玻璃体切割联合内界膜剥除治疗糖尿病性黄斑水肿

摘要

目的:评估玻璃体切割联合内界膜剥除对糖尿病性黄斑水肿(DME)的疗效.方法:回顾性病例对照研究.2014年6月至2017年1月间因糖尿病视网膜病变合并玻璃体积血或增殖病变于温州医科大学附属眼视光医院杭州院区行玻璃体切割手术治疗,且术前或术中经光学相干断层扫描(OCT)检查确诊合并DME的患者31例(33眼)纳入研究.16例(18眼)术中联合内界膜剥除作为剥膜组,15例(15眼)仅接受玻璃体切割手术治疗者作为对照组.所有手术均由同一医师主刀完成.术后1、3个月随访时复查OCT,对比观察黄斑中心厚度(CMT)和视力的术后变化情况.随访中CMT和最佳矫正视力(BCVA)比较采用重复测量方差分析,组间CMT和BCVA比较采用独立样本t检验.结果:手术前,手术后1、3个月2组间比较LogMAR视力总体差异有统计学意义(F=15.93,P＜0.001).术后1个月时剥膜组BCVA高于对照组(t=2.55,P=0.02),但术后3个月时2组间差异无统计学意义(t=0.82, P=0.42).手术前,手术后1、3个月CMT总体差异无统计学意义(F=2.85,P=0.065).术后1、3个月时,剥膜组的CMT均低于对照组,2组间差异均有统计学意义(t=2.24,P=0.03;t=3.79,P=0.001).术后1个月时,剥膜组有效(与术前比CMT减少20%以上)、无效(变化不超过20%)及恶化(增厚超过20%)的例数分别为8、6、4例,术后3个月时则分别为11、5、2例,与对照组相比,术后1个月时组间差异无统计学意义(Z=-1.687,P=0.092),术后3个月时剥膜组DME改善有效比例明显高于对照组,组间差异有统计学意义(Z=-2.177,P=0.029).结论:对于非牵拉性DME,内界膜剥除有助于术后早期DME消退.%Objective: To investigate the effects of vitrectomy combined with internal limiting membrane (ILM) peeling indiabetic macular edema (DME). Methods: In this retrospective clinical study, 33 eyes of 31 patients with DME confirmed preoperatively or intraoperatively by optical coherence tomography (OCT) were included. All patients underwent vitrectomy for dense vitreous hemorrhages due to diabetic retinopathy or proliferative diabetic retinopathy between June 2014 and January 2017 at the Eye Hospital, Wenzhou Medical University. A total of 16 patients (18 eyes) with vitrectomy and ILM peeling were in the ILM-removed group, 15 eyes of 15 patients with vitrectomy only were in the control group. All the surgeries were performed by the same surgeon. All subjects underwent OCT examination at 1 month and 3 months postoperatively. The central macular thickness (CMT) and visual outcomes between the two groups were analyzed relative to each other. The data were analyzed by repeated measures analysis and t-tests. Results: Before the therapy, and at one and three months after therapy, the total difference of best corrected visual acuity (BCVA) between the two groups was statistically significant (F=15.93, P＜0.001). The BCVA in the ILM-removed group was higher than the control group at one month after therapy (t=2.55, P=0.02). However, there was no significant difference between the two groups in terms of BCVA at three months after therapy (t=0.82, P=0.42). Before the therapy, and at one and three months after therapy, the total difference of CMT between the two groups was not statistically significant (F=2.85, P=0.065). At both one month and three months after therapy, the CMT in the ILM-removed group was lower than the control group (t=2.24, P=0.03; t=3.79, P=0.001). At 1 month postoperatively, the subjects of effectiveness (a decrease in CMT by at least 20%), ineffectiveness (a change in CMT by ＜20%) and deterioration (an increase in CMT by more than 20%) were 8, 6 and 4 respectively, while the subjects were 11, 5 and 2 respectively at 3 months after therapy. There was no significant difference from the control group (Z=-1.687, P=0.092) at one month after therapy, but there was a significant difference at three months after therapy (Z=-2.177, P=0.029). Conclusions: The removal of ILM contributes to the resolution of nontractional DME at an early stage after therapy.