本文選題：特發(fā)性黃斑前膜 + 視功能��； 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：黃斑前膜(epiretinal membranes)是由視網(wǎng)膜黃斑區(qū)內(nèi)表面增生而形成的纖維無血管的細胞性增殖膜,其致病因素多種多樣。總體來說,根據(jù)病因可將黃斑前膜分為特發(fā)性黃斑前膜(idiopathic epiretinal membrane,IERM)和繼發(fā)性黃斑前膜(secondary epiretinal membrane)。特發(fā)性黃斑前膜主要的臨床表現(xiàn)為中心視力降低,視物變形等。這些癥狀嚴重影響著患者的生活質(zhì)量。目前,玻璃體手術(shù)剝除黃斑前膜是治療黃斑前膜的唯一手段,術(shù)后患者視力可恢復(fù)至一定水平。但是,黃斑前膜的治療還有多問題無法解決,如:患者手術(shù)時機如何選擇、術(shù)后黃斑結(jié)構(gòu)為何難以恢復(fù)至正常、哪些術(shù)前因素會影響術(shù)后視力的恢復(fù)、是否有更好的方法能進一步改善黃斑的結(jié)構(gòu)與功能等。目的本課題擬通過回顧性研究探討特發(fā)性黃斑前膜玻璃體手術(shù)治療前后視網(wǎng)膜黃斑區(qū)結(jié)構(gòu)及視功能的變化關(guān)系,尋找影響黃斑區(qū)結(jié)構(gòu)及視功能恢復(fù)的因素,評價黃斑區(qū)結(jié)構(gòu)變化與視功能預(yù)后的關(guān)系,然后通過隨機雙盲對照性研究探討玻璃體手術(shù)聯(lián)合抗VEGF藥物治療特發(fā)性黃斑前膜的有效性和安全性,為探索更有效的治療方案提供依據(jù)。方法研究分為兩部分,第一部分:回顧性分析2013年1月至2014年12月于我院行玻璃體手術(shù)治療的特發(fā)性黃斑前膜患者,測量患者術(shù)前術(shù)后最佳矯正視力(best corrected visual acuity,BCVA)、黃斑中心凹厚度(central foveal thickness,CFT)、黃斑區(qū)視網(wǎng)膜平均厚度,并分析BCVA、CFT與黃斑區(qū)視網(wǎng)膜平均厚度之間的相關(guān)性。根據(jù)橢圓體區(qū)(Ellipsoid Zone,EZ)是否缺損將患者分為兩組,測量EZ缺損長度,比較兩組之間的BCVA、CFT和黃斑區(qū)視網(wǎng)膜平均厚度的差異。第二部分:采用前瞻性隨機雙盲試驗,將我院診斷特發(fā)性黃斑前膜患者分為2組,聯(lián)合治療組行玻璃體手術(shù)聯(lián)合玻璃體腔注射抗VEGF藥物治療黃斑前膜,對照組行玻璃體手術(shù)剝除黃斑前膜,分析2組患者術(shù)后1、3、6月視力變化值及CMT減少值,以及2組患者術(shù)后6月多焦視網(wǎng)膜電圖(mf-ERG)的變化情況。結(jié)果第一部分:(1)患者接受玻璃體手術(shù)后黃斑區(qū)水腫減輕,BCVA提高至(0.45±0.26),CFT減少至(334.5±69.5)um。(2)術(shù)前BCVA與術(shù)前黃斑區(qū)平均厚度相關(guān)(r=0.433,P=0.007);術(shù)后BCVA與術(shù)后CFT相關(guān)(r=0.363,P=0.025);術(shù)后黃斑中心凹厚度、黃斑區(qū)平均厚度減少值與術(shù)后視力提升值呈正相關(guān)(r=0.459,P=0.04;r=0.445,P=0.005)。(3)橢圓體區(qū)連續(xù)組術(shù)后BCVA(0.35±0.25)優(yōu)于橢圓體區(qū)不連續(xù)組(0.59±0.23,P=0.005)。第二部分:(1)術(shù)后1月、3月、6月,聯(lián)合治療組與對照組的視力變化值及CFT減少值2組比較無統(tǒng)計學(xué)差異;(2)術(shù)后6月聯(lián)合治療組與對照組mf-ERG中心一環(huán)的b波幅值變化比較無統(tǒng)計學(xué)差異。結(jié)論測定CFT可用于評價術(shù)后視力恢復(fù)情況,特發(fā)性黃斑前膜患者應(yīng)在橢圓體區(qū)出現(xiàn)缺損前進行手術(shù)治療。玻璃體手術(shù)聯(lián)合玻璃體腔注射抗VEGF藥物治療特發(fā)性黃斑前膜與常規(guī)玻璃體手術(shù)剝除黃斑前膜相比,在減輕特發(fā)性黃斑前膜術(shù)后黃斑水腫、提高術(shù)后視功能上無明顯促進作用。
[Abstract]:The macular membrane (epiretinal membranes) is a fibrous non vascular proliferation membrane formed by the proliferation of the inner surface of the retinal macular region. Its pathogenic factors are varied. In general, the macular membrane can be divided into the idiopathic epiretinal membrane (IERM) and the secondary macular membrane (secondary epireti) according to the cause of the macular region. Nal membrane). The main clinical manifestations of the idiopathic macular membrane are the decrease of central vision and the deformation of the visual substance. These symptoms seriously affect the quality of life of the patients. At present, vitreous surgery is the only means to treat macular membrane, and the visual acuity of the patients can be restored to a certain level. However, the treatment of the macular membrane is still available. Many problems can not be solved, such as: how to choose the timing of the operation, why the macular structure is difficult to recover to normal after operation, which factors will affect the recovery of visual acuity after operation, and whether there is a better way to improve the structure and function of macula. The relationship between the retinal macular region structure and visual function before and after surgical treatment, to find the factors that affect the structure of macular region and the recovery of visual function, to evaluate the relationship between