Cheng Lingyun, Azen Stanley P, El-Bradey Mohamed H, Toyoguchi Mitsuko, Chaidhawangul Sunan, Rivero Maria E, Scholz Barbara M, Freeman William R
Department of Ophthalmology, Shiley Eye Center, University of California San Diego, La Jolla 92093-0946, USA.
Ophthalmology. 2002 Aug;109(8):1514-20. doi: 10.1016/s0161-6420(02)01093-x.
To investigate the effects of epiretinal membranes (ERMs) on macular hole surgical results and postoperative visual restoration.
A subgroup analysis arising from a multicenter, controlled, randomized clinical trial.
Ninety-one phakic eyes with an idiopathic macular hole that underwent standard vitrectomy for macular hole repair with or without ERM peeling.
Preoperative, intraoperative, and postoperative data of macular status, ERM status, and visual function status were recorded, and their relationships were analyzed.
Visual acuity and clinical features of macular hole and ERM on baseline examination and scheduled follow-ups.
ERM peeling was associated with greater anatomic hole closure success rates (67% of the ERM peeled vs. 35% of nonpeeled, P = 0.03) but not associated with visual improvement in eyes with anatomic hole closure (2.9 lines improvement vs. 3.6 lines improvement, P > 0.5). Macular hole reopening was associated with excessive ERM growth (P = 0.005). Postoperative ERMs were more common in the eyes that underwent cataract surgery after vitrectomy (77% in aphakic and 36% in phakic eyes, P = 0.02). Macular hole edge approximation or hole appearance after initial vitrectomy for hole repair was stable over the average 18-month period in 89% of the eyes; only approximately 10% of the eyes underwent changes in their hole appearance. The hole edge approximation or hole appearance was associated with preoperative hole size and postoperative visual acuity. Preoperative hole size was found to be the major predictor of postoperative visual acuity (P < 0.005).
Surgical ERM peeling increases the anatomic hole closure rate. The presence of postoperative ERMs was not associated with postoperative visual acuity; however, excessive ERM growth contributed to hole reopening. Preoperative hole size was the most sensitive predictor for postoperative visual acuity. Surgical intervention during the early stages of macular hole before ERM formation is strongly recommended.
探讨视网膜前膜（ERM）对黄斑裂孔手术效果及术后视力恢复的影响。
一项来自多中心、对照、随机临床试验的亚组分析。
91只患有特发性黄斑裂孔的有晶状体眼，接受了标准玻璃体切除术以修复黄斑裂孔，术中进行或未进行ERM剥除。
记录黄斑状态、ERM状态和视功能状态的术前、术中和术后数据，并分析它们之间的关系。
基线检查和定期随访时的视力以及黄斑裂孔和ERM的临床特征。
ERM剥除与更高的解剖学上裂孔闭合成功率相关（ERM剥除组为67%，未剥除组为35%，P = 0.03），但与解剖学上裂孔闭合的眼睛的视力改善无关（改善2.9行 vs. 改善3.6行，P > 0.5）。黄斑裂孔重新开放与ERM过度生长相关（P = 0.005）。术后ERM在玻璃体切除术后接受白内障手术的眼睛中更常见（无晶状体眼中为77%，有晶状体眼中为36%，P = 0.02）。在最初进行裂孔修复的玻璃体切除术后，平均18个月期间，89%的眼睛黄斑裂孔边缘接近或裂孔外观稳定；只有约10%的眼睛裂孔外观发生变化。裂孔边缘接近或裂孔外观与术前裂孔大小和术后视力相关。术前裂孔大小被发现是术后视力的主要预测因素（P < 0.005）。
手术剥除ERM可提高解剖学上裂孔闭合率。术后ERM的存在与术后视力无关；然而，ERM过度生长导致裂孔重新开放。术前裂孔大小是术后视力最敏感的预测因素。强烈建议在黄斑裂孔形成ERM之前的早期阶段进行手术干预。
