本文選題：玻璃體切割術(shù)　切入點：眼部視力　出處：《中華眼科醫(yī)學(xué)雜志(電子版)》2016年02期 　論文類型：期刊論文

【摘要】：目的探討玻璃體切割術(shù)治療特發(fā)性黃斑部前膜(IMEM)病變的療效及其預(yù)后的影響因素。方法收集2011年6月至2013年6月在重慶市渝北區(qū)人民醫(yī)院眼科行玻璃體切割術(shù)治療的220例(242只眼)IMEM患者的臨床資料。全部患者按照術(shù)后有、無視力提高分為兩組。分別記錄或檢查全部患者的性別、年齡、術(shù)中填充物類型、術(shù)前眼前段合并癥、術(shù)前眼后段并發(fā)癥、病程、術(shù)前最佳矯正視力(BVCA)、術(shù)前黃斑中心凹平均厚度(CMT)、術(shù)前視網(wǎng)膜感光細(xì)胞層內(nèi)外節(jié)(IS/OS)是否連續(xù)、術(shù)中是否用曲安奈德染色、術(shù)中是否剝除內(nèi)界膜(ILM)以及術(shù)后是否出現(xiàn)并發(fā)癥等12種可能影響IMEM患者術(shù)后視力恢復(fù)的相關(guān)因素。計數(shù)資料采用眼數(shù)和百分比表示,組間率的比較采用χ~2檢驗;同時為控制混雜,進(jìn)一步進(jìn)行多因素分析,采用多元Logistic回歸分析,以尋找影響視力恢復(fù)的相關(guān)因素。結(jié)果所有患者均順利完成手術(shù),術(shù)后對患者隨訪6~12個月,平均隨訪時間為(8.5±2.2)個月。在全部220例(242只眼)患者中,視力較治療前提高者有180例(194只眼),占80.17%;術(shù)后視力未提高者有32例(38只眼),占15.70%;視力下降者有8例(10只眼),占4.13%。術(shù)后共有9例(12只眼)出現(xiàn)并發(fā)癥。其中,低眼壓2例(3只眼),眼內(nèi)炎3例(4只眼),眼底出血4例(5只眼)。經(jīng)單因素χ~2檢驗,結(jié)果表明影響IMEM患者術(shù)后視力提高的因素包括病程、術(shù)前BVCA、術(shù)前CMT、術(shù)前IS/OS是否連續(xù)、術(shù)中是否用曲安奈德染色、術(shù)中是否剝除ILM及術(shù)后是否出現(xiàn)并發(fā)癥等7種因素與患者術(shù)后視力恢復(fù)有關(guān)(χ~2=15.232,15.976,12.489,11.567,6.783,8.904,8.340;P0.05),而性別、年齡、術(shù)中填充物類型、術(shù)前眼前段合并癥、術(shù)前眼后段并發(fā)癥與患者術(shù)后視力恢復(fù)無關(guān)(χ~2=0.037,0.346,1.206,0.004,0.111;P0.05)。經(jīng)多元Logistic回歸分析可知,病程[OR=4.986(1.232-7.025),P0.05]、CMT355μm[OR=4.223(1.269-6.425),P0.05]、術(shù)前IS/OS不連續(xù)[OR=4.112(1.326-6.986),P0.05]及術(shù)中應(yīng)用曲安奈德[OR=3.996(1.118-5.232),P0.05]是影響IMEM患者術(shù)后視力恢復(fù)的獨立危險因素,而ILM未剝除[OR=0.297(0.164-0.803),P0.05]是IMEM患者術(shù)后視力恢復(fù)的保護(hù)因素。結(jié)論 BVCA、CMT、術(shù)前IS/OS不連續(xù)、術(shù)中無應(yīng)用曲安奈德及ILM未剝除均與IMEM患者術(shù)后視力恢復(fù)有關(guān)。術(shù)中盡量避免剝除ILM可有效保護(hù)IMEM患者的視力。
[Abstract]:Objective to investigate the effect of vitrectomy in the treatment of idiopathic macular anterior membrane (IMEM) lesions and its prognostic factors. Methods from June 2011 to June 2013, vitrectomy was performed in the ophthalmology of Yubei people's Hospital of Chongqing. Clinical data of 220 patients with IMEM, all of whom were treated with IMEM. The patients were divided into two groups without visual acuity improvement: sex, age, intraoperative filling type, preoperative anterior segment complications, postoperative complications and course of disease. The preoperative best corrected visual acuity (BVCA), mean macular fovea thickness (CMT), and intraretinal photoreceptor layer (ISR) OS were continuous and stained with triamcinolone acetonide. There were 12 related factors that might affect the recovery of visual acuity in IMEM patients, such as dissection of the inner limiting membrane (ILM) and postoperative complications. The counting data were expressed by the number of eyes and the percentage of eyes, and the rate between groups was compared by 蠂 ~ 2 test. Multivariate Logistic regression analysis was used to find the related factors affecting the recovery of visual acuity. Results all the patients were successfully operated and followed up for 6-12 months. The mean follow-up time was 8.5 鹵2.2 months. The visual acuity was improved in 180 cases (80.17 eyes), the postoperative visual acuity was not improved in 32 cases (38 eyes) (15.70%), and the visual acuity decreased in 8 cases (10 eyes), accounting for 4.13% (4.13%). Low intraocular pressure was found in 3 eyes, endophthalmitis in 4 eyes and fundus hemorrhage in 5 eyes. By univariate 蠂 2 test, the results showed that the factors affecting the postoperative visual acuity of IMEM patients included course of disease, preoperative IS/OS, preoperative IS/OS, and continuity of preoperative IS/OS. Whether triamcinolone acetonide was used in the operation, whether to remove ILM during operation and whether there were complications after operation were related to postoperative visual acuity (蠂 ~ 2 / 2 15.232n 15.976 / 12.489 ~ 6.787 / 8.9048.340 / P 0.05). Sex, age, type of intraoperative filling, preoperative anterior segment complication, and so on. There was no correlation between postoperative visual acuity and postoperative visual acuity (蠂 ~ 2 / 0. 037 ~ 0. 346 ~ 1. 206n ~ 0. 004 / 0. 111p ~ (0.05)). By multivariate Logistic regression analysis, the course of the disease [OR4.9861.232-7.025] CMT355 渭 m [OR4.2231.269-6.425], preoperative IS/OS discontinuous [OR4.1121.326-6.986] and triamcinolone acetonide [OR3.9961.118-5.232] were independent risk factors affecting the recovery of visual acuity in IMEM patients. But ILM was not exfoliated [ORV 0.297U 0.164-0.803P] was the protective factor of postoperative visual acuity recovery in IMEM patients. Conclusion BVCA-CMT, IS/OS before operation is not continuous. The absence of triamcinolone acetonide and the absence of ILM exfoliation were related to the recovery of visual acuity in patients with IMEM. Avoiding ILM during operation can effectively protect the visual acuity of IMEM patients.
【作者單位】： 重慶市渝北區(qū)人民醫(yī)院眼科;
【基金】：重慶市科委自然科學(xué)基金支助項目(No.CSTC-2008BB5380)
【分類號】：R779.6

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