不同类型黄斑前膜术后黄斑区形态结构和视力变化的比较  

Comparison of morphological structure and visual acuity changes after surgery for different types of macular epiretinal membranes

作　　者：郭姝蓉 李冬莉[1] 崔忆辛[1] 代梦欢 饶玲娜 李齐瑞 袁玲[1] Guo Shurong;Li Dongli;Cui Yixin;Dai Menghuan;Rao Lingna;Li Qirui;Yuan Ling(Department of Ophthalmology,the First Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]昆明医科大学第一附属医院眼科,昆明650000

出　　处：《中华眼外伤职业眼病杂志》2023年第12期893-899,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：国家自然科学基金项目(82260207);云南省科学技术厅应用基础研究基金(202201AY070001-036)。

摘　　要：目的比较不同类型黄斑前膜手术后的黄斑区形态结构情况和视力变化。方法前瞻性队列研究。连续纳入昆明医科大学第一附属医院眼科2022年9月至2023年3月黄斑前膜33例(33只眼),所有患者行玻璃体切除联合黄斑前腹及内界膜剥除术,其中无其他眼部疾病或仅存玻璃体后脱离的特发性黄斑前膜(IERM)18例(18只眼)为A组,而并存其他眼部疾病的继发性黄斑前膜15例(15只眼)为B组。观察两组患者术前,术后1、3及6个月的最佳矫正视力(BCVA)。采用光学相干断层扫描血管成像(OCTA)测量黄斑中心区厚度(CMT)和黄斑中心凹无血管区面积(FAZ)的变化。结果与术前相比较两组患眼术后1、3及6个月BCVA均有明显改善(F=18.03,P<0.001),CMT明显变薄(F=22.43,P<0.001),OCTA显示FAZ面积有一定程度增加(F=7.46,P=0.001);而两组间治疗后1、3及6个月BCVA比较差异有统计学意义(F=8.12,P<0.001);CMT、FAZ比较差异无统计学意义(F=0.04、0.01,P=0.855、0.960)。多因素回归分析显示黄斑前膜类型(特发性或继发性),CMT及术后恢复时间均对BCVA有明显影响(均P<0.01);术后恢复时间对术后CMT有明显影响(P<0.001),而黄斑前膜类型(特发性或继发性)对其无明显影响(P=0.747)。结论特发性黄斑前膜患者术后视力恢复总体优于继发性黄斑前膜患者;黄斑前膜术后1个月内是视力及黄斑中心凹结构恢复最快速的重要时期。Objective To compare the changes of macular morphology structure and visual acuity after surgery for different types of epiretinal membranes(ERM).Methods This was a prospective cohort study.A total of 33 patients(33 eyes)with ERM admitted to the First Affiliated Hospital of Kunming Medical University from Sep.2022 to Mar.2023 were included.All patients underwent pars plana vitrectomy(PPV)ERM and internal limiting membrane(ILM)peeling,with 18 eyes of idiopathic epiretinal membranes(IERM)in group A without other ocular diseases or only posterior vitreous detachment and 15 eyes of secondary ERM in group B with other ocular diseases.Best corrected visual acuity(BCVA),central macular area thickness(CMT)and foveal avascular zone(FAZ)area mesured by optical coherence tomography angiography(OCTA)were observed preoperatively and at 1,3 and 6 months after surgery,and the differences were compared between the two groups.Results Compared with preoperative data,BCVA improved at 1,3 and 6 months after operation in both groups(F=18.03,P<0.001).CMT thinned significantly(F=22.43,P<0.001)and the FAZ area showed by OCTA was significantly enlarged(F=7.46,P=0.001).BCVA at 1,3 and 6 months after treatment were significantly different between the two groups(F=8.12,P<0.001).There were no significant differences in CMT or FAZ between the two groups at 1,3 and 6 months after treatment(F=0.04,0.01;P=0.855,P=0.960).Also,it was found that the type of ERM(idiopathic/secondary),CMT thickness and postoperative recovery time had significant effects on postoperative BCVA(all P<0.01).Postoperative recovery time had significant influence on postoperative thickness of CMT(P<0.001),while the type of ERM(idiopathic/secondary)had no significant influence on it(P=0.747).Conclusion There are obvious differences in recovery of postoperative visual acuity among different aetiologies of ERM.The recovery of visual acuity in IERM is better than that in secondary epiretinal membranes.It is an important period for visual acuity and macular foveal structure to r

关 键 词：视网膜前膜 玻璃体切除术 光学相干断层扫描血管成像 

分 类 号：R779.6[医药卫生—眼科]