非玻璃体切割与玻璃体切割手术治疗特发性黄斑前膜的疗效比较  

Comparison of therapeutic effects of non-vitrectomy versus vitrectomy for idiopathic epiretinal membrane

作　　者：侯亚南 王沁 田青山 犹爱林 王一 Hou Yanan;Wang Qin;Tian Qingshan;You Ailin;Wang Yi(Hefei Aier Eye Hospital,Hefei 340000,China;Chongqing Aier Eye Hospital,Chongqing 400038,China)

机构地区：[1]合肥爱尔眼科医院,合肥340000 [2]重庆爱尔眼科医院,重庆400038

出　　处：《中华眼底病杂志》2022年第10期799-804,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的对比观察玻璃体切割手术(PPV)和非PPV(NVS)治疗特发性黄斑前膜(IMEM)的疗效。方法前瞻性随机对照临床研究。2019年4月至2020年5月于重庆爱尔眼科医院检查确诊的IMEM患者21例21只眼纳入研究。其中,男性11例11只眼,女性10例10只眼。所有患眼均行最佳矫正视力(BCVA)、光相干断层扫描血管成像(OCTA)检查以及角膜、眼内及全眼像差测量。采用国际标准对数视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力。采用iTrace视功能分析仪测量患眼角膜、眼内及全眼像差,计算晶状体功能失调指数(DLI)。采用Pentacam三维眼前节分析诊断系统计算Scheimpflug图像中的晶状体密度。采用OCTA仪对患眼黄斑区6 mm×6 mm范围进行扫描,软件自动将黄斑区划分为以中心凹为中心的3个同心圆,分别是直径1 mm的中心区,1~3 mm的内环区,3~6 mm的外环区,测量黄斑区整体、中心区、内环区、外环区血流密度(SVD)和血流灌注(SPD)。采用随机数字表法将患者分为PPV联合黄斑前膜(MEM)剥除组(PPV组)和NVS直接剥除MEM组(NVS组),分别为10例10只眼、11例11只眼。两组患者年龄(t=-0.72)、logMAR BCVA(t=-0.98)、晶状体密度(t=-1.10)、DLI(t=1.15)、黄斑区整体SVD(t=0.82)和SPD(t=1.19)、角膜像差(t=0.45)、眼内像差(t=-0.22)、全眼像差(t=0.83)比较,差异均无统计学意义(P>0.05)。所有患眼均采用27G玻璃体切割系统进行手术。NVS组患眼NVS条件下剥除MEM,PPV组患眼PPV条件下剥除MEM,同时记录手术时间。手术后随访时间12个月。采用手术前相同设备和方法行相关检查。以末次随访为疗效判定时间点,对比观察两组患眼BCVA、晶状体混浊程度、DLI、视觉质量、黄斑区SVD和SPD以及MEM复发情况。两组各指标比较采用配对t检验。结果PPV组、NVS组患眼手术时间分别为(20.81±3.52)、(5.70±1.30)min,差异有统计学意义(t=7.23,P<0.001)。末次随访时,PPV组、NVS组患�Objective To compare the efficacy of pars plana vitrectomy(PPV)and nonvitrectomizing vitreous surgery(NVS)in the treatment of idiopathic epimacular membrane(IMEM).Methods A prospective,randomized and comparative clinical study.From April 2019 to May 2020,21 eyes of 21 patients with IMEM diagnosed in Chongqing Aier Eye Hospital were included in the study.Among them,11 males had 11 eyes,and 10 females had 10 eyes.Best-corrected visual acuity(BCVA),optical coherence tomography angiography(OCTA),and corneal,intraocular,and global aberration measurements were performed in all eyes.The international standard logarithmic visual acuity chart was used for BCVA examination,and the visual acuity was converted into logarithm of minimum angle of resolution(logMAR)during statistics.The iTrace visual function analyzer was used to measure the corneal,intraocular and whole ocular aberrations,and the dysfunction lens index(DLI)was calculated.Lens density in Scheimpflug images was calculated using Pentacam three-dimensional anterior segment analysis and diagnosis system.The 6 mm×6 mm area of the macular area was scanned by OCTA,which was divided by the software automatically into three concentric circles with the fovea as the center,namely the central area with a diameter of 1 mm,the inner ring area with a diameter of 1-3 mm,The outer ring area of 3-6 mm was used to measure the superficial vessel density(SVD)and superficial perfusion density(SPD)of the entire macular area,the central area,the inner ring area,and the outer ring area.The patients were divided into PPV combined with epimacular membrane(MEM)peeling group(PPV group)and NVS direct peeling MEM group(NVS group)by random number table method,10 cases with 10 eyes and 11 cases with 11 eyes,respectively.The age of the two groups(t=-0.72),logMAR BCVA(t=-0.98),lens density(t=-1.10),DLI(t=1.15),SVD(t=0.82)and SPD(t=1.19)of entire macular area,corneal aberration(t=0.45),intraocular aberration(t=-0.22),and whole eye aberration(t=0.83),there was no significant difference(P>0.05).Al

关 键 词：玻璃体切除术 玻璃体视网膜手术 黄斑前膜 

分 类 号：R779.6[医药卫生—眼科]