中华眼底病杂志

中华眼底病杂志

特发性黄斑前膜患眼玻璃体切割联合内界膜剥除手术前后视力和视物变形度与黄斑形态结构的相关性

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目的 观察特发性黄斑前膜(IEM)患眼玻璃体切割联合内界膜剥除(ILMP)手术前后视力视物变形度与黄斑形态结构的相关性。 方法 回顾性系列病例研究。临床确诊为IEM并接受玻璃体切割联合ILMP手术治疗的47例患者49只眼纳入研究。手术前后均采用国际标准视力表检查患眼最佳矫正视力(BCVA),并将结果转换为最小分辨角对数视力进行记录;采用视物变形评分表检测患眼视物变形值(M值);采用光相干断层扫描检测患眼黄斑中心视网膜厚度(CMT)、内核层厚度(INT)、内层视网膜厚度(IRT)及外层视网膜厚度(ORT);同时观察患眼的椭圆体带(EZ)完整性。以手术后12个月为疗效判定时间点,对比分析手术前后患眼BCVA、M值、CMT、INT、IRT、ORT及EZ完整性的变化情况。同时分析手术前后BCVA、M值与CMT、MV、INT、IRT、ORT、EZ完整性的相关性。 结果 与手术前比较,手术后12个月患眼平均BCVA明显提高(F=6.133),平均M值、CMT、INT、IRT、ORT均明显降低(F=12.481、10.565、15.739、6.046、10.569),差异均有统计学意义(P<0.001)。手术后12个月患眼EZ完整性较手术前明显改善,差异有统计学意义(χ2=12.309,P<0.001)。相关性分析结果显示,手术前BCVA与手术前CMT(r=0.720)、ORT(r=0.887)呈正相关(P<0.05);与手术前EZ完整性呈负相关(r=−0.291,P<0.05);与手术前INT(r=0.208)、IRT(r=0.274)无相关性(P>0.05)。手术后BCVA与手术前BCVA(r=0.774)以及手术后CMT(r=0.754)、ORT(r=0.842)呈正相关(P<0.05);与手术后EZ完整性呈负相关(r=−0.676,P<0.05);与手术后INT(r=0.186)、IRT(r=0.280)无相关性(P>0.05)。手术前M值与手术前CMT(r=0.931)、INT(r=0.668)、IRT(r=0.840)、ORT(r=0.637)呈正相关(P<0.05);与手术前EZ完整性无相关性(r=−0.100,P>0.05)。手术后M值与手术前M值(r=0.723)及手术后CMT(r=0.722)、INT(r=0.767)、IRT(r=0.825)、ORT(r=0.387)呈正相关(P<0.05);与手术后EZ完整性无相关性(r=−0.248,P>0.05)。 结论 IEM患眼经玻璃体切割联合ILMP手术后视力、视物变形度及黄斑形态结构均有改善;手术前后视力、视物变形度与黄斑形态结构明显相关。

Objective To analyze the correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling (ILMP) in idiopathic macular epiretinal membrane (IMEM) eyes. Methods This is a retrospective case series of 47 IMEM patients (49 eyes). All the patients underwent 25G pars plana vitrectomy with IMEM removal and ILMP. The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The severity of metamorphopsia was measured using M-charts. The central macular thickness (CMT), inner nuclear layer thickness (INT), inner retinal layer thickness (IRT), outer retinal layer thickness (ORT), the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT, INT, IRT, ORT and status of EZ before and after surgery were analyzed, so did the correlations between these indexes at the same time. Results Compared with baseline, the postoperative BCVA was significantly increased (F=6.133, P<0.001), but the M value, CMT, INT, IRT, ORT were significantly decreased (F=12.481, 10.565, 15.739, 6.046, 10.569; P<0.001);the integrity of EZ was improved significantly (χ2=12.309, P<0.001). Preoperative BCVA was positively related to the CMT (r=0.720) and ORT (r=0.720, 0.887; P<0.05), while negatively related to preoperative integrity of EZ (r=−0.295, P<0.05). The postoperative BCVA was positively related to the preoperative BCVA and postoperative CMT, ORT (r=0.774, 0.754, 0.842; P<0.05), while negatively related to postoperative integrity of EZ (r=−0.676, P<0.05). The preoperative M value was positively related to the preoperative CMT, INT, IRT, and ORT (r=0.931, 0.668, 0.840, 0.637; P<0.05). The postoperative M value was positively related to the preoperative M value and postoperative CMT, INT, IRT, and ORT (r=0.723, 0.722, 0.767, 0.825, 0.387; P<0.05). Conclusions Vitrectomy with ILMP for IMEM can improve the visual acuity, metamorphopsia and foveal morphology. Both visual acuity and metamorphopsia correlate with foveal morphology.

关键词: 黄斑; ; 玻璃体切除术; 体层摄影术,光学相干

Key words: Macula lutea; Membranes; Vitrectomy; Tomography, optical coherence

引用本文: 曾苗, 陈晓, 洪玲, 晏颖, 黄志坚. 特发性黄斑前膜患眼玻璃体切割联合内界膜剥除手术前后视力和视物变形度与黄斑形态结构的相关性. 中华眼底病杂志, 2017, 33(4): 378-382. doi: 10.3760/cma.j.issn.1005-1015.2017.04.012 复制

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