玻璃體手術聯合曲安奈德眼內注射治療特發性黃斑前膜療效觀察

【摘要】  目的：探討玻璃體手術治療特發性黃斑前膜聯合與未聯合眼內注射曲安奈德行黃斑前膜剝離術的療效比較。方法：回顧性分析我院采用玻璃體切除術治療特發性黃斑前膜88例101眼的臨床資料。其中治療組51眼聯合曲安奈德注入，對照組50眼未注入曲安奈德。所有病例均采用標準三切口經睫狀體平坦部玻璃體切除手術。治療組術中玻璃體切除完畢后行氣�惨航粨Q，待玻璃體腔無液體后注入曲安奈德(triamcinolone acetonide,TA)2.5mg染色，然后放入眼內灌注液進行黃斑前膜剝除術，其中28眼同時進行了內界膜撕除術。對照組玻璃體切除完畢后直接進行黃斑前膜剝除。手術后隨訪3～24(平均17)mo。對最佳矯正視力(BCVA)、眼壓、黃斑結構及手術并發癥進行長期療效觀察，分析其統計學意義。結果：隨訪3mo，治療組視力不同程度提高48眼(94.1%)，不變2眼(3.9%)，視力下降1眼(2.0%)。對照組視力提高46眼(92.0%)，不變2眼(4.0%)，下降2眼(4.0%)。治療組與對照組術后3mo BCVA差異無統計學意義(t=1.424，P>0.05);但術后6，12，24mo比較差異有統計學意義(t=4.528，P<0.05)。治療組合并視網膜內界膜撕除28眼，對照組2眼。OCT顯示所有手術患者前膜均已消除，黃斑水腫不同程度逐漸減輕。隨訪期末治療組未見前膜復發，對照組9眼前膜再次復發。其他并發癥：治療組和對照組在術中和隨訪期末兩者比較有明顯差異(t=6.324,P<0.05)。治療組病例術中經TA注入能更清晰地顯示出黃斑前膜的范圍，特別是殘留的微膜和未成熟膜，能更清晰地辨認。必要時進行二次剝膜，利于手術醫生操作，特別是手術技巧欠嫻熟的。早期手術治療有助于更好的視功能恢復，未見明顯不良反應及其它并發癥，提高了手術成功率。兩組術前術后眼壓差異比較無統計學意義(t=1.324,P>0.05)。　結論：利用曲安奈德在玻璃體切除術中的良好可視性能有效識別特發性黃斑前膜范圍大小，剝除的完整性。術中能更清晰地辨認、剝離，不易誤傷視網膜，手術效果更好，利于手術醫生操作。進一步提高了手術安全性及成功率，縮短了手術時間，減少了手術并發癥，使手術小量化。并且相應減輕了患者經濟負擔。

【關鍵詞】  黃斑前膜;特發性;曲安奈德;玻璃體手術;相干光斷層成像教育教學論文發表

　　Abstract�rAIM: To investigate therapeutic effect of vitrectomy and intravitreal triamcinolone acetonide(TA) in surgical removal of idiopathic epimacular membrane.METHODS: The data of 88 patients 101 eyes with vitrectomy and intravitreal TA with surgical removal of idiopathic epimacular membrane were reviewed and analyzed, among which 51 eyes in treatment group were injected TA and 50 eyes were not injected TA. After undergoing fluid�瞐ir�瞖xchange, all the eyes underwent a standard three port pars plana vitrectomy and then 2.5mg TA was injected to stain, and epiretinal membrane was removed after perfusate influxed, 28 eyes also were with internal limiting membrane peeling. Postoperative observa�瞭ion was 3��24(average 17) months. The visual acuity, complications of the surgery and foveal structural changes of macula were observed in long period and analyzed its statistic meaning.�rRESULTS: After observing the different degree of eyesight in treatment group for three months, the sight of 48(94.1%) eyes were improved , the vision of 2(3.9%) eyes were remained the same as before and that of 1 (1.9%) eye decreased. Compared with the other group, improved eyes were 46 (92.0%) , unchanged eyes were 2 (4.0%) and the eyesight of 2 (4.0%) eyes dereased. The difference of BCVA of two groups in three months had no statistical significance (t=1.424, P>0.05), whereas the compared difference of six, twelve and twenty�瞗our months was statistically significant (t=4.528; P<0.05). In treatment group, 28 eyes with removed of combined retina with inner limiting membrane, and in compared group that was 2 eyes. All epimacular membrane were disap�瞤eared on OCT after surgery and macular edema lessened gradually. There were obvious differences in other complications between two groups in operation and at end of observation(t=6.324; P<0.05). By the way, injecting TA in operation can show the scope of epiretinal membrane of macula more clearly. Especially the remain�瞖d trifled membrane and under�� mature membrane can be better recognized. When necessary, it is especially helpful for doctors who are not so proficient in skills to conduct the second dissecting membrane. Early treatment was good for better acuity, and to refrain from adverse effect or other complications, which improved the success of opera�瞭ion. The difference of