摘要
目的研究特发性黄斑前膜手术前后视物变形的变化及影响因素。方法采用系列病例观察方法,于2013年10月至2014年6月纳入北京同仁医院行23G玻璃体切割术+内界膜剥除术+C2F6填充术的黄斑前膜患者39例39眼进行回顾性分析,对术前、术后3个月和术后6个月随访情况进行评估。采用M图得出M评分值,评估患者视物变形程度。采用EDTRS视力表测定患者最佳矫正视力(BCVA)(LogMAR视力)。采用频域光相干断层扫描(OCT)仪测量黄斑中心凹厚度(CFT)和黄斑中心凹平均厚度(CST)、黄斑区平均厚度(CAT)、视网膜神经节细胞层(GCL)厚度、内核层(INL)厚度和外层视网膜[外核层(ONL)+外丛状层(OPL)]厚度,并观察外界膜、椭圆体带和嵌合体带的完整性,计算黄斑区容积(CV)。结果患眼平均M评分由术前的0.8(0.3,1.1)减小至术后3个月的0.5(0.2,0.8),差异有统计学意义(Z=-2.013,P=0.044)。术后6个月平均M评分为0.6(0.2,0.8),与术前、术后3个月比较,差异均无统计学意义(Z=-1.873,P=0.061;Z=-0.288,P=0.773)。其中,术后3个月、6个月水平M评分均较术前明显减小,差异均有统计学意义(Z=-2.329,P=0.020;Z=-2.858,P=0.004)。术后3个月、6个月垂直M评分与术前比较,差异均无统计学意义(均P>0.05)。术前BCVA为0.40(0.30,0.66),术后3个月为0.20(0.06,0.42),差异有统计学意义(Z=-4.087,P<0.001),术后6个月BCVA为0.30(0.10,0.52),与术后3个月比较差异有统计学意义(Z=-2.235,P=0.025)。联合手术组术后3个月和6个月BCVA较术前提高,差异均有统计学意义(Z=-2.613,P=0.009;Z=-2.466,P=0.014);未联合手术组术后3个月BCVA较术前显著提高,差异有统计学意义(Z=-3.104,P=0.002),术后6个月较术后3个月显著下降,差异有统计学意义(Z=-3.464,P=0.001)。术前M值与术前BCVA、CST、CFT均呈正相关(rs=0.384,P=0.016;rs=0.585,P<0.001;rs=0.601,P<0.001),与GCL、INL、ONL+OPL厚度均无明显相关性。术后6个月水平M值与术后6个月CST、CV、CAT均呈正相关(rs=0.322,P=0.045;rs=0.340,P=0.034;rs=0.336,P=0.036),与术后6个月LogMAR视力、CFT、GCL厚度、INL厚度、ONL+OPL厚度均无明显相关性。术后6个月垂直M值和平均M值与术后各参数均无相关性。术后6个月平均M值与术前平均M值、CST、CV、CAT均呈正相关(rs=0.589,P<0.001;rs=0.330,P=0.040;rs=0.404,P=0.011;rs=0.410,P=0.009),与术前BCVA、CFT、GCL厚度、INL厚度、ONL+OPL厚度均无明显相关性。多元线性逐步回归模型分析显示,术前M值是术后M值的预测因素(调整后R^2=0.211,P=0.002)。结论黄斑前膜手术可以使多数患者的视物变形症状减轻,术后残余视物变形程度与术前视物变形程度和CFT有关。
Objective To investigate the changes of metamorphopsia between before and after surgery in the patients with idiopathic epiretinal membrane and its influence factors.Methods A series cases observitional study included 39 eyes of 39 patients with idiopathic epiretinal membrane.Follow-up was carried out at 1 week before surgery and 3,6 months after surgery respectively.M-chart was used to quantify the severity of metamorphopsia(M-score).EDTRS visual chart was used to quantify best corrected visual acuity(BCVA)(converted to LogMAR).Central subfield thickness(CST),central foveal volumn(CV),cube average thickness(CAT),central foveal thichness(CFT),ganglion cell layer(GCL)thickness,inner nuclear layer(INL)thickness,outer nuclear layer(ONL)and outer plexiform layer(OPL)thickness,the integrity of external limiting membrane,ellipsoid zone and interdigitation zone were analyzed by using spectral domain-optical coherence tomography(OCT).This study protocol was approved by Ethic Committee of Beijing Tongren Hospital(No.TRECKY-012).Written informed consent was obtained from each subject before surgery.Results Mean M-score was significantly decreased from 0.8(0.3,1.1)before surgery to 0.5(0.2,0.8)at 3 months after surgery,with a significant difference between the two time points(Z=-2.013,P=0.044).Mean M-score was 0.6(0.2,0.8)at 6 months after surgery,which was not significantly different in comparison with before surgery and 3 months after surgery(Z=-1.873,P=0.061;Z=-0.288,P=0.773).Compared with before