[1]王丽英,李洁,温晓英,等.内界膜剥除联合玻璃体内注射曲安奈德治疗继发性黄斑前膜的疗效观察[J].眼科新进展,2017,37(8):763-765.[doi:10.13389/j.cnki.rao.2017.0193]
　WANG Li-Ying,LI Jie,WEN Xiao-Ying,et al.Efficacy of retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide for secondary epiretinal membrane[J].Recent Advances in Ophthalmology,2017,37(8):763-765.[doi:10.13389/j.cnki.rao.2017.0193]
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内界膜剥除联合玻璃体内注射曲安奈德治疗继发性黄斑前膜的疗效观察/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
37卷
期数:
2017年8期
页码:
763-765
栏目:
应用研究
出版日期:
2017-08-05

文章信息/Info

Title:
Efficacy of retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide for secondary epiretinal membrane
作者:
王丽英; 李洁; 温晓英; 张月玲
071000　河北省保定市，保定市第一中心医院眼科
Author(s):
WANG Li-Ying; LI Jie; WEN Xiao-Ying; ZHANG Yue-Ling
Department of Ophthalmology，the First Center Hospital of Baoding,Baoding 071000，Hebei Province，China
关键词:
玻璃体内注射; 曲安奈德; 继发性黄斑前膜; 内界膜剥除
Keywords:
intravitreal injection; triamcinolone acetonide; secondary epiretinal membrane; retinal inner limiting membrane peeling
分类号:
R774.5
DOI:
10.13389/j.cnki.rao.2017.0193
文献标志码:
A
摘要:
目的　观察内界膜剥除联合玻璃体内注射曲安奈德治疗继发性黄斑前膜的疗效。方法　回顾性分析我院2011年6月至2015年6月因继发性黄斑前膜需行玻璃体视网膜手术者42例42眼，所有患者均行标准的23 G经睫状体平坦部的三通道玻璃体切割+黄斑前膜剥除+视网膜内界膜剥除+玻璃体内注射曲安奈德术，术后随访3.0~18.0（8.3±2.4）个月，对手术前后最佳矫正视力、黄斑形态及手术并发症等进行观察。结果　随访期末，最佳矫正视力提高者30眼，不变者8眼，下降者4眼；术后最佳矫正视力与术前相比，差异有统计学意义（t=3.145，P=0.000）。黄斑中心神经上皮层厚度术前为（315.62±132.12）μm，术后为（233.42±146.32）μm，手术前后相比差异有统计学意义（t=4.322，P=0.000）。术后视网膜少许出血6眼，玻璃体积血1眼，一过性高眼压6眼；3眼周边牵引性小裂孔，激光治疗后，行玻璃体内C3F8填充，视网膜在位。结论　玻璃体内注射曲安奈德可以加速黄斑水肿消退，降低黄斑前膜复发，促进视功能恢复。视网膜内界膜剥除在继发性黄斑前膜手术中可以松解黄斑区视网膜皱褶，解除对黄斑中心凹的牵引，改善黄斑区局部的代谢，有利于黄斑功能的恢复。
Abstract:
Objective　To observe the efficacy of retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide for secondary epiretinal membrane.Methods　Forty-two patients (42 eyes) with secondary epiretinal membrane underwent vitretinal surgery in our hospital from June 2011 to June 2015 were retrospectively studied.All patients underwent pars plana vitrectomy+epiretinal membrane peeling+retinal inner limiting membrane peeling and intravitreal injection of triamcinolone acetonide.The follow-up time was from 3.0 months to 18.0 months,averaged (8.3±2.4)months.Postoperative best corrected visual acuity (BCVA),macular morphology and complications were observed.Results　At the final follow-up,BCVA improved in 30 eyes,unchanged in 8 eyes and decreased in 4 eyes,and there was significant difference compared with that before operation (t=3.145,P=0.000).The preoperative and postoperative thickness of meuroepithelium in the centual macular area were（315.62±132.12）μm and （233.42±146.32）μm,and there was significant difference(t=4.322,P=0.000).Small amount of retinal hemorrhage happened in 6 eyes after operation,vitreous hemorrhage was in 1 eye,transient high intraocular pressure was in 6 eyes;Prepheral retinal hole occurred in 3 eyes,which were cured by laser treatment and C3F8 tamponade.Conclusion　Intravitreal injection of triamcinolone acetonide can reduce the macular edema,decrease the reoccurrence of epiretinal membrane and imporve the visual acuity.The retinal inner limiting membrane peeling in secondary macular epiretinal membrane surgery can release the macular pucker,lifting and traction on the fovea,improve the metabolism of macular local,is conducive to the recovery of macular function.

