特发性黄斑前膜手术前后相干光断层扫描的对比研究

摘要

Objective To evaluate idiopathic macular membrane(idiopathic macular epiretinal membranes, IMEM)before and after surgery using optical coherence tomography(OCT).Methods 23patientswith idiopathic macular membrane(23 eyes)were enrolled and received vitrectomy and IMEM peeling.Visual acuity and macula thickness were analyzed before and after treatment.Results Before surgery,an epiretinal high reflective band with varied thickness was visible on OCT in all patients.Macula edema was found in 14 eyes,proliferative MEM was found in 6 eyes,pseudo macula hole was found in 1 eye,and macula hole was found in 1 eye.Macula thickness increased in most of the eyes,along with decrease in visual acuity.Pseudo macula hole manifested as tight connection of the MEM and retina with steep margin at the fovea,and increased or normal thickness of the macula retina.Macula hole was characterized as absent neural epitheli-um at the fovea and thinned macula retina.After surgery, the epiretinal high reflective band disappeared in all patients. Foveal thickness and visual acuity restored gradually.Conclusions OCT can be used to evaluate structural changes in macula retina before and after surgery,and to provide information for the indication and outcome of the surgery.%目的 对比分析特发性黄斑前膜(IMEM)手术前后相干光断层扫描(OCT)的差异,探讨OCT对IMEM手术前后黄斑区视网膜厚度的检测意义.方法 收集我院确诊为IMEM的病例23例(23只眼),行玻璃体切除联合黄斑前膜剥离术,观察患者手术前后的视力及 OCT检查情况,进行统计学分析比较手术前后黄斑区视网膜厚度的变化.结果 手术前黄斑部视网膜前膜的OCT图像均可见黄斑区神经上皮层表面厚薄不一的膜样高反光带.黄斑前膜并发黄斑水肿14只眼,增生型黄斑前膜6只眼,黄斑前膜引起黄斑假孔2只眼,黄斑前膜引起黄斑板层孔1只眼.绝大多数黄斑区视网膜厚度增加,患眼视力不同程度下降.假性黄斑裂孔表示为黄斑前膜与视网膜表面粘连紧密,中心凹边缘陡峭,黄斑区视网膜厚度增加或正常.板层黄斑裂孔表现为黄斑中心凹神经上皮层部分缺失,黄斑区视网膜厚度变薄.IMEM手术后所有患眼黄斑区膜样高反光带均消失.黄斑区中心凹厚度逐渐恢复正常,黄斑区功能逐渐恢复.结论 OCT可以清楚的显示手术前后黄斑区组织结构形态的改变,为黄斑前膜的手术指征评估及手术效果评价,提供客观准确的信息.