儿童不明原因黄斑前膜的临床特点及手术治疗效果分析  

Clinical characteristics and surgical outcomes of pediatric epiretinal membranes without specific etiologies

作　　者：刘敬花 王倩 李松峰 邓光达 李亮 麻婧 原铭贞 焦永红 卢海 Liu Jinghua;Wang Qian;Li Songfeng;Deng Guangda;Li Liang;Ma Jing;Yuan Mingzhen;Jiao Yonghong;Lu Hai(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心、北京市眼科研究所、北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼科杂志》2024年第1期43-48,共6页Chinese Journal of Ophthalmology

摘　　要：目的探讨儿童不明原因黄斑前膜的临床特点和手术治疗效果。方法回顾性病例系列研究。收集2019年1月至2021年9月在首都医科大学附属北京同仁医院就诊、年龄14岁及以下、因无明显原因黄斑前膜行玻璃体切除手术并随访12个月及以上的14例(17只眼)患者的临床资料,总结和分析患者的就诊年龄和主诉、彩色眼底图像、相干光层析成像术(OCT)特征、手术前和后的视功能、解剖结构预后和并发症。结果14例(17只眼)患者中,女性5例(6只眼),男性9例(11只眼);年龄为(6.31±2.91)岁。术后随访时间为(17.3±9.5)个月。8例(8/14)患者为学校体检发现视力低下;15只眼(15/17)彩色眼底图像示黄斑前膜呈玻璃膜样外观。OCT检查黄斑区视网膜内表面,10只眼(10/17)为Taco褶皱,7只眼(7/17)为Ripple褶皱;5只眼(5/17)黄斑区卵圆体带破坏,12只眼(12/17)黄斑区卵圆体带完整。最佳矫正视力(最小分辨角对数视力)术前为0.532±0.302,术后末次随访为0.340±0.298。术后17只眼黄斑区解剖结构改善,其中1只眼术后随访期间发生外伤性白内障和继发视网膜脱离,再次手术后视网膜复位。结论儿童不明原因黄斑前膜多于学龄期因发现视力低下就诊,多数患者为玻璃膜样外观伴视网膜内表面Taco褶皱改变;玻璃体切除手术有助于恢复患者黄斑解剖结构,并改善患者视功能。Objective To describe clinical characteristics and surgical outcomes of pediatric epiretinal membranes(ERMs)without specific etiologies.Methods Medical data of a cohort of pediatric patients(≤14 years)who had ERMs without specific etiologies,underwent surgical removal from January 2019 to September 2021,and were followed up for at least 12 months were retrospectively reviewed.Age at presentation,chief complaints,color fundus photographs,optical coherence tomographic images,preoperative and postoperative visual acuities,anatomical changes,and postoperative complications were assessed.Results There were 14 patients(17 eyes),including 5 females(6 eyes)and 9 males(11 eyes).The mean age at surgery was 6.31±2.91 years,and the follow-up duration was 17.3±9.5 months.Eight patients were found to have low vision in the school physical examination.Fifteen eyes had an appearance of cellophane macular reflex on fundus images.On optical coherence tomographic images,10 eyes had"taco"folds,and 7 eyes had"ripple"folds.Five eyes had ellipsoid zone disruptions,while 12 eyes had ellipsoid zone integrity.The preoperative and postoperative best-corrected visual acuities in logMAR were 0.532±0.302 and 0.340±0.298.One patient suffered traumatic cataract and secondary retinal detachment postoperatively,and after further vitrectomy,the retina became attached.Conclusion Pediatric ERMs without specific etiologies were mostly found in school-age children with cellophane macular reflex and"taco"folds.Vitrectomy may result in both potential visual acuity and macular anatomical improvements.

关 键 词：视网膜前膜 玻璃体切除术 治疗结果 儿童 

分 类 号：R779.6[医药卫生—眼科]