不同手术方法治疗继发性黄斑前膜效果的观察

doi:10.3877/cma.j.issn.2095-2007.2018.02.003

目的

探讨不同手术方法治疗继发性黄斑前膜的临床效果。

方法

回顾性分析2014年1月至2017年1月于河北省保定市第一中心医院眼科进行继发性黄斑前膜手术患者76例(76只眼)的临床资料。根据治疗方法的不同，将全部患者分为非联合组和联合组，非联合组为A组，联合组为B组。A组患者38例(38只眼)行睫状体平坦部三切口玻璃体切除联合黄斑前膜剥除及内界膜剥除术，B组患者38例(38只眼)行睫状体平坦部三切口玻璃体切除联合黄斑前膜剥除及内界膜剥除术，且于玻璃体腔内注射曲安奈德。对全部患者手术前后的最佳矫正视力(BCVA)、黄斑形态及手术并发症等进行随访及观察。手术前后患者的BCVA采用中位数(最小值－最大值)进行描述，手术前后视力的比较采用配对Mann－Whitney U检验，视力改善程度的描述采用眼数和百分比，组间比较采用Kruskal－Wallis H秩和检验。手术前后患者黄斑中心神经上皮层厚度(CMT)采用均数±标准差(±s)进行描述，手术前后的组内比较和组间比较均采用配对t检验。

结果

全部患者均接受随访，随访时间3～12个月，平均(6.3±2.4)个月。A组患者术后BCVA提高者25例(25只眼)，视力不变者11例(11只眼)，视力下降者2例(2只眼)。术后BCVA与术前相比，差异有统计学意义(u＝4.251，P<0.05)。B组患者术后BCVA提高者28例(28只眼)，视力不变者7例(7只眼)，视力下降者3例(3只眼)。术后BCVA与术前相比，差异有统计学意义(u＝3.71，P<0.05)。将两组患者术后视力的改善程度进行组间比较，差异无统计学意义(u＝0.67，P>0.05)。A组患者术前CMT平均厚度为(336.87±123.18)μm，术后为(295.17±90.23)μm。手术前后患者的CMT差异有统计学意义(t＝5.43，P<0.05)。B组患者术前CMT平均厚度为(321.18±132.12)μm,术后为(245.15 ±79.64)μm。手术前后患者的CMT差异有统计学意义(t＝4.89，P<0.05)。术后两组间行独立样本t检验，差异有统计学意义(t＝－2.51，P<0.05)，这一结果表明，B组患者术后CMT厚度的改善较A组快。A组患者术后周边牵引性小裂孔3例(3只眼)，经激光治疗后恢复1例(1只眼)，再次手术2例(2只眼)。B组患者术后周边牵引性小裂孔2例(2只眼)，均采用激光进行治疗。随访期间，A组患者有4例(4只眼)复发前膜。

结论

两种手术方式均可以有效治疗继发性黄斑前膜。其中，B组的手术方式能够更快地改善CMT，减少黄斑前膜的复发。

关键词: 继发性黄斑前膜, 内界膜剥除, 玻璃体腔内注射, 曲安奈德

Objective

To observe the effect of different surgical methods for secondary macular epiretinal membrane.

Methods

The clinical data of 76 patients (76 eyes) with secondary macular membrane surgery in the Department of Ophthalmology of Baoding First Central Hospital from January 2014 to January 2017 were retrospectively analyzed. According to the different methods of treatment, all patients were divided into non union group and combined group. The non joint group was A group and the combined group was B group. In group A, 38 cases (38 eyes) were treated with vitrectomy with three incision of ciliary body combined with macular anterior membrane stripping and internal boundary membrane stripping. 38 cases (38 eyes) in group B were treated with vitrectomy with three incision of ciliary body combined with macular anterior membrane stripping and internal boundary membrane stripping, and intravitreal injection of triamcinolone acetonide. The best corrected visual acuity (BCVA), macular morphology and operative complications before and after operation were followed up. The visual acuity of the patients before and after operation was described with the median (max-mini). The comparison of visual acuity before and after operation was made by paired Mann-Whitney U test. The visual improvement was described by the number of eyes and percentage, and the Kruskal-Wallis H rank and test were used in the group. The thickness of the central neuroepithelial layer (CMT) before and after operation was described with mean standard deviation(±s). The comparison between the groups before and after the operation and the comparison between the groups before and after the operation were compared with the paired t-test.

Results

All patients were followed up for 3~12 month with an average of (6.3±2.4) month. In group A, BCVA was increased in 25 cases (25 eyes), 11 cases (11 eyes) remained unchanged, and 2 cases (2 eyes) decreased. There was a significant difference in BCVA after operation compared with that before operation (u=4.251, P<0.05). In group B, BCVA was increased in 28 cases (28 eyes), 7 cases (7 eyes) remained unchanged, and 3 cases (3 eyes) decreased. There was a significant difference in BCVA after operation compared with that before operation (u=3.71, P<0.05). There was no significant difference in the improvement of postoperative visual acuity between the two groups (u=0.67, P>0.05). The average thickness of CMT in group A was (336.87±123.18) μm before operation, and (295.17±90.23) μm after operation. The difference of CMT before and after operation was statistically significant (t=5.43, P<0.05). The average thickness of CMT in group B was (321.18 ±132.12) μm before operation, and (245.15±79.64) μm after operation. The difference of CMT before and after operation was statistically significant (t=4.89, P<0.05). The difference was statistically significant (t=-2.51, P<0.05) between the two groups after the operation (t=-2.51, P<0.05). The results showed that the improvement of CMT thickness in group B was faster than that in group A. Group A had 3 cases (3 eyes) with peripheral traction small holes, 1 case (1 eye) recovered after laser treatment, and 2 cases (2 eyes) reoperation. In group B, 2 cases (2 eyes) with peripheral traction small holes were treated by laser. During the follow-up period, 4 patients (4 eyes) in group A had recurrent anterior membrane.

Conclusions

Two surgical approaches can effectively treat secondary macular epiretinal membrane. Among them, operation in group B can improve CMT and reduce the recurrence of macular epiretinal membrane.

Key words: Secondary macular membrane, Denudation of inner boundary membrane, Intravitreous intravitre injection, Triamcinolone acetonide

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Effect of different surgical methods on secondary macular epiretinal membrane

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Effect of different surgical methods on secondary macular epiretinal membrane