特发性黄斑视网膜前膜的眼底分析

探讨特发性黄斑视网膜前膜的眼底改变特性及其视力预后。方法采用眼底彩照和荧光血管造影对６５例患者进行检查,其中１５例,作了眼底形态和视力的随访观察。结果依据患者的眼底及ＦＦＡ改变特征将其分为Ⅰ、Ⅱ、Ⅲ期;６８．３％的患眼视力≥０．５。所有随访患超的视均保持稳定。结论因病程不同,眼底可有多种改变,但大部分患眼的视力预后良好。     

特发性黄斑视网膜前膜

为观察６０例６７眼特发性黄斑视网膜前膜的临床特点和视力预后，并探讨其程度分期。用荧光造影，９０Ｄ前置镜或三面镜裂隙灯作检查。结果①视网膜前膜多发生在老年人，本组占９６．７％，单眼发病占８８．３％，双眼发病占１１．７％，左右眼发病无差异。②玻璃体后脱离占６１．２％。③按程度分期：一期３８只眼占５６．７％，二期２１只眼占３１．３％，三期５只眼占７．５％。４．３６例（６４．３％）视力在０．５以上。结论：视网膜前膜为一老年性病变，病情发展缓慢，视力预后好。有明显膜形成者作玻璃体切割和膜剥离术可改善视力。     

玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔

目的评价玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔的临床疗效。方法采用玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔17例17眼,对患者术前术后视功能、术后黄斑裂孔闭合及手术主要并发症等进行检查和随访。结果本组17眼均成功剥离内界膜。随访5～24个月,其中13眼黄斑裂孔完全闭合,4眼裂孔直径缩小,裂孔封闭成功率为76.47%;17眼中14眼视力提高,视力提高率为82.35%;视物变形等症状也有明显改善。并发症主要有术中毛细血管性出血、术后一过性高眼压及晶状体后囊下混浊。结论玻璃体切割联合内界膜剥离术可有效封闭特发性黄斑裂孔,提高视功能。     

Vitrectomy for impending idiopathic macular holes

We performed pars plana vitrectomy in 15 patients with physical changes and visual loss believed to indicate impending macular hole formation. Twelve (80%) of 15 eyes have not progressed to macular holes during a minimum follow-up period of 15 months (average, 26 months). In these 12 patients final vision was within one line of the preoperative vision in four eyes, improved two or more lines in five eyes, and was two lines worse in three eyes. Decreased vision in all three eyes was the result of progressive lenticular nuclear sclerosis. A thin sheet of cortical vitreous fibers was sometimes found intraoperatively on the surface of the retina, despite an apparent complete posterior vitreous detachment.     

Prognostic factors in idiopathic preretinal macular fibrosis

We retrospectively studied 124 eyes with idiopathic preretinal macular fibrosis to assess the value of fluorescein angiography and vitreous examination for predicting the visual prognosis. During a mean follow-up period of 43 months (range, 12–14 months), the visual acuity of 33 eyes (27%) declined two or more lines from the initial value, although the appearance of the fibrosis remained unchanged in 114 cases (92%). At initial examination, 38 eyes (31%) showed fluorescein leakage into the macula; these eyes were more prone to further visual deterioration than were those without leakage (P< 0.05). Of 14 eyes with partial vitreous detachment and vitreous traction to the fibrosis, 6 (43%) had a final visual acuity of 20/200 or worse; this proportion was significantly higher than that found either in eyes with no detachment or in those with complete vitreous detachment (P< 0.05). The presence of fluorescein leakage and/or vitreous traction to the fibrosis may predict worse functional prognosis in eyes with idiopathic preretinal macular fibrosis.J. Akiba and A. Yoshida were on leave from the Department of Ophthalmology, Asahikawa Medical College, Japan     

