视网膜内界膜剥除在继发性黄斑前膜的应用.docVIP

PAGE PAGE 1 视网膜内界膜剥除在继发性黄斑前膜的应用 【摘要】 目的：描述视网膜内界膜剥离在继发性黄斑前膜手术中的应用、临床特点及效果。方法：回顾我院2000/2006年因继发性黄斑前膜需行玻璃体视网膜手术患者32例32眼，其中男24例，女8例;年龄13～69(平均41±28)岁;病程3～69(平均21±19)mo，有6眼病程在1a以上。术前视力:CF～0.4。原发病:常规视网膜脱离复位术后13眼(男/女:13/0)、玻璃体切除术后8眼(男/女:7/1)、视网膜血管病变6眼(男/女:4/2)、平坦部炎5眼(男/女:0/5)，其中经平坦部后部玻璃体手术中发现黄斑部有铁锈和炎性物质附着共5眼5例。所有患者行标准的经睫状体平坦部的三通道玻璃体切除，术中先剥除前膜后再剥除视网膜内界膜，部分患者结合TA标记，眼内空气充填1wk左右。追踪观察6～38mo。结果：术后视力0.05～0.7，其术前与术后差视力差异有显著性(采用fisher确切概率法Plt;0.05)。术后黄斑中心凹厚度与术前相比差异具有显著性(采用Friedman test，Plt;0.05)。尚未发现由视网膜内界膜剥离所致的严重并发症。结论：视网膜内界膜剥离在继发行黄斑前膜手术中的应用不但可以达到整理松解黄斑区处视网膜皱褶,解除对黄斑中心凹的牵引，还可以清除紧密附着在黄斑前视网膜表面的炎性物质，改善黄斑区局部的代谢，有利于黄斑功能的恢复。 【关键词】 视网膜内界膜剥离;玻璃体视网膜手术;继发性黄斑前膜 　　Abstract 　　AIM:To describe the applications, clinical features and effect of the divesting of retinal inner limiting membrane in secondary epiretinal membrane in macular. 　　METHODS: Retrospective series of consecutive but noncomparative cases from 2000 to 2006 was reviewed. There were 32 patients 32 eyes underwent vitreoretinal surgery(par plana vitrectomy)for secondary macular epiretinal membrane.26 cases were male and 6 case were female;age ranged from 13 to 69 yeas old ,and the average was 41.5 years old. Course of illness was from 3 to 69 months,and the average was 21.6 months.6 cases lasted for more than one year. The records of 5 cases 5 eyes were diagnosed as intraocular foreign body associated with siderosis bulbi in macular.During the operation, divesting of retinal inner limiting membrane was performed after peeling epiretinal membrane. A part of patient were targeted with TA. Air intraocular tamponaded for about a week. The followup was 638 months. 　　RESULTS:Postoperative visual acuity of suffering eyes ranged from 0.05 to 0.7. There was significant difference between the preoperative vision and the postoperative vision(fishers exact test,Plt;0.05)，and there was also significant difference between the foveal thickness of preoperative and postoperative (Friedman test，Plt;0.05).Serious complication of tearing reti