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目的探讨玻璃体切除联合黄斑前膜剥离术治疗特发性黄斑前膜的手术效果及手术时机的选择。方法回顾性分析手术治疗的特发性黄斑前膜58例(59眼),所有病例均行三切口玻璃体切除及黄斑前膜剥除术,其中20眼同时进行了内界膜撕除术。32眼行气液交换。6眼联合行晶状体超声乳化及人工晶状体植入术。手术后随访1～24月,平均4.7月。对视力、黄斑结构及手术并发症等进行了临床观察。结果随访期末视力提高43眼,占72.88%(其中提高2行以上者29眼占49.15%);不变15眼,占25.42%;下降1眼,占1.70%。随访期内未见前膜复发。OCT显示所有患眼的前膜均已消除,黄斑水肿不同程度逐渐减轻。并发症:术中少许点状出血6眼;手术后11d发生玻璃体积血1眼;周边小牵引孔3眼(其中视网膜脱离1眼);术中中心凹处小牵引孔1眼;手术后1a并发性白内障2眼。结论玻璃体切除术联合膜剥离治疗特发性黄斑前膜的手术效果较好,但也可能出现一些较严重的并发症。在手术技巧比较娴熟的情况下,较早手术治疗可能有助于恢复较好视功能。
Objective To investigate the effect of vitrectomy combined with anterior macular debridement on the treatment of idiopathic macular anterior membrane and the choice of timing. Methods Fifty-eight cases (59 eyes) of idiopathic macular degeneration treated by surgery were retrospectively analyzed. All the cases underwent three-incision vitrectomy and macular debridement. Among them, 20 cases underwent endometrial debridement at the same time. 32 eye gas and liquid exchange. 6 eyes combined with phacoemulsification and intraocular lens implantation. Follow-up 1 to 24 months after surgery, an average of 4.7 months. Visual acuity, macular structure and surgical complications were observed. Results At the end of the follow-up period, visual acuity increased by 43 eyes (72.88%), of which 29 eyes (49.15% increased by 2 lines or more), 15 eyes (25.42%), and 1 eyes (1.70%). No previous membrane recurrence was observed during the follow-up period. OCT showed that all pre-ophthalmic membranes were eliminated, and macular edema gradually reduced to varying degrees. Complications: a little bit of intraoperative bleeding in 6 eyes; vitreous hemorrhage occurred in 1 eye 11d after surgery; 3 small traction holes in the periphery (1 retina detachment); 1 small traction hole in the fovea; 1 la Cataract 2 eyes. Conclusions Vitrectomy combined with membrane stripping treatment of idiopathic macular anterior membrane is effective, but some serious complications may occur. In the case of more skilled surgical techniques, early surgery may help to restore better visual function.