玻璃体切割联合内界膜剥离术治疗IMEM不同眼内填充物的临床观察

目的:探讨玻璃体切割联合视网膜内界膜剥离手术治疗特发性黄斑前膜(idiopathic macular epiretinal membrane,IMEM)术不同眼内填充物术后疗效及并发症的观察。方法:回顾性分析特发性黄斑前膜患者44例44眼。患者随机分成A、B两组,其中A组20例;B组24例,两组患者均行玻璃体切割联合视网膜内界膜剥离手术,A组玻璃体腔内行平衡盐溶液(BSS)填充,B组行气体填充(13眼填充滤过空气,11眼填充100mL/LC3F8),术后随访12～16(平均13)mo。术前、术后1,3,6,12mo检查最佳矫正视力(BCVA),光学相干断层扫描(OCT)测量黄斑中心凹厚度(CFT),术后1,7d;1,3mo行眼压(IOP)检查,对比观察手术前后视力,间接检眼镜,CFT,IOP检查结果。结果:末次随访时两组患眼BCVA较术前显著提高,提高0.2logMAR及以上者29眼(66%)。两组间logMARBCVA的差异手术前(0.53±0.18vs0.52±0.14)及末次随访时(0.31±0.14vs0.28±0.09)均无统计学意义(P>0.05)。末次随访时A、B组患眼CFT较术前明显降低,从407.82±97.00μm下降到285.25±70.07μm(Z=4.29,P<0.05)。两组间CFT的差异术前(409.45±108.40μmvs406.46±88.76μm)及末次随访时(287.60±66.94μmvs283.29±73.95μm)均无统计学意义(P>0.05)。术后1d,A组眼压(14.25±3.06mmHg)低于B组(17.71±3.20mmHg),差异有统计学意义(Z=3.12,P<0.05),但两组眼压均值均未超过正常范围(10～21mmHg)。术前、术后7d;1,3mo两组间眼压差异均无统计学意义(P>0.05)。A组患者术后无需俯卧位,B组患者填充滤过空气者术后俯卧位1～3d,填充100mL/LC3F8者俯卧位至少7d。结论:玻璃体切割联合视网膜内界膜剥离手术治疗特发性黄斑前膜手术末填充BSS或气体均能显著提高视力、降低黄斑中心凹厚度,两者的临床疗效无显著差异,但填充BSS可避免术后俯卧位,减轻患者术后身体及精神负担,同时手术更加快捷、安全。     

Spontaneous detachment of the preretinal membrane in preretinal macular fibrosis

Preretinal macular fibrosis is one of the most frequently encountered conditions of the macula; it is based on the formation of a transparent or white-gray preretinal membrane. Usually these changes do not progress and persist without change for many years. In rare cases it may come to a spontaneous detachment of the preretinal membrane connected usually with an improvement of the visual acuity. Presented are 2 patients with preretinal macular fibrosis in whom--after a various duration of the disease--it came to a spontaneous detachment of the preretinal membrane.     

The incidence of idiopathic preretinal macular gliosis

A series of 1,000 consecutive routine eye examinations performed on patients over the age of 50 was evaluated with particular reference to the presence of idiopathic preretinal macular gliosis (IPMG). In this group, there were 64 patients with IPMG (6.4%), 13 (20%) of whom had bilateral IPMG. The large majority of cases (63%), however, had only minor visual disability as a result of this disorder.     

Vitrectomy without postoperative posturing for idiopathic macular holes

PURPOSE: To determine the success of vitrectomy with ILM peeling and C(3)F(8) tamponade for macular holes without the need for postoperative face-down posturing. METHODS: Twenty-four eyes of 24 consecutive patients undergoing pars plana vitrectomy with indocyanine green-assisted ILM peeling and C(3)F(8) tamponade without prone posturing were included in the study. All patients had follow up on 1 day, 2 weeks and 3 months postoperatively. Biomicroscopy and optical coherence tomography were used to assess macular hole closure at 3 months postoperatively. Snellen visual acuity was compared pre- and postoperatively. RESULTS: Of the 24 eyes recruited, two (8%) had stage II, 17 (71%) had stage III and five (21%) had stage IV macular holes. Nineteen (79%) eyes were phakic and five (21%) eyes were pseudophakic at the time of surgery. The macular holes had been present for an average of 7.5 months (range 3-18 months). At 3-month follow up, 22/24 (91.6%) holes were closed. Both of the two holes that failed to close were stage IV macular holes. Preoperative visual acuity ranged from 6/18 to 6/60 (mean 6/36). Postoperative visual acuity ranged from 6/9 to 6/60 (mean 6/18). Eighteen eyes had improvement of visual acuity of at least one line on the Snellen chart, six eyes had no improvement. No eyes had worse vision postoperatively. CONCLUSION: Macular hole surgery without face-down posturing provides anatomical and functional results comparable to those with prone posturing. Combined phacovitrectomy is not essential to avoid prone posturing.     

Role of the vitreous in idiopathic preretinal macular fibrosis

Of 250 eyes with idiopathic preretinal macular fibrosis, 56 had no posterior vitreous detachment (Group 1), ten had partial posterior vitreous detachments without vitreous traction to the macula (Group 2), 29 had partial posterior vitreous detachments with vitreous traction to the macula (Group 3), and 155 had complete posterior vitreous detachments (Group 4). There were significantly more eyes with visual acuities of 20/60 or worse, cystoid macular changes, or macular fluorescein leakage in Group 3 than in Group 1 or Group 4. Thus, the presence of vitreous traction to the macula was associated with worse anatomic and functional findings.     

