内界膜剥除治疗顽固性糖尿病性黄斑水肿的疗效以及对视功能的影响  

Effect of inner limiting membrane peeling on refractory diabetic macular edema and visual function

作　　者：苏锐锋[1] 李晓红[1] 李新秀 谭小波[1] SU Ruifeng;LI Xiaohong;LI Xinxiu;TAN Xiaobo(Department of Ophthalmology,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院眼科,河北承德067000

出　　处：《实用医学杂志》2021年第14期1811-1814,共4页The Journal of Practical Medicine

基　　金：河北省自然科学基金项目(编号:H2020406019);承德市自筹经费项目(编号:202006A037)。

摘　　要：目的观察玻璃体切割(PPV)联合或不联合内界膜剥除治疗顽固性糖尿病性黄斑水肿(DME)的疗效及对视功能的影响。方法回顾性分析我院2018年5月至2020年5月确诊为顽固性DME并接受PPV联合或不联合内界膜剥除的患者40例,其中PPV联合内界膜剥除的患者20例作为联合组,不联合内界膜剥除的患者20例作为对照组。比较两组患者术前,术后1、3、6个月最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CMT)、黄斑视网膜敏感度(RMS)、固视稳定性及并发症。结果末次随访时,两组患者BCVA较术前提高(均P<0.05),联合组BCVA优于对照组(P<0.05)。治疗后1个月两组CMT较同组治疗前均下降(均P<0.05);1个月、3个月、6个月时,联合组CMT较对照组薄(均P<0.05)。联合组患者患眼术后RMS增加(P<0.05);术后6个月,联合组的对侧眼RMS优于术眼(P<0.05)。治疗后联合组术眼固视稳定性提高,但与术前比较差异无统计学意义(P>0.05)。结论治疗顽固性DME时采用PPV联合内界膜剥除术,能更有效提高患者BCVA及降低CMT,一定程度上提高固视稳定性。Objective To observe the effect of pars plana vitrectomy(PPV)combined with or without inner limiting membrane peeling in the treatment of refractory diabetic macular edema(DME)and its effect on visual function.Method We conducted a retrospective analysis of 40 patients with refractory DME diagnosed in our hospital from May 2018 to May 2020 who received PPV combined with or without inner limiting membrane peeling,including 20 patients received PPV combined with inner limiting membrane peeling as the combination group,and 20 patients received PPV combined without inner limiting membrane peeling as the control group.The best corrected visual acuity(BCVA),central macular thickness(CMT),retinal mean sensitivity(RMS),fixation stability and complications were compared between the two groups.Result In the last follow⁃up,BCVA of the two groups was significantly higher than that before operation(P<0.05),and BCVA of the combination group was better than that of the control group(P<0.05).The CMT of the combined group and the control group decreased 1 month after the operation(P<0.05);at 1,3 and 6 month,the CMT in the combination group was thinner than that in the control group(P<0.05).The RMS of the combined group increased after surgery(P<0.05),and the RMS of the contralateral eye in the combination group was better than that in the surgical eye 6 month after operation(P<0.05).After treatment,the fixation stability of the combined group was improved,but the difference was not statistically significant(P>0.05).Conclusion In the treatment of refractory DME,PPV combined with inner limiting membrane peeling can effectively improve BCVA and reduce CMT and improve fixation stability to a certain extent.

关 键 词：内界膜剥除 玻璃体切割术 顽固性糖尿病性黄斑水肿 微视野 黄斑中心视网膜厚度 

分 类 号：R774.1[医药卫生—眼科]