继发性黄斑前膜的病因分析及手术疗效观察

目的 观察各种原因引起的继发性黄斑前膜眼的黄斑形态及功能变化，探讨手术治疗的意义。方法 回顾性分析2008年10月至2012年8月因“继发性黄斑前膜”行剥除黄斑前膜手术55例（55眼）的临床资料，对继发性黄斑前膜的病因及发病情况作分类和比较，应用光学相干断层扫描(OCT)观察黄斑形态的变化、黄斑中心神经上皮层厚度(CMT)、IS/OS层的完整性，比较手术前后最佳矫正视力(BCVA，logMAR)的变化。手术前后视力的比较用配对t检验，IS/OS层完整组与不完整组的视力及CMT比较用独立样本t检验。结果 造成继发性黄斑前膜的病因有眼外伤、白内障手术、激光视网膜光凝术、视网膜静脉栓塞等。除5例失访(9.09%)外，完成随访的50例视力与术前相比，40例(80.00%)提高，10例(20.00%)不变；术后BCVA较术前相比，差异有统计学意义(t=-7.467， P<0.001)。IS/OS层完整组的术后BCVA好于IS/OS不完整组(t=-4.437， P<0.001)，而两组间CMT差异无统计学意义(t=-0.990， P=0.329)。结论 继发性黄斑前膜对黄斑功能影响显著，手术治疗可以保存或改善患者的视功能。

Causes and efficacy of vitrectomy for secondary epiretinal membrane

Objective To observe morphological and functional changes in the macular in eyes with different kinds of secondary epiretinal membranes (SEM) and to explore the significance of surgical treatment. Methods A retrospective， observational case series of 55 patients with SEM who underwent pars plana vitrectomy and membrane peeling during October 2008 and August 2012 were included. The causes of SEM were classified. Changes in macular morphology before and after the surgery were observed by optical coherence tomography. The thickness of neuroepithelium in the central macular area(CMT) and the integrity of its IS/OS layer were recorded， as well as best corrected visual acuity (BCVA， logMAR). Paired t test was used to compare pre-operative and post-operative BCVA. Independent sample t test was used to compare BCVA and CMT between group of IS/OS layer integrity and unintegrity. Results Trauma， cataract surgery，laser photocoagulation，and retinal vein occlusion etc had relation with this disease.5 patients(9.09%) were lost for follow-up. In the other 50 patients， 40 eyes (80.00%) had their vision improved and 10 eyes (20.00%) had no changed. Post operative BCVA was improved (t=-7.467, P<0.001).The eyes with intact IS/OS layer had better post-operative BCVA than the other eyes(t=-4.437, P<0.001),but CMT did not(t=-0.990, P=0.329). Conclusion Secondary epiretinal membrane has significant influence on macular function. Surgical treatment can save or improve the patients’ visual quality.