Vitrectomy for idiopathic epiretinal membranes causing macular pucker.

We used vitreous surgery to remove idiopathic epiretinal membranes from the macular area in 70 consecutive cases. The abnormal tissue was successfully removed in each case. Vision improved postoperatively in 61 eyes (87%), remained unchanged in six eyes (9%), and worsened in three eyes (4%). However, at the time of final examination vision was improved in only 47 eyes (67%), primarily because of the occurrence or progression of nuclear sclerosis, which occurred in 38 of 60 phakic eyes (63%). Four preoperative factors were associated with final visual acuity of 20/60 or better: (1) initial vision of 20/100 or better, (2) shorter preoperative duration of blurred vision, (3) thin epiretinal membrane, and (4) absence of traction retinal detachment.     

Two cases of idiopathic preretinal macular fibrosis in children

We report herein the findings in two patients less than 15 years old with the diagnosis of idiopathic preretinal macular fibrosis, a disorder found primarily in the older population. Only a few reports have discussed idiopathic preretinal macular fibrosis in children and its pathogenesis is still unknown. One is a 10-year-old boy and the other is a 14-year-old girl who visited our hospital with a chief complaint of blurred vision in their right eyes. Epiretinal membranes were recognized on the macular region of their right eyes. Since there was no causative factors, a diagnosis of idiopathic preretinal macular fibrosis was made. They were conservatively followed up. The vision of the boy once worsened but improved spontaneously and remained stable for three years. Because the vision of the girl worsened rapidly, vitreous surgery was performed to remove the epiretinal membrane, resulting in poor vision. It was suggested that this disorder in children should be followed up conservatively and the indication of vitreous surgery should be carefully determined.     

玻璃体切除术联合内界膜剥除治疗特发性黄斑裂孔

目的:探讨玻璃体切除术联合内界膜剥除治疗特发性黄斑裂孔的疗效。方法:对93例93眼特发性黄斑裂孔患者行玻璃体切除联合内界膜剥除,气液交换,眼内填充C3F8。术后观察术眼视力及OCT了解黄斑裂孔变化。结果:特发性黄斑裂孔患者93例中裂孔完全愈合89例(96%),4例裂孔未闭,患者拒绝再次手术。绝大多数患者术后视力提高。结论:玻璃体切除联合内界膜剥除是治疗特发性黄斑裂孔的有效方法,能使绝大多数患者的裂孔得到解剖愈合,视力提高。     

玻璃体切除和自体血小板治疗特发性黄斑裂孔

目的评价玻璃体切除、浓缩自体血小板和气体眼内填充治疗全层特发性黄斑裂孔的效果。方法对6例全层特发性黄斑裂孔患者的6只眼采用玻璃体切除，剥除玻璃体后皮质，气液交换，自体血小板溶液滴于后极部，20%～30%SF6注入玻璃体腔的方法进行治疗。术后患者仰卧1小时，然后俯卧2周。结果手术后9天～12个月6只眼黄斑裂孔闭合，视网膜平复。视力改善2行以上5只眼，占83.3%，视力达到0.3以上者4只眼，占66.7%，1只眼发生周边视网膜新裂孔伴视网膜脱离。结论玻璃体切除、浓缩自体血小板和气体眼内填充可使全层特发性黄斑裂孔闭合，视力提高。(中华眼底病杂志,1998,14:14-15)     

Vitrectomy with membrane peeling for vasocentric idiopathic epiretinal membranes

PURPOSE: To report the clinical course and outcome of surgery for idiopathic epiretinal membranes (ERMs) centered on retinal blood vessels. METHODS: Retrospective observational case series review of the case records of 15 patients with idiopathic ERMs overlying retinal blood vessels, of whom 9 underwent vitrectomy with membrane peeling. The patients attended two eye departments under the care of four vitreoretinal surgeons with a total of more than 50 years of surgical experience. RESULTS: The patients were aged 12-74 years (mean = 34.3 years). Difficulties were experienced in achieving vitreoretinal and membranoretinal separation in the 9 eyes undergoing vitreous microsurgery. Recurrent ERM formation occurred in 8 of these eyes (89%) of which 6 underwent revision vitrectomy. Visual improvement was achieved in 55% of patients. Mean follow-up was 2.5 years. CONCLUSIONS: The authors describe a subgroup of patients with idiopathic ERMs in which the membrane is centered over a large retinal vessel. This occurs predominantly but not exclusively in a young age group. Surgical removal is characterized by a high recurrence rate.     

