黄斑前膜分级法对特发性黄斑前膜手术效果的评估:基于OCT图像的研究

摘要

目的 根据OCT检查结果对特发性黄斑前膜进行分级,评估其预判患者术后视力恢复的应用价值.方法 选取2013年2月至2016年5月在深圳市眼科医院接受手术治疗的29例(30眼)特发性黄斑前膜患者为研究对象,根据术前OCT检查显示的黄斑中心凹形态变化将该病分为4级.各级患者均进行微创玻璃体切割术剥除黄斑前膜,术后6个月对所有患者进行检查,分析各级患者最佳矫正视力(best corrected visual acuity,BCVA)和黄斑中心凹厚度(central foveal thickness,CFT)情况.结果 随着分级增高,患者的黄斑中心凹形态改变越紊乱,黄斑前膜出现和中心凹部丢失也越明显.各级患者术前与术后的LogMAR BCVA比较差异均有统计学意义(均为P＜0.01).各级患者术前及术后的LogMAR BCVA随着分级增高而增加,整体比较以及两两比较差异均有统计学意义(均为P＜O.05).提示特发性黄斑前膜分级越高患者的视力越差.特发性黄斑前膜Ⅱ级患者术前和术后LogMAR BCVA差值最大,且与其他各级比较差异均有统计学意义(均为P ＜0.001).提示特发性黄斑前膜Ⅱ级患者的BCVA在术后的改善程度最大.除Ⅲ级患者外,其余各级患者术前与术后CFT比较,差异均无统计学意义(均为P＞0.05).术前及术后各级患者间的CFT随着分级增高而增加,整体比较以及两两比较差异均有统计学意义(均为P ＜0.001).提示特发性黄斑前膜分级越高患者的黄斑厚度越高.结论 基于OCT检查图像对特发性黄斑前膜患者进行分级,不仅有助于预判患者术后视力和CFT的恢复情况,还有利于特发性黄斑前膜患者手术时机的选择.%Objective To classify idiopathic macular epiretinal membrane (IMEM) on the basis of OCT and its application value in predicting visual acuity of patients after operation.Methods Totally 29 patients (30 eyes) with IMEM admitted in Shenzhen Eye Hospital from February 2013 to May 2016 were included in this study and divided into 4 levels based on the morphologic change of macular fovea by preoperative OCT examination.All the patients were given minimally invasive vitrectomy for stripping macular epiretinal membrane (MEM),and examined for best corrected visual acuity (BCVA) and central foveal thickness (CFT) 6 months after surgery.Results As the grading increased,the patient's macular foveal became disorganized,the appearance of the macular membrane was presented and the loss of macular foveal was more obvious.There was significant difference between preoperative and postoperative LogMAR BCVA (all P ＜ 0.01).Preoperative and postoperative LogMAR BCVA was increased with the grading,and the difference was statistically significant (all P ＜ 0.05),suggesting that patients with high-level epiretinal membranes suffered from poor visual acuity.The difference between preoperative and postoperative LogMAR BCVA was the largest in patients with grade Ⅱ idiopathic macular degeneration,and the difference was statistically significant compared with other levels (all P ＜ 0.001).It is suggested that BCVA of grade Ⅱ patients has the greatest improvement after operation.Apart from grade Ⅲ patients,there was no significant difference in CFT among the patients with other levels before and after operation (all P ＞ 0.05).The preoperative and postoperative CFTs between patients were increased with the grading,and the differences were statistically significant (all P ＜ 0.001),suggesting that the higher the level was,the larger the macular thickness.Conclusion The classification of IMEM based on OCT examination images not only helps to predict the postoperative visual acuity and CFT recovery but also the timing of operation in patients with idiopathic macular degeneration.