 11 eyes with Grade 2 postoperatively. The postoperative foveal contour grade was significantly different between the two groups （Z=-2. 466, P〈0.05）. The logMAR BCVA at 1, 3 months after surgery both improved significantly compared with baseline （P〈0.05） in Group 1 （t=-3.226, -5.439） and Group 2 （

关 键 词：黄斑 膜 玻璃体视网膜手术 体层摄影术 光学相干 

分 类 号：R779.6[医药卫生—眼科]