特发性黄斑前膜手术治疗后黄斑微结构变化的观察

摘要

目的 探讨特发性黄斑前膜患者手术治疗前后视网膜黄斑区结构功能与预后的关系.方法 回顾性系列病例研究.收集2013年1月至2015年12月于天津医科大学眼科医院接受手术治疗的特发性黄斑前膜患者74例(74只眼),其中男性31例,女性43例,年龄(68.1±6.9)岁.术前进行眼科术前常规检查及相干光层析成像术(OCT)检查,行玻璃体切除术剥除黄斑前膜,术后随访至少12个月,观察患者手术前后最佳矫正视力(BCVA)、黄斑中心凹厚度、椭圆体带形态的变化,并按术前椭圆体带是否连续将患者分为连续组52例、断裂组22例.对术前黄斑区视网膜厚度、年龄及病程与手术前后BCVA的关系采用重复测量方差分析;术后BCVA的组间比较采用t检验进行统计学分析.结果 患者术前及术后1、3、6、12个月LogMAR视力分别为0.59±0.26、0.63±0.34、0.46±0.22、0.45±0.23、0.41±0.23(F=25.122,P＜0.05),黄斑中心凹视网膜厚度分别为(468.12±73.07)、(371.57±57.09)、(320.57±65.88)、(294.85±69.36)、(283.5±66.56)μm,差异均有统计学意义(F=8.802,P＜0.05).连续组患者术后视力为(0.34±0.27),较断裂组(0.62±0.24)改善明显(t=-4.209,P＜0.05).术前黄斑水肿的程度与术后视功能无明显相关(r=-0.015,P＞0.05).术后1年7例患者存在黄斑水肿.结论 特发性黄斑前膜患者术后视功能的恢复与术前黄斑中心凹厚度无明显相关性,椭圆体带连续性好的患者术后视力预后较好.%Objective To evaluate the relationship between the structure of macular region and prognosis after vitrectomy in idiopathic macular epiretinal membrane patients.Methods Retrospective case series study.The cases of 74 idiopathic macular epiretinal membrane patients (31 female patients,43 male patients,aged 68.1 ±6.9) who received surgery treatment in our hospital during January 2013 and December were collected and analyzed.Ophthalmic routine examination and optical coherence tomography (OCT) have been conducted for all patients prior to operation.All eyes underwent vitecrtomy and macular epiretinal membrane peeling.During the 12 months follow up,the preoperative and postoperative data including best corrected visual acuity (BCVA),foveal thickness,changes of morphology in ellipsoid zone were observed and analyzed.All the patients were divided into two groups,continuous group (52 patients) and discontinuous group (22 patients),based on the preoperative continuity status of ellipsoid zone.The data of preoperative macular retinal thickness,the relationship between age and course of the disease,preoperative BCVA and postoperative BCVA were analyzed statistically with repeated ANOVA method.The postoperative BCVA were analyzed statistically with t test mtehod,based on the different grouping of continuity status of ellipsoid zone.Results The preoperative LogMar BCVA,and the postoperative LogMAR BCVA of 1 month,3 month,6 month and 12 month after operation were 0.59±0.26,0.63±0.34,0.46±0.22,0.45±0.23,0.41±0.23 (F=25.122,P＜0.05) respectively.The preoperative foveal thickness,and the postoperative foveal thickness of 1 month,3 month,6 month and 12 month after operation were (468.12± 73.07),(371.57 ± 57.09),(320.57 ± 65.88),(294.85 ± 69.36),(283.5 ± 66.56)μm (F=8.802,P＜0.05),the difference between the figures are of statistical significance.The postoperative BCVA of continuous group (0.34±0.27) improved significantly,as compared to the BCVA of discontinuous group (0.62±0.24) (t=-4.209,P＜0.05).There is no obvious relationship between the degree of preoperative macular edema and postoperative visual function (r=0.015,P＞ 0.015).Seven patients still have macular edema one year after surgery.Conclusion The postoperative visual function in patients with idiopathic macular epiretinal membrane has negative correlation with preoperative thickness of fovea,and has positive correlation with continuity of ellipsoid zone.