特发性视网膜前膜与血管旁内层视网膜异常(PIRA)的关系以及前膜剥除手术对PIRA的影响  

Correlation analysis between IERM and PIRA and effect of epiretinal membrane stripping surgery on PIRA

作　　者：李文鹏 刘昕笛 廖丁莹 姚静[1] 刘倩影[1] 郑玉萍[1] LI Wenpeng;LIU Xindi;LIAO Dingying;YAO Jing;LIU Qianying;ZHENG Yuping(Department of Ophthalmology,the Second Affiliated Hospital,Medical College of Xi’an Jiaotong University,Xi’an 710004,Shaanxi Province,China;Department of Clinical Medicine,Zhejiang University School of Medicine,Hangzhou 310000,Zhejiang Province,China)

机构地区：[1]西安交通大学医学院第二附属医院眼科,陕西省西安市710004 [2]浙江大学医学院临床医学系,浙江省杭州市310000

出　　处：《眼科新进展》2020年第4期362-364,368,共4页Recent Advances in Ophthalmology

基　　金：陕西省自然科学基金资助(编号2017JM8074)。

摘　　要：目的探讨特发性视网膜前膜(idiopathic epiretinal membrane,IERM)和血管旁内层视网膜异常(paravascular inner retinal abnormalities,PIRA)的关系以及前膜剥除手术对PIRA的影响。方法收集2017年11月至2018年5月在西安交通大学第二附属医院就诊的IERM患者49例49眼。将21例同时具有IERM和PIRA的患者作为PIRA病变组;28例有IERM但不伴有PIRA的患者作为对照组。每例患者行光学相干断层扫描检查,检测黄斑部视网膜厚度(macular retinal thickness,MRT)和PIRA病变等级,分析两组间MRT的差异;对于接受视网膜前膜剥除手术的患者,比较手术前后MRT和PIRA病变的变化情况。结果PIRA病变组患者MRT为(250.05±54.34)μm,对照组为(218.89±17.64)μm,PIRA病变组MRT大于对照组,差异有统计学意义(t=2.529,P<0.05)。PIRA病变组中,8眼为1级病变,6眼为2级病变,7眼为3级病变。1级病变组患者MRT小于对照组,但差异无统计学意义(P>0.05);2级病变组及3级病变组患者MRT均大于对照组,差异均有统计学意义(均为P<0.05)。15眼IERM伴有牵拉性黄斑水肿的患者接受玻璃体切除+黄斑前膜剥除+内界膜剥除术,手术后伴有PIRA的IERM患者黄斑水肿消退且PIRA亦消失。结论2级以上PIRA病变与IERM显著相关,并可通过前膜剥除手术修复病变,提示PIRA病变的加重与IERM对视网膜的切向牵拉力有关。Objective To investigate the relationship between idiopathic epiretinal membrane(IERM)and paravascular inner retinal abnormalities(PIRA)and the effect of epiretinal membrane stripping surgery on PIRA.Methods Totally 49 eyes of 49 IERM patients who received treatment in the Second Affiliated Hospital of Xi'an Jiaotong University from November 2017 to May 2018 were collected.Twenty-one patients with both IERM and PIRA were selected as the PIRA lesion group;another 28 patients with IERM but not accompanied by PIRA were collected as the control group.Each patient underwent optical coherence tomography to detect macular retinal thickness(MRT)and grade of PIRA lesions,and analyze the difference in MRT between the two groups.For patients undergoing epiretinal membrane stripping surgery,changes of MRT and PIRA lesions were compared between before and after surgery.Results The MRT was(250.05±54.34)μm of patients in the PIRA lesion group,which was higher than(218.89±17.64)μm for patients in control group,and the difference was statistically significant(t=2.529,P<0.05).In the PIRA lesion group,8 eyes had grade 1 lesions,6 eyes grade 2 lesions,and 7 eyes grade 3 lesions.The MRT in patients with grade 1 lesion group was less than that in the control group,but the difference was not statistically significant(P>0.05);patients with grade 2 lesions and grade 3 lesions had larger MRT than the control group,and the differences were statistically significant(both P<0.05).Fifteen eyes of IERM patients with referred macular edema underwent vitrectomy+epiretinal membrane stripping+internal limiting membrane ablation.Macular edema subsided and PIRA disappeared in IERM patients with PIRA after surgery.Conclusions PIRA at grade 2 and above is significantly associated with IERM and could be repaired by epiretinal membrane stripping surgery,suggesting that the exacerbation of PIRA lesions is related to the tangential pull of the IERM on the retina.

关 键 词：血管旁内层视网膜异常 特发性视网膜前膜 黄斑部视网膜厚度 

分 类 号：R774[医药卫生—眼科]