the changes in the macular region and the prognosis of the visual function, and then to explore the effectiveness of the combination of vitreous surgery and anti VEGF drugs for the treatment of idiopathic macular membrane through a randomized double blind control study. And safety to provide the basis for the exploration of a more effective treatment scheme. The method study is divided into two parts. Part one: a retrospective analysis of the idiopathic macular premacular membrane (best corrected visual acuity, BCVA), and the macular fovea in patients who underwent vitreous surgery in our hospital from January 2013 to December 2014. The thickness (central foveal thickness, CFT), the average retinal thickness of the macular region, and the correlation between the BCVA, CFT and the average retinal thickness in the macular region. According to the defect of the ellipsoid region (Ellipsoid Zone, EZ), the patients are divided into two groups, and the length of the EZ defect is measured, compared with the BCVA, the difference between the average thickness of the retina and the CFT and macular region between the two groups. The second part: the second part: a prospective randomized double blind trial was used to divide the patients with idiopathic macular membrane into 2 groups. The combined treatment group was treated with vitreous surgery combined with vitreous intravitreal injection against macular membrane, and the control group was stripped of the macular membrane by vitreous surgery, and the changes of visual acuity and CMT decreased in the 2 groups after the operation of the 2 groups. And the changes in the multifocal electroretinogram (mf-ERG) of the 2 groups of patients after the operation in June. Results the first part: (1) the macular edema decreased after vitreous surgery, the BCVA increased to (0.45 + 0.26), and CFT decreased to (334.5 + 69.5) um. (2) before the operation, BCVA was correlated with the average thickness of the macular region before operation (r=0.433, P=0.007); BCVA was associated with postoperative CFT (r=0). .363, P=0.025); the postoperative macular fovea thickness, the average thickness reduction of macular area was positively correlated with the postoperative visual acuity improvement (r=0.459, P=0.04; r=0.445, P=0.005). (3) BCVA (0.35 + 0.25) in the continuous group of ellipsoid region was superior to the discontinuous group (0.59 + 0.23, P=0.005). Second: (1) in January, March, and June, the combined treatment group and the control group. There was no significant difference in the value of visual change and CFT reduction in the 2 groups. (2) there was no significant difference in the amplitude of B wave in the mf-ERG center of the combined treatment group in June and the control group. Conclusion CFT can be used to evaluate the recovery of visual acuity after the operation. The idiopathic macular anterior membrane patients should be treated with the operation before the elliptical area defect. Vitreous surgery combined with intravitreal injection of anti VEGF drugs for the treatment of idiopathic macular macular membrane and conventional vitreous surgical removal of macular membrane has no significant effect on alleviating macular edema after idiopathic macular membrane surgery and improving visual function after operation.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6

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