玻璃体手术单独或联合抗VEGF治疗黄斑前膜的回顾分析与前瞻研究

发布时间：2018-06-16 06:22

本文选题：特发性黄斑前膜 + 视功能　；参考：《第三军医大学》2017年硕士论文

【摘要】：黄斑前膜(epiretinal membranes)是由视网膜黄斑区内表面增生而形成的纤维无血管的细胞性增殖膜,其致病因素多种多样。总体来说,根据病因可将黄斑前膜分为特发性黄斑前膜(idiopathic epiretinal membrane,IERM)和继发性黄斑前膜(secondary epiretinal membrane)。特发性黄斑前膜主要的临床表现为中心视力降低,视物变形等。这些症状严重影响着患者的生活质量。目前,玻璃体手术剥除黄斑前膜是治疗黄斑前膜的唯一手段,术后患者视力可恢复至一定水平。但是,黄斑前膜的治疗还有多问题无法解决,如:患者手术时机如何选择、术后黄斑结构为何难以恢复至正常、哪些术前因素会影响术后视力的恢复、是否有更好的方法能进一步改善黄斑的结构与功能等。目的本课题拟通过回顾性研究探讨特发性黄斑前膜玻璃体手术治疗前后视网膜黄斑区结构及视功能的变化关系,寻找影响黄斑区结构及视功能恢复的因素,评价黄斑区结构变化与视功能预后的关系,然后通过随机双盲对照性研究探讨玻璃体手术联合抗VEGF药物治疗特发性黄斑前膜的有效性和安全性,为探索更有效的治疗方案提供依据。方法研究分为两部分,第一部分:回顾性分析2013年1月至2014年12月于我院行玻璃体手术治疗的特发性黄斑前膜患者,测量患者术前术后最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹厚度(central foveal thickness,CFT)、黄斑区视网膜平均厚度,并分析BCVA、CFT与黄斑区视网膜平均厚度之间的相关性。根据椭圆体区(Ellipsoid Zone,EZ)是否缺损将患者分为两组,测量EZ缺损长度,比较两组之间的BCVA、CFT和黄斑区视网膜平均厚度的差异。第二部分:采用前瞻性随机双盲试验,将我院诊断特发性黄斑前膜患者分为2组,联合治疗组行玻璃体手术联合玻璃体腔注射抗VEGF药物治疗黄斑前膜,对照组行玻璃体手术剥除黄斑前膜,分析2组患者术后1、3、6月视力变化值及CMT减少值,以及2组患者术后6月多焦视网膜电图(mf-ERG)的变化情况。结果第一部分:(1)患者接受玻璃体手术后黄斑区水肿减轻,BCVA提高至(0.45±0.26),CFT减少至(334.5±69.5)um。(2)术前BCVA与术前黄斑区平均厚度相关(r=0.433,P=0.007);术后BCVA与术后CFT相关(r=0.363,P=0.025);术后黄斑中心凹厚度、黄斑区平均厚度减少值与术后视力提升值呈正相关(r=0.459,P=0.04;r=0.445,P=0.005)。(3)椭圆体区连续组术后BCVA(0.35±0.25)优于椭圆体区不连续组(0.59±0.23,P=0.005)。第二部分:(1)术后1月、3月、6月,联合治疗组与对照组的视力变化值及CFT减少值2组比较无统计学差异;(2)术后6月联合治疗组与对照组mf-ERG中心一环的b波幅值变化比较无统计学差异。结论测定CFT可用于评价术后视力恢复情况,特发性黄斑前膜患者应在椭圆体区出现缺损前进行手术治疗。玻璃体手术联合玻璃体腔注射抗VEGF药物治疗特发性黄斑前膜与常规玻璃体手术剥除黄斑前膜相比,在减轻特发性黄斑前膜术后黄斑水肿、提高术后视功能上无明显促进作用。
[Abstract]:The macular membrane (epiretinal membranes) is a fibrous non vascular proliferation membrane formed by the proliferation of the inner surface of the retinal macular region. Its pathogenic factors are varied. In general, the macular membrane can be divided into the idiopathic epiretinal membrane (IERM) and the secondary macular membrane (secondary epireti) according to the cause of the macular region. Nal membrane). The main clinical manifestations of the idiopathic macular membrane are the decrease of central vision and the deformation of the visual substance. These symptoms seriously affect the quality of life of the patients. At present, vitreous surgery is the only means to treat macular membrane, and the visual acuity of the patients can be restored to a certain level. However, the treatment of the macular membrane is still available. Many problems can not be solved, such as: how to choose the timing of the operation, why the macular structure is difficult to recover to normal after operation, which factors will affect the recovery of visual acuity after operation, and whether there is a better way to improve the structure and function of macula. The relationship between the retinal macular region structure and visual function before and after surgical treatment, to find the factors that affect the structure of macular region and the recovery of visual function, to evaluate the relationship between the changes in the macular region and the prognosis of the visual function, and then to explore the effectiveness of the combination of vitreous surgery and anti VEGF drugs for the treatment of idiopathic macular membrane through a randomized double blind control study. And safety to provide the basis for the exploration of a more effective treatment scheme. The method study is divided into two parts. Part one: a retrospective analysis of the idiopathic macular premacular membrane (best corrected visual acuity, BCVA), and the macular fovea in patients who underwent vitreous surgery in our hospital from January 2013 to December 2014. The thickness (central foveal thickness, CFT), the average retinal thickness of the macular region, and the correlation between the BCVA, CFT and the average retinal thickness in the macular region. According to the defect of the ellipsoid region (Ellipsoid Zone, EZ), the patients are divided into two groups, and the length of the EZ defect is measured, compared with the BCVA, the difference between the average thickness of the retina and the CFT and macular region between the two groups. The second part: the second part: a prospective randomized double blind trial was used to divide the patients with idiopathic macular membrane into 2 groups. The combined treatment group was treated with vitreous surgery combined with vitreous intravitreal injection against macular membrane, and the control group was stripped of the macular membrane by vitreous surgery, and the changes of visual acuity and CMT decreased in the 2 groups after the operation of the 2 groups. And the changes in the multifocal electroretinogram (mf-ERG) of the 2 groups of patients after the operation in June. Results the first part: (1) the macular edema decreased after vitreous surgery, the BCVA increased to (0.45 + 0.26), and CFT decreased to (334.5 + 69.5) um. (2) before the operation, BCVA was correlated with the average thickness of the macular region before operation (r=0.433, P=0.007); BCVA was associated with postoperative CFT (r=0). .363, P=0.025); the postoperative macular fovea thickness, the average thickness reduction of macular area was positively correlated with the postoperative visual acuity improvement (r=0.459, P=0.04; r=0.445, P=0.005). (3) BCVA (0.35 + 0.25) in the continuous group of ellipsoid region was superior to the discontinuous group (0.59 + 0.23, P=0.005). Second: (1) in January, March, and June, the combined treatment group and the control group. There was no significant difference in the value of visual change and CFT reduction in the 2 groups. (2) there was no significant difference in the amplitude of B wave in the mf-ERG center of the combined treatment group in June and the control group. Conclusion CFT can be used to evaluate the recovery of visual acuity after the operation. The idiopathic macular anterior membrane patients should be treated with the operation before the elliptical area defect. Vitreous surgery combined with intravitreal injection of anti VEGF drugs for the treatment of idiopathic macular macular membrane and conventional vitreous surgical removal of macular membrane has no significant effect on alleviating macular edema after idiopathic macular membrane surgery and improving visual function after operation.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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