付燕; 谢天皓; 杨娜; 李丽英; 张月玲; 顾朝辉

doi:10.3760/cma.j.cn115989-20190428-00188

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• 临床研究 •

内界膜剥除对孔源性视网膜脱离玻璃体切割术后黄斑前膜形成及视力预后的影响

中华实验眼科杂志, 2022,40(1) : 62-66. DOI: 10.3760/cma.j.cn115989-20190428-00188

摘要

目的

研究累及黄斑的孔源性视网膜脱离(RRD)玻璃体切割联合内界膜(ILM)剥除对预防黄斑前膜(ERM)形成和视力预后的影响。

方法

采用队列研究方法，纳入2015年1月至2018年1月就诊于保定市第一中心医院累及黄斑的RRD患者74例74眼。所有患者均接受玻璃体切割术及硅油眼内填充，且术后视网膜均成功复位。根据玻璃体切割术中是否行ILM剥除，将患者分为ILM未剥除组36例36眼和ILM剥除组38例38眼；所有受检者均于玻璃体切割术后3~5个月行硅油取出术。分别于术前及硅油取出术后1、6和12个月行最佳矫正视力(BCVA)、裂隙灯显微镜、间接检眼镜、彩色眼底照相、光相干断层扫描(OCT)检查。

结果

术后1个月，2个组患眼中均未发现ERM；术后6个月，ILM未剥除组中3眼形成ERM，占8.33%，ILM剥除组2眼出现ERM，占5.26%，2个组ERM发生率比较差异无统计学意义(P＝0.067)；术后12个月，ILM未剥除组中共9眼出现ERM，占25.00%，ILM剥除组中共4眼出现ERM，占10.53%，2个组ERM的发生率比较差异无统计学意义(χ²＝2.674，P＝0.102)。2个组患者手术前后不同时间点间BCVA总体比较差异有统计学意义(F_时间＝31.692，P<0.001)；各组内术后1、6、12个月BCVA均明显优于术前值，差异均有统计学意义(均P<0.05)。2个组间BCVA总体比较差异无统计学意义(F_组别＝0.117，P＝0.773)。OCT结果显示，术后12个月时ILM未剥除组中椭圆体带完整者25眼，占77.78%，ILM剥除组椭圆体带完整者30眼，占78.95%，2个组间椭圆体带完整眼数比较差异无统计学意义(χ²＝0.875，P＝0.350)。

结论

与单纯玻璃体切割术比较，累及黄斑的RRD患者玻璃体切割术中联合ILM剥除不能预防术后ERM的发生，对患者的视力预后无明显影响。

引用本文: 付燕, 谢天皓, 杨娜, 等. 内界膜剥除对孔源性视网膜脱离玻璃体切割术后黄斑前膜形成及视力预后的影响 [J] . 中华实验眼科杂志, 2022, 40(1) : 62-66. DOI: 10.3760/cma.j.cn115989-20190428-00188.

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孔源性视网膜脱离(rhegmatogenous retinal detachment，RRD)是眼科较常见的疾病之一，虽然近年来手术后解剖复位率高，但术后视功能的恢复仍不理想，尤其是视网膜脱离累及黄斑区者^[1]。黄斑前膜(epiretinal membrane，ERM)是RRD术后较常见并发症，其导致的视物变形和视力下降直接影响视网膜脱离的手术治疗效果，是视功能恢复不理想的常见原因^[2]。内界膜(internal limiting membrane，ILM)位于视网膜的最内层，是一层1~2 μm的无结构均质膜，由Müller细胞的基底膜、少量胶质细胞及玻璃体纤维组成^[3]。ILM对玻璃体界面病变的发生和发展具有重要作用，尤其是牵拉性黄斑病变，如黄斑裂孔、黄斑囊样水肿及ERM等^[4,5,6]。玻璃体切割联合ILM剥除已成为ERM的主要治疗手段^[7]。有研究认为，ERM剥离术联合ILM剥除可有效降低ERM的复发率^[8]。对于累及黄斑的RRD，ILM剥除是否可降低其术后ERM的发生率目前尚不明确。ILM对维持视网膜的发育和功能具有重要作用，ILM剥除是否会对视功能造成影响目前尚存在争议。本研究拟探讨累及黄斑的RRD行玻璃体切割术联合ILM剥除对术后ERM的发生是否有预防作用，及其对术后最佳矫正视力(best corrected visual acuity，BCVA)的影响。