surgery,the horizontal M-score was significantly decreased 3 months and 6 months after surgery(Z=-2.329,P=0.020;Z=-2.858,P=0.004).No significant difference was found in vertical M-score among before surgery and 3,6 months after surgery(all at P>0.05).The BCVA was improved from 0.40(0.30,0.66)before surgery to 0.20(0.06,0.42)3 months after surgery and declined to 0.30(0.10,0.52)at 6 months after surgery,and significant differences were obtained between 3 months after surgery and before surgery or 6 months after surgery(Z=-4.087,P<0.001;Z=-2.235,P=0.025).Compared with before surgery,the BCVA in cataract combined with vitrectomy operative group was significantly improved in 3 months and 6 months after surgery(Z=-2.613,P=0.009;Z=-2.466,P=0.014)and the BCVA in only vitrectomy group was significantly improved at 3 months after surgery but decreased 6 months after surgery,showing significant differences between 3 months after surgery and before surgery or 6 months after surgery(Z=-3.104,P=0.002;Z=-3.464,P=0.001).Preoperative M-score was positively correlated with preoperative BCVA,preoperative CST or preoperative CFT(rs=0.384,P=0.016;rs=0.585,P<0.001;rs=0.601,P<0.001).No correlation was found between BCVA with GCL,INL or ONL + OPL thickness.Horizontal M-score was positively correlated with CST,postoperative CV and postoperative CAT(rs=0.322,P=0.045;rs=0.340,P=0.034;rs=0.336,P=0.036),and no correlation was found between horizontal M-score and BCVA,CFT,GCL thickness,INL thickness,ONL+OPL thickness in 6 months after surgery.The vertical M-score and mean M-score were not correlated with OCT parameters in 6 months after surgery.The mean M-score was positively correlated with preoperative mean M-score,preoperative CST,preoperative CV,preoperative CAT in 6 months after surgery(rs=0.589,P<0.001;rs=0.330,P=0.040;rs=0.404,P=0.011;rs=0.410,P=0.009).In addition,and no significant correlation between mean M-score and preoperative BCVA,CFT,GCL thickness,INL thickness,ONL+OPL thickness.Multivariate stepwise linear regression showed that preoperative M-score was a predictor of postoperative M-values(adjusted R^2=0.211,P=0.002).Conclusions Most metamorphopsia can be alleviated after idiopathic epiretinal membrane surgery.The residue metamorphopsia after surgery probably is correlated with preoperative metamorphopsia and CFT.
作者
梁曦达
王怡
刘丽梅
高萌
郁艳萍
王曾仪
陈金秋
刘欣欣
刘武
Liang Xida;Wang Yi;Liu Limei;Gao Meng;Yu Yanping;Wang Zengyi;Chen Jinqiu;Liu Xinxin;Liu Wu(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology and Visual Sciences Key Laboratory,Beijing 100730,China;Department of Ophthalmology,Yantai Yuhuangding Hospital,Affiliated Hospital of Medical College,Qingdao University,Yantai 264000,China;Department of Ophthalmology,Kailuan General Hospital,Tangshan 063003,China)
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2019年第1期21-28,共8页
Chinese Journal Of Experimental Ophthalmology
基金
国家自然科学基金项目(81541106).
