黄斑前膜手术治疗后的长期随诊观察

目的观察黄斑前膜手术治疗后的长期效果，评价视力预后与黄斑水肿的关系。方法回顾分析22例经玻璃体切割手术剥离黄斑前膜手术治疗并随诊1年以上的黄斑前膜患者22只眼的临床资料。其中，特发性黄斑前膜17只眼，占77%；继发性黄斑前膜5只眼，占23% 。所有患眼治疗前后均进行视力、眼底彩色照相、荧光素眼底血管造影( FFA)以及光相干断层扫描(OCT)检查。视力采用5分记录，FFA、OCT检查按常规方法进行。治疗前手术眼平均视力为(4.25±0.36)，黄斑平均厚度为(499±114) μm；对侧眼视力正常，黄斑平均厚度(1 84±37) μm。黄斑前膜均经手术成功剥除，手术后随访 12～40个月，平均随访时间(23±8)个月。回顾分析时，采用线性回归分析的方法，着重对 比分析手术前后视力、眼底彩色照相、FFA以及OCT检查结果的相关关系以及手术并发症的发生情况。结果13只眼视力提高，占59％；6只眼视力不变，占27%；3只眼视力减退，占14％。平均视力提高到(4.57±0.31)，与治疗前视力比较，差异有统计学意义(t=3.40，P＜0.05)。末次随访视力≥4.5者15只眼，占66%。黄斑平均厚度降低 到(286±104) μm，与治疗前黄斑平均厚度比较，差异有统计学意义(t=8.33，P＜0.05)。但仍未恢复到对侧眼水平（t=4.68，P＜0.05）。排除手术后白内障加重未行手术治疗的患眼， 手术前后视力与黄斑水肿程度呈线性相关( r=-0.64, P=0.001；r=-0.58, P=0.01)。6只眼手术中剥膜后黄斑区少量点状出血，占27%；2只眼手术中视网膜周边发生裂孔，占9%。 5只眼手术后继发高眼压 ，占23%；1只眼出现黄斑裂孔，占5%；8只眼白内障加重，占36%。结论经玻璃体切割手术剥离黄斑前膜可以减轻黄斑水肿，提高视力，是治疗黄斑前膜的有效方法。（中华眼底病杂志，2008，24：206-209）

Long-term follow-up for surgery in treating macular epiretinal membrane

Objective To evaluate the long-term result of vitrectomy for macular epiretinal membranes(ERM)and the relationship between best-corrected visual acuity(VA)and macular thickness.Methods In a retrospective consecutive series,twenty-two eyes(17eyes of idiopathic(77%)and 5 of secondary ERM(23%))of 22 patients with macular ERM who underwent pars plana vitrectomy and membrane peeling which had more than 1 year's(12-40 months,mean(23±8)months)follow up were included.All the patients were examined by VA,fundus color photography,fluorescein fundus angiography(FFA)optical coherence tomography(OCT)before and after treatment.VA was adopted 5 points record;FFA and OCT were underway as common way.The mean of VA was(4.25±0.36),the mean of macular thickness was(499±114)μm.Compared the VA, appearance of fundus photography,fluorescein angiography and optical coherence tomography(OCT)before and after surgery.Results Visual Improvement was achieved in 13 eyes(59%),meanwhile,6 eyes(27%)were stable and 3 eyes(14%)were worse;VA of 15 eyes(66%)was more than 4.5 at last follow-up.The mean VA increased from (4.25±0.36)to(4.57±0.31)postoperatively,the difference was statistically significant(P＜0.05).Mean macular thickness decreased from(499±114)μm(317-774μm)to(286±104)μm(150-597μm)(P＜0.05)postoperatively,the difference was statistically significant(P＜0.05),but still different to the opposite eyes'((184±37)μm)(P＜0.05).VA correlated with macular thickness preoperatively (r=-0.64,P=0.001)and postoperatively(r=-0.58,P=0.01)except the patients with cataract Improvement without therapy.6 eyes(27%)had retinal hemorrhage and 2 eyes(9%)had peripheral retinal breaks intraoperatively;5 eyes(23%)had secondary higher intraocular pressure,1 eye(5%)had macula hole and 8 eyes(36%)had cataract improvement postoperatively. Conclusions Surgery is successful in treating ERM.It can relieve macular edema and improve visual acuity.