曲安奈德重复染色辅助内界膜剥除术治疗特发性黄斑前膜安全性及有效性观察

摘要

目的 探讨曲安奈德(TA)重复染色辅助内界膜剥除联合玻璃体切除术治疗特发性黄斑前膜(IMEM)的安全性及有效性.方法 回顾性分析40例(40只眼)因IMEM接受TA重复染色辅助内界膜剥除联合玻璃体切除术患者的临床资料,对所有患者均行最佳矫正视力、眼压、裂隙灯、眼底照相、OCT检查,记录患者的主观症状,病史长短,随访6个月,观察手术前及术后1、3、6个月最佳矫正视力(BCVA)、主观症状变化、黄斑中心凹视网膜厚度变化.对各项指标进行正态性分析,正态数据的采用t检验.结果 40例患者中,36只眼视力有不同程度提高,其中视力改善2行者为25只眼,占62.5%;视力改善3行以上为11只眼,占27.5%,4只眼视力未提高,无视力下降眼.手术前视力,手术后1、3、6个月的BCVA分别为0.97±0.33、0.89±0.27、0.75±0.22、0.63±0.20,术后各时间点与术前相比有统计学意义(t=3.167,7.722,12.227,P<0.05).手术前黄斑区视网膜厚度、手术后1、3、6个月黄斑区厚度分别为(482.22±77.369)μm、(438.22±70.317)μm、(388.02±50.452)μm、(343.52±39.577)μm,术后各时间点与术前相比有统计学意义(t=14.692,12.934,14.279,P<0.05).所有视物变形患者的症状消失或好转.结论 TA重复染色辅助内界膜剥除联合玻璃体切除术治疗IMEM安全有效,术后视力、黄斑区视网膜厚度、视物变形症状得到一定程度改善.%Objective To investigate the safety and efficacy of triamcinolone acetonide double staining assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes (IMEM).Methods Retrospectively studied 40 IMEM patients who underwent vitrectomy combined with internal limiting membrane peeling assisted by triamcinolone acetonide double staining.Best corrected visual acuity (BCVA), intraocular pressure (NCT), slit-lamp examination,fundus photography,optical coherence tomography (OCT) were done to evaluate the efficacy of treatment.Patients were followed for six months.Changes in visual acuity, the thickness of macular before and after operation at 1, 3, and 6 months.Paired-sample t test was used to compare the visual acuity and macular foveal thickness before and after surgery.Results Among the 40 patients, BCVA improved 2 lines in 25 patients (62.5%) and improved 3 lines in 11 (27.5%), and remained unchanged in 4 patients.There was no reduction in visual acuity.Average BCVA (LogMAR) before surgery and 1, 3, and 6 months after surgery were 0.97±0.33, 0.89±0.27, 0.75±0.22, and 0.63±0.20 respectively.The difference was significant between pre-and post-operative BCVA (t=3.167, 7.722, and 12.227;P<0.05).Average thickness of macular were 482.22±77.369 μm, 438.22±70.317 μm, 388.02±50.452 μm,and 343.52±39.577 μm respectively.The difference between pre-and post-operative thickness were significant (t=14.692, 12.934,and 14.279;P<0.05).Conclusions Triamcinolone acetonide double staining assisted internal limiting membrane peeling combined with vitrectomy in the treatment of IMEM is safe and effective.Visual acuity and macular thickness and metamorphopsia were greatly improved.