参考文献/References:

［1］　DELLOMO R，CIFARIELLO F，DELLOMO E，DE LENA A，DILORIO R，FILIPPELLI M，et al.Influence of retinal vessel printings on meta morphopsia and retinal architeetural abnormalities in eyes with idiopathie macular epiretinal membrane［J］.Invest Ophthalmol Vis Sci，2013，54（120）：803-811.
［2］　张承芬.眼底病学［M］.北京：人民卫生出版社，2010：340-341.
ZHANG CF.Ocular fundology［M］.Beijing：People’s Health Publishing House，2010：340-341.
［3］　NIGAM N，BARTSCH DU，CHENG L，BRAR M，YUSON RM，KOZAK L，et al，Spectral domain optical coherence tomography for imaging ERM，retinal edema，and vitreomacular interface［J］.Retina，2010，30（2）：246-253.
［4］　MESSMER EM,HEIDENKUMMER HP,KAMPIK A.Ultrastructure of epiretinal membranes associated with macular holes［J］.Graefes Arch Clin Exp Ophthahnol，1998，236（4）：248-254.
［5］　FANG X，ZHENG X，WENG Y，CHEN Z，LIU J，CHEN B，et al.Anatomical and visual outcome after vitrectomy with triamcinolone acedonider-assisted epiretinal membrane removal in highly myopic eyes with retinal detachment due to macular hole［J］.Eye（Lond），2009，23（2）：248-254.
［6］　SHAHSUVARYAN ML.Therapeutic potential of intravitreal pharmacotherapy in retinal vein occlusion［J］.Int J Ophthalmol，2012，5（6）：759-770.
［7］　许静，冯洁，吕学森.不同手术方法治疗继发性黄斑前膜的效果观察［J］.中华眼外伤职业眼病杂志，2016，38（1）：60-63.
XU J，FENG J，LV XS.The dfficacy of different surgical methods for secondary macular epiretinal membrane［J］.Chin J Ocul Traum Occupat Eye Dis，2016，38（1）：60-63.
［8］　OLSEN TW，STERNBERG P，CAPONE A，MAR TIN DF，LIM JI，GROSSNIKLAUS HE，et al.Macular hole surgery using thrombin activated fibfinogen and slective removal of the internal limiting membrane［J］.Retina，1998，18（4）：322-329.
［9］　GARCIA-FERNANDEZ M，CASTRO-NAVARRO J，GONZA-LEZ-CASTANO C，GARCIA-ALONSO A，FONLLA-GIL M.Epiretinal membrane surgery：anatomic and functional outcomes［J］.Arch Soc Esp Oftalmol，2013，88（4）：139-144.
［10］　赵婷婷，周民稳，施靖容，陈秋莹，何玉萍，樊莹.特性黄斑前膜术后黄斑区结构改变与视功能的相关性［J］.眼科新进展，2016，36（6）：536-539.
ZHAO TT，ZHOU MW，SHI JR，CHEN QY，HE YP，FAN Y.Correlation between macular structure and visual function after idiopathic epiretinal membrane surgery［J］.Rec Adv Ophthalmol，2016，36（6）：536-539.
［11］　TERASAKI H，MIYAKE Y，NOMURA R.Focal macular ERGs in eyes after removal of macular ILM during macular hole surely［J］.Invest Ophthalmol Vis Sci，2001，42（1）：229-234.
［12］　周静，刘武，李倩，李翔，郝静，王心蕾.特发性黄斑前膜手术前后黄斑厚度与功能等相关性研究［J］.中华眼科杂志，2012，48（2）：119-123.
ZHOU J，LIU W，LI Q，LI X，HAO J，WANG XL，A comparative study of macular thickness and function before and after idiopathic macular epiretinal membrane surgery［J］.Chin J Ophtalmol，2012，48（2）：119-123.

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更新日期/Last Update: 2017-08-14