贡献者信息

付燕

保定市第一中心医院眼科　071000

谢天皓

河北大学附属医院基本外科，保定　071000

杨娜

保定市第一中心医院眼科　071000

李丽英

保定市第一中心医院眼科　071000

张月玲

保定市第一中心医院眼科　071000

顾朝辉

保定市第一中心医院眼科　071000

通信作者

顾朝辉

保定市第一中心医院眼科　071000

Email：zhaohui-gu@sohu.com

关键词

视网膜脱离，孔源性/手术; 黄斑前膜; 视力; 内界膜剥除; 椭圆体带;

基金项目

保定市科技计划项目（1941ZF048）

利益冲突

所有作者均声明不存在利益冲突

历史

出版日期：2022-01-10

收稿日期：2021-05-27

修回日期：2021-11-26

本文编辑

张宇

Clinical Science

Effects of internal limiting membrane peeling on post-vitrectomy epiretinal membrane and visual prognosis of rhegmatogenous retinal detachment

Fu Yan, Xie Tianhao, Yang Na, Li Liying, Zhang Yueling, Gu Zhaohui

Published 2022-01-10

Cite as Chin J Exp Ophthalmol, 2022, 40(1): 62-66. DOI: 10.3760/cma.j.cn115989-20190428-00188

Abstract

Objective

To analyze the effect of vitrectomy combined with internal limiting membrane (ILM) peeling on the prevention of post-vitrectomy epiretinal membrane (ERM) in macular-off rhegmatogenous retinal detachment (RRD) and its influence on visual outcomes.

Methods

A cohort study was conducted.Seventy-four patients (74 eyes) with macular-off RRD, who realized retinal reattachment after vitrectomy and silicone oil tamponade from January 2015 to January 2018 in Baoding NO.1 Central Hospital, were enrolled.The patients were divided into the non-ILM peeling group (36 cases, 36 eyes) and ILM peeling group (38 cases, 38 eyes) according to whether they received ILM peeling or not.The patients underwent silicone oil removal within 3 to 5 months after the surgery.Best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscopy, fundus photography and optical coherence tomography (OCT) were examined before and at 1, 6 and 12 months after the surgery.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Baoding NO.1 Central Hospital (No.[2019]042). Written informed consent was obtained from each patient.

Results

There was no ERM found in the two groups at 1 month after the operation.There were 3 eyes (8.33%) with ERM in the non-ILM peeling group and 2 eyes (5.26%) in the ILM peeling group at 6 months after the operation, with no statistically significant difference between them (P=0.067). There were 9 eyes (25.00%) with ERM in the non-ILM peeling group and 4 eyes (10.53%) in the ILM peeling group at 12 months postoperatively, with no statistically significant difference between them (χ²=2.674, P=0.102). There was a significant difference in BCVA between before and after the operation in the two groups (F_time=31.692, P<0.001). Postoperative 1-, 6-and 12-month BCVA were all significantly better than the preoperative BCVA in the two groups (all at P<0.05). There was no significant difference in BCVA between the two groups (F_group=0.117, P=0.773). OCT images showed that there were 25 eyes (77.78%) and 30 eyes (78.95%) with the intact ellipsoid zone in the non-ILM peeling group and ILM peeling group at 12 months after the operation, respectively, with no statistically significant difference between them (χ²=0.875, P=0.350).

Conclusions

Compared with vitrectomy alone, the vitrectomy combined with ILM peeling does not show better efficacy in the prevention of ERM occurrence in macula-off RRD patients and has no obvious influence on postoperative visual acuity.

Key words:

Retinal detachment, rhegmatogenous/surgery; Epiretinal membrane; Visual acuity; Internal limiting membrane peeling; Ellipsoid zone

Contributor Information

Fu Yan