异位中心凹内层黄斑前膜分期方案对患者术后视力预后的评估  

Effect of ectopic inner foveal layer staging scheme on the prognosis of patients’postoperative vision outcomes

作　　者：胡旭萌 李晓丽 李苗 黄子旭 张贝贝 魏圆梦 杨琪翔 周佳木 葛可可 李盼 宋宗明 HU Xumeng;LI Xiaoli;LI Miao;HUANG Zixu;ZHANG Beibei;WEI Yuanmeng;YANG Qixiang;ZHOU Jiamu;GE Keke;LI Pan;SONG Zongming(Zhengzhou University People’s Hospital,Henan Provincial People’s Hospital,Henan Eye Hospital,Henan Eye Institution,Zhengzhou 450003,Henan Province,China)

机构地区：[1]郑州大学人民医院,河南省人民医院,河南省立眼科医院,河南省眼科研究所,河南省郑州市450003

出　　处：《眼科新进展》2021年第11期1057-1061,共5页Recent Advances in Ophthalmology

基　　金：河南省医学科技攻关省部共建项目(编号SBGJ2018080);河南省重点研发与推广专项项目(编号192102310075)。

摘　　要：目的探究异位中心凹内层(EIFL)分期方案对特发性黄斑前膜(IMEM)手术患者视力预后的评估。方法本研究纳入确诊为单眼IMEM的79例患者,术后随访6个月以上。所有患者均接受23 G玻璃体切割术,剥除黄斑前膜(MEM)及内界膜,联合超声乳化白内障吸出及人工晶状体植入术。分析患者术前和术后不同EIFL分期与患者最佳矫正视力(BCVA)的差异,以及术前不同EIFL分期与BCVA的相关性。结果根据EIFL分期方案,2期患者15眼(19.0%),3期患者54眼(68.4%),4期患者10眼(12.7%)。与3期、4期患者相比,2期患者术前和术后BCVA均较好(P=0.224、P<0.001)。术后6个月,所有EIFL分期患者的BCVA较术前均有明显提高(均为P<0.05)。EIFL分期与患者术前BCVA、CFT均呈正相关(均为P<0.001),与患者术后6个月BCVA、CFT也呈正相关(均为P<0.001)。术后6个月,46.7%的2期患者中心凹恢复正常形态,3期患者中5.6%改善为2期,4期患者100.0%黄斑区视网膜结构稍改善。随访期间,所有患者均未见明显眼部或全身不良反应。结论EIFL分期方案是评估IMEM手术视力预后的一种简便、快捷、重复性好的方法,有利于患者手术时机的选择。相比3期、4期患者,2期IMEM手术可显著改善患者视力,并增加解剖结构恢复的机会。Objective To evaluate the effect of ectopic inner foveal layers(EIFL)staging scheme on the visual prognosis of patients undergoing idiopathic macular epiretinal membrane(IMEM)surgery.Methods Seventy-nine patients with monocular IMEM were included in this study.They were followed up for at least 6 months after surgery.All of them had undergone 23 G vitrectomy with the macular epiretinal membrane and internal limiting membrane removed,as well as phacoemulsification and intraocular lens implantation.The difference between the preoperative and postoperative EIFL staging and the best corrected visual acuity(BCVA),as well as the correlation between the preoperative EIFL staging and the BCVA were analyzed.Results According to the EIFL staging scheme,15 eyes(19.0%)were diagnosed as stage 2 IMEM,54 eyes(68.4%)as stage 3 IMEM,and 10(12.7%)eyes as stage 4 IMEM preoperatively.Compared with stage 3/4 IMEM patients,stage 2 IMEM patients had better BCVA both preoperatively and postoperatively(P=0.224,P<0.001).Six months after surgery,all patients’final BCVA significantly improved compared with the preoperative values(all P<0.05).EIFL staging was positively correlated with the preoperative and 6-month postoperative BCVA and CFT(all P<0.001).Six months after surgery,46.7%of stage 2 IMEM patients recovered their normal foveal,5.6%of stage 3 IMEM patients improved to stage 2,and all of stage 4 IMEM patients had improved macular retinal structure.During the follow-up visits,no obvious ocular or systemic adverse reactions were found in all patients.Conclusion The EIFL staging scheme is a simple,fast,and reproducible method for assessing the visual prognosis after IMEM surgery,which is instrumental to the timing of surgery.Compared with stage 3/4 IMEM patients,the visual acuity of stage 2 IMEM patients can significantly improve after the IMEM surgery,and their anatomical structure is more easily to recove.

关 键 词：特发性黄斑前膜 异位中心凹内层 光学相干断层扫描 视力 

分 类 号：R774[医药卫生—眼科]