220例玻璃体切割术治疗黄斑前膜的临床疗效观察

发布时间：2018-03-19 18:13

本文选题：玻璃体切割术　切入点：眼部视力　出处：《中华眼科医学杂志(电子版)》2016年02期 　论文类型：期刊论文

【摘要】：目的探讨玻璃体切割术治疗特发性黄斑部前膜(IMEM)病变的疗效及其预后的影响因素。方法收集2011年6月至2013年6月在重庆市渝北区人民医院眼科行玻璃体切割术治疗的220例(242只眼)IMEM患者的临床资料。全部患者按照术后有、无视力提高分为两组。分别记录或检查全部患者的性别、年龄、术中填充物类型、术前眼前段合并症、术前眼后段并发症、病程、术前最佳矫正视力(BVCA)、术前黄斑中心凹平均厚度(CMT)、术前视网膜感光细胞层内外节(IS/OS)是否连续、术中是否用曲安奈德染色、术中是否剥除内界膜(ILM)以及术后是否出现并发症等12种可能影响IMEM患者术后视力恢复的相关因素。计数资料采用眼数和百分比表示,组间率的比较采用χ~2检验;同时为控制混杂,进一步进行多因素分析,采用多元Logistic回归分析,以寻找影响视力恢复的相关因素。结果所有患者均顺利完成手术,术后对患者随访6~12个月,平均随访时间为(8.5±2.2)个月。在全部220例(242只眼)患者中,视力较治疗前提高者有180例(194只眼),占80.17%;术后视力未提高者有32例(38只眼),占15.70%;视力下降者有8例(10只眼),占4.13%。术后共有9例(12只眼)出现并发症。其中,低眼压2例(3只眼),眼内炎3例(4只眼),眼底出血4例(5只眼)。经单因素χ~2检验,结果表明影响IMEM患者术后视力提高的因素包括病程、术前BVCA、术前CMT、术前IS/OS是否连续、术中是否用曲安奈德染色、术中是否剥除ILM及术后是否出现并发症等7种因素与患者术后视力恢复有关(χ~2=15.232,15.976,12.489,11.567,6.783,8.904,8.340;P0.05),而性别、年龄、术中填充物类型、术前眼前段合并症、术前眼后段并发症与患者术后视力恢复无关(χ~2=0.037,0.346,1.206,0.004,0.111;P0.05)。经多元Logistic回归分析可知,病程[OR=4.986(1.232-7.025),P0.05]、CMT355μm[OR=4.223(1.269-6.425),P0.05]、术前IS/OS不连续[OR=4.112(1.326-6.986),P0.05]及术中应用曲安奈德[OR=3.996(1.118-5.232),P0.05]是影响IMEM患者术后视力恢复的独立危险因素,而ILM未剥除[OR=0.297(0.164-0.803),P0.05]是IMEM患者术后视力恢复的保护因素。结论 BVCA、CMT、术前IS/OS不连续、术中无应用曲安奈德及ILM未剥除均与IMEM患者术后视力恢复有关。术中尽量避免剥除ILM可有效保护IMEM患者的视力。
[Abstract]:Objective to investigate the effect of vitrectomy in the treatment of idiopathic macular anterior membrane (IMEM) lesions and its prognostic factors. Methods from June 2011 to June 2013, vitrectomy was performed in the ophthalmology of Yubei people's Hospital of Chongqing. Clinical data of 220 patients with IMEM, all of whom were treated with IMEM. The patients were divided into two groups without visual acuity improvement: sex, age, intraoperative filling type, preoperative anterior segment complications, postoperative complications and course of disease. The preoperative best corrected visual acuity (BVCA), mean macular fovea thickness (CMT), and intraretinal photoreceptor layer (ISR) OS were continuous and stained with triamcinolone acetonide. There were 12 related factors that might affect the recovery of visual acuity in IMEM patients, such as dissection of the inner limiting membrane (ILM) and postoperative complications. The counting data were expressed by the number of eyes and the percentage of eyes, and the rate between groups was compared by 蠂 ~ 2 test. Multivariate Logistic regression analysis was used to find the related factors affecting the recovery of visual acuity. Results all the patients were successfully operated and followed up for 6-12 months. The mean follow-up time was 8.5 卤2.2 months. The visual acuity was improved in 180 cases (80.17 eyes), the postoperative visual acuity was not improved in 32 cases (38 eyes) (15.70%), and the visual acuity decreased in 8 cases (10 eyes), accounting for 4.13% (4.13%). Low intraocular pressure was found in 3 eyes, endophthalmitis in 4 eyes and fundus hemorrhage in 5 eyes. By univariate 蠂 2 test, the results showed that the factors affecting the postoperative visual acuity of IMEM patients included course of disease, preoperative IS/OS, preoperative IS/OS, and continuity of preoperative IS/OS. Whether triamcinolone acetonide was used in the operation, whether to remove ILM during operation and whether there were complications after operation were related to postoperative visual acuity (蠂 ~ 2 / 2 15.232n 15.976 / 12.489 ~ 6.787 / 8.9048.340 / P 0.05). Sex, age, type of intraoperative filling, preoperative anterior segment complication, and so on. There was no correlation between postoperative visual acuity and postoperative visual acuity (蠂 ~ 2 / 0. 037 ~ 0. 346 ~ 1. 206n ~ 0. 004 / 0. 111p ~ (0.05)). By multivariate Logistic regression analysis, the course of the disease [OR4.9861.232-7.025] CMT355 渭 m [OR4.2231.269-6.425], preoperative IS/OS discontinuous [OR4.1121.326-6.986] and triamcinolone acetonide [OR3.9961.118-5.232] were independent risk factors affecting the recovery of visual acuity in IMEM patients. But ILM was not exfoliated [ORV 0.297U 0.164-0.803P] was the protective factor of postoperative visual acuity recovery in IMEM patients. Conclusion BVCA-CMT, IS/OS before operation is not continuous. The absence of triamcinolone acetonide and the absence of ILM exfoliation were related to the recovery of visual acuity in patients with IMEM. Avoiding ILM during operation can effectively protect the visual acuity of IMEM patients.
【作者单位】：重庆市渝北区人民医院眼科;
【基金】：重庆市科委自然科学基金支助项目(No.CSTC-2008BB5380)
【分类号】：R779.6

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