内界膜剥除预防孔源性视网膜脱离术后黄斑前膜形成的有效性和安全性分析  

Efficacy and safety of internal limiting membrane peeling in preventing epiretinal membrane formation after rhegmatogenous retinal detachment

作　　者：付燕[1] 杨娜[1] 耿任飞 李丽英[1] 张月玲[1] 顾朝辉[1] Fu Yan;Yang Na;Geng Renfei;Li Liying;Zhang Yueling;Gu Zhaohui(Department of Ophthalmology, Baoding First Central Hospital, Baoding 071000, China)

机构地区：[1]河北省保定市第一中心医院眼二科,071000

出　　处：《临床眼科杂志》2021年第1期20-24,共5页Journal of Clinical Ophthalmology

基　　金：保定市科技计划自筹经费项目(1941ZF048)。

摘　　要：目的探讨预防性内界膜(ILM)剥除预防孔源性视网膜脱离(RRD)复位术后黄斑前膜(ERM)发生的有效性和对视力及视网膜结构的影响。方法收纳2016年1月至2018年6月就诊于我院的RRD行玻璃体切割术后成功复位者,共114例(114只眼)纳入研究,根据玻璃体切割术中是否行ILM剥除分为ILM剥除组和无ILM剥除组。所有受检者行23G玻璃体切割联合硅油眼内填充,视网膜成功复位者均于玻切术后3~5个月行硅油取出术。术前及玻璃体切割术后1、3、6、12个月进行复查,至末次随访。比较两组间视力和黄斑区微结构的改变包括中央视网膜厚度(CRT)、椭圆体带(EZ)和外界膜(ELM)连续性,是否存在黄斑水肿及视网膜下液(SRF)。结果术后114只眼中ERM形成者19只眼,占16.7%。94.7%ERM形成者发生于术后6个月内。术后3、6、12个月,组间ERM形成率差异有统计学意义(均P<0.05)。两组患者术后1、3、6、12个月BCVA较术前均明显提高,差异有统计学意义(均P<0.05)。术后不同时间点BCVA的组间比较差异无统计学意义。ERM形成和未发生ERM者logMAR BCVA分别为(0.59±0.31、0.31±0.28),差异有统计学意义(t=-2.341,P<0.05)。两组间CRT、EZ、ELM连续性、黄斑水肿和SRF发生率比较无统计学意义。结论预防性ILM剥除可有效预防RRD术后ERM发生,且对视力和视网膜微结构改变无影响。Objective To investigate the effectiveness of prophylactic internal limiting membrane(ILM)peeling in the prevention of epimacular membrane(ERM)after rhegmatogenous retinal detachment(RRD)reduction,as well as its effect on visual acuity and retinal structure.Methods A total of 114 consecutive patients(114 eyes)with rhegmatogenous retinal detachment successfully treated with vitrectomy in our hospital from 2016 to 2018 were retrospectively analyzed.The patients were divided into the ILM peeling group(49 eyes)and non-ILM peeling group(65 eyes),according to whether or not the ILM was removed during vitrectomy.All patients underwent 23g vitrectomy combined with silicone oil tamponade,and silicone oil removal was performed at 3~5 months after the surgery.The patients were reexamined before operation and at 1,3,6 and 12 months after vitrectomy.The best corrected visual acuity(BCVA)and macular microstructures,including central retinal thickness(CRT),ellipsoid zone(EZ),external limiting membrane(ELM)continuity,macular edema and subretinal fluid(SRF)were compared between the two groups.Results s Among 114 eyes,ERM was formed in 19 eyes(4 eyes in the ILM peeling group and 15 eyes in non-ILM peeing group),and 94.7%of ERM occurred within 6 months after the surgery.The prevalence of ERM formation was significantly higher in the non-ILM peeing group than the ILM peeling group at 3,6 and 12 months after the surgery(P<0.05).The BCVA of the two groups at 1,3,6 and 12 months after the surgery was significantly better than that before the surgery,and the difference was statistically significant(P<0.05).There was no significant difference in BCVA at different time points after the surgery.The BCVA for participants with ERM and without ERM was(0.59±0.31 and 0.31±0.28),respectively with statistically significant difference(t=-2.341,P<0.05).No difference was observed in CRE,EZ,ELM continuity,macular edema or SRF between the two groups.Conclusions Prophylactic ILM peeling can effectively prevent the occurrence of ERM formation after RR

关 键 词：孔源性视网膜脱离 黄斑前膜 内界膜剥除 视力 玻璃体切割术 

分 类 号：R47[医药卫生—护理学]