基于OCT分型的特发性黄斑前膜经25G玻璃体切除术后的疗效评估和比较  

Evaluation and comparison of the efficacy of 25 gauge vitrectomy based on optical coherence tomography classification of the epiretinal membrane

作　　者：郑洁[1] 许亚静[1] 李小凤 刘伦[1] Zheng Jie;Xu Yajing;Li Xiaofeng;Liu Lun(Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China)

机构地区：[1]安徽医科大学第一附属医院眼科,合肥230022

出　　处：《临床眼科杂志》2021年第4期299-302,共4页Journal of Clinical Ophthalmology

摘　　要：目的分析和比较相干光层析成像术(OCT)不同分型的特发性黄斑前膜(IMEM)患者经25G玻璃体切除术后视力及黄斑区视网膜厚度的变化。方法回顾性病例研究。收集安徽医科大学第一附属医院2018年6月至2020年3月经眼底检查、相干光层析成像术(OCT)确诊为IMEM的患者68例(70只眼)的临床资料。所有患者均接受25G经睫状体平坦部玻璃体切除(PPV)联合黄斑前膜剥除及内界膜剥除术(ILM)。根据患者术前黄斑中心凹OCT形态的不同,经过定量测量后将所有IMEM患者分为3型:分别为凹陷型、平坦型及隆起型。每型为1组,检查3组患者术前、术后的最佳矫正视力(BCVA)以及黄斑中心凹视网膜厚度(CMT)。对比患眼术前及术后1个月、3个月、6个月BCVA、CMT的变化情况,分析各分型IMEM术后不同时间点视力与黄斑厚度的变化趋势,比较各分型IMEM术后视力和黄斑厚度的改善程度。结果组内比较:除凹陷组术后第3个月平均logMAR BCVA外,余各组患者在手术后3次随访的平均logMAR BCVA与术前比较均降低,且差异有统计学意义(P<0.001)。各组患者在手术后3次随访的平均CMT与术前比较均降低,且差异均有统计学意义(P<0.001)。组间比较:术后第6个月与术前平均logMAR BCVA变化值,组间差异无统计学意义(P>0.05)。术后第6个月与术前平均CMT变化值,组间差异无统计学意义(P>0.05)。结论各型IEME患者术后视力均提高,CMT均降低。不同分型患者术后视力提高程度和厚度改善无明显差异。Objective To analyze and compare the changes of visual acuity and macular retinal thickness after 25G vitrectomy combined with membrane peeling surgery based on optical coherence tomography(OCT)classification of the idiopathic macular epiretinal membrane(IMEM).Methods The clinical data of 68 patients(70 eyes)with IMEM diagnosed by fundus examination and OCT at the First Affiliated Hospital of Anhui Medical University from June 2018 to March 2020 were collected for this retrospective study.All patients underwent 25G pars plana vitrectomy(PPV)combined with macular epiretinal membrane and internal limiting membrane(ILM)peeling.According to the quantitative preoperative measurement of different OCT morphology in the macular fovea,all IMEM patients were divided into three groups based on its type,namely the depressed type,flat type and elevated type.The best corrected visual acuity(BCVA)and macular fovea retinal thickness(CMT)of patients in the three groups were examined before and after the surgery.The changes of BCVA and CMT before the surgery and at 1 month,3 months and 6 months after the surgery for each IMEM type were compared,and the extent of improvement of visual acuity and macular thickness at different time points after the operation for each IMEM type was analyzed.Results Except for the depressed group,the average logMAR BCVA during the three follow-ups after the surgery in the other groups were lower than that before the surgery,and the difference was statistically significant(P<0.001).The average CMT of patients at three follow-ups after the surgery in each group was lower than that before the surgery,and the difference was statistically significant(P<0.001).The inter-group difference regarding the changes of average logMAR BCVA and average CMT at 6 months after the surgery and before the surgery were not statistically significant(P>0.05).Conclusions The postoperative visual acuity was improved and the CMT was decreased in all types of IMEM patients.There were no significant differences in the improvement

关 键 词：相干光层析成像术 特发性黄斑前膜 玻璃体切除术 视力 黄斑中心凹视网膜厚度 

分 类 号：R73[医药卫生—肿瘤]