Yamamoto Teiko, Hitani Koichiro, Sato Yukihiro, Yamashita Hidetoshi, Takeuchi Shinobu
Department of Ocular Cellular Engineering, Yamagata University Hospital, Yamagata, Japan.
Ophthalmologica. 2005 Jul-Aug;219(4):206-13. doi: 10.1159/000085729.
To compare the efficacy of surgically removing or not removing the internal limiting membrane (ILM) during pars plana vitrectomy on the visual acuity and retinal thickness in eyes with diabetic macular edema.
A prospective, case-control study was carried out on 30 eyes of 29 patients undergoing pars plana vitrectomy for diabetic macular edema. Fifteen eyes underwent pars plana vitrectomy with ILM removal and 15 eyes without ILM