应用25G系统玻璃体切除术联合内界膜剥离治疗特发性黄斑孔

目的探讨应用25G系统玻璃体切除术联合内界膜剥离治疗特发性黄斑孔的手术效果。方法对10例（10眼）特发性黄斑孔行25G系统玻璃体切除术联合内界膜剥离,气液交换,眼内充填C3F8。术后观察视力,并进行OCT检查了解黄斑孔封闭情况。结果10例（10眼）黄斑孔均闭合。随访1～6个月,2眼视力未提高,8眼视力提高1～3行,10眼均未见复发。结论玻璃体切除术联合内界膜剥离治疗特发性黄斑孔是有效的;25GTSV应用于黄斑孔的手术治疗具有手术时间短、创伤小及术后恢复怏等优点。     

Vitrectomy in treatment of idiopathic and secondary pre-retinal fibrosis

PURPOSE: To present the results of vitrectomy in the management of preretinal fibrosis. MATERIAL AND METHODS: 45 patients with preretinal fibrosis treated with vitrectomy were analysed. 33 of them were treated from 1997 to 1998 in Ophthalmology Dept. University of Heidelberg (Germany) and 12 were treated from 1998 to 1999 in the 1st Eye Hospital Lublin University School of Medicine. The reason for preretinal fibrosis: idiopathic-22 patients, retinal detachment--16, retinal vein occlusion--2, trauma--2, uveitis-1, perivasculitis--1, alopecia--1. RESULTS: Due to applied treatment 27 patients (60%) showed visual improvement, 13 patients (29%) had the same visual acuity before and after vitrectomy and 5 patients (11%) noticed a decrease of visual acuity after the treatment. CONCLUSIONS: Vitrectomy is an effective method of treatment of patients with preretinal fibrosis. In cases with no improvement of visual acuity after surgery, vitrectomy could reduce a metamorphopsia.     

Vitrectomy for epimacular membrane secondary to adult-onset Coats' disease

The authors describe the management of an epimacular membrane secondary to adult-onset Coats' disease. A 26-year-old man presented with decreased vision (20/120) in the right eye for 4 months. Fundus examination revealed features suggestive of Coats' disease, with a thick epimacular membrane. Optical coherence tomography revealed underlying macular thickening. The patient underwent vitrectomy with removal of the epimacular membrane and internal limiting membrane; peripheral telangiectasia were simultaneously photocoagulated. Postoperatively, his visual acuity improved to 20/20, which remained stable for 12 months. Vitrectomy yields an excellent anatomical and functional outcome in epimacular membrane due to adult-onset Coats' disease, if performed before macular exudation leads to subretinal fibrosis.     

玻璃体切割联合双层膜剥除治疗特发性黄斑前膜

目的：对比分析玻璃体切割术行黄斑前膜剥除联合黄斑区内界膜剥除与单纯黄斑前膜剥除治疗特发性黄斑前膜(IERM)的疗效及安全性。

方法：回顾性病例对照研究。将2015-01/12在我院行手术治疗的IERM患者53例53眼纳入研究,根据手术方式不同分为单纯黄斑前膜剥除组(ERM组,21例21眼)和黄斑前膜剥除联合内界膜剥除组(ERM+ILM组,32例32眼),随访24mo,分别记录两组术前、术后1、3、12、24mo的最佳矫正视力(BCVA,LogMAR)、黄斑中心凹厚度(CMT)、术后并发症及复发情况,并进行统计学分析,比较两组结果差异有无统计学意义。

结果：ERM组术前及术后1、3、12、24mo BCVA分别为0.676±0.137、0.576±0.099、0.551±0.085、0.514±0.077、0.506±0.032; ERM+ILM组分别为0.659±0.132、0.582±0.111、0.578±0.101、0.523±0.062、0.511±0.081; 术后1、3、12、24mo 两组BCVA与术前比较均有不同程度改善(P<0.05); 术后1、3、12、24mo两组间比较,无显著差异(P>0.05)。ERM组术前及术后1、3、12、24mo CMT分别为461.14±13.477、402.36±11.346、368.52±13.216、325.24±8.246、273.29±8.973μm; ERM+ILM组分别为462.47±14.287、414.72±9.237、373.44±8.328、328.94±6.923、274.28±8.340μm; 术后1、3、12、24mo 两组CMT与术前比较均有不同程度下降(P<0.05); 术后1、3、12、24mo两组间比较,差异均无统计学意义(P>0.05)。患者53例53眼术后有3例3眼出现视网膜点状出血,其中ERM组1例1眼(5%)、ERM+ILM组2例2眼(6%),两组比较差异无统计学意义(P=1.000)。在随访的24mo内ERM组复发4例4眼(19%),ERM+ILM组无复发患者,两组比较差异有统计学意义(P=0.020)。

结论：玻璃体切割术行黄斑前膜剥除联合黄斑区内界膜剥除治疗IERM安全有效,能降低IERM复发率。