内界膜剥除联合玻璃体内注射曲安奈德治疗继发性黄斑前膜的疗效观察  

Efficacy of retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide for secondary epiretinal membrane

作　　者：王丽英[1] 李洁[1] 温晓英[1] 张月玲[1] 

机构地区：[1]保定市第一中心医院眼科,河北省保定市071000

出　　处：《眼科新进展》2017年第8期763-765,共3页Recent Advances in Ophthalmology

摘　　要：目的观察内界膜剥除联合玻璃体内注射曲安奈德治疗继发性黄斑前膜的疗效。方法回顾性分析我院2011年6月至2015年6月因继发性黄斑前膜需行玻璃体视网膜手术者42例42眼,所有患者均行标准的23 G经睫状体平坦部的三通道玻璃体切割+黄斑前膜剥除+视网膜内界膜剥除+玻璃体内注射曲安奈德术,术后随访3.0~18.0(8.3±2.4)个月,对手术前后最佳矫正视力、黄斑形态及手术并发症等进行观察。结果随访期末,最佳矫正视力提高者30眼,不变者8眼,下降者4眼;术后最佳矫正视力与术前相比,差异有统计学意义(t=3.145,P=0.000)。黄斑中心神经上皮层厚度术前为(315.62±132.12)μm,术后为(233.42±146.32)μm,手术前后相比差异有统计学意义(t=4.322,P=0.000)。术后视网膜少许出血6眼,玻璃体积血1眼,一过性高眼压6眼;3眼周边牵引性小裂孔,激光治疗后,行玻璃体内C_3F_8填充,视网膜在位。结论玻璃体内注射曲安奈德可以加速黄斑水肿消退,降低黄斑前膜复发,促进视功能恢复。视网膜内界膜剥除在继发性黄斑前膜手术中可以松解黄斑区视网膜皱褶,解除对黄斑中心凹的牵引,改善黄斑区局部的代谢,有利于黄斑功能的恢复。Objective To observe the efficacy of retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide for secondary epiretinal membrane.Methods Forty-two patients （42 eyes） with secondary epiretinal membrane underwent vitretinal surgery in our hospital from June 2011 to June 2015 were retrospectively studied.All patients underwent pars plana vitrectomy＋epiretinal membrane peeling＋retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide.The follow-up time was from 3.0 months to 18.0 months,averaged （8.3±2.4）months.Postoperative best corrected visual acuity （BCVA）,macular morphology and complications were observed.Results At the final follow-up,BCVA improved in 30 eyes,unchanged in 8 eyes and decreased in 4 eyes,and there was significant difference compared with that before operation （t=3.145,P=0.000）.The preoperative and postoperative thickness of meuroepithelium in the centual macular area were（315.62±132.12）μm and （233.42±146.32）μm,and there was significant difference（t=4.322,P=0.000）.Small amount of retinal hemorrhage happened in 6 eyes after operation,vitreous hemorrhage was in 1 eye,transient high intraocular pressure was in 6 eyes;Prepheral retinal hole occurred in 3 eyes,which were cured by laser treatment and C3F8 tamponade.Conclusion Intravitreal injection of triamcinolone acetonide can reduce the macular edema,decrease the reoccurrence of epiretinal membrane and imporve the visual acuity.The retinal inner limiting membrane peeling in secondary macular epiretinal membrane surgery can release the macular pucker,lifting and traction on the fovea,improve the metabolism of macular local,is conducive to the recovery of macular function.

关 键 词：玻璃体内注射 曲安奈德 继发性黄斑前膜 内界膜剥除 

分 类 号：R774.5[医药卫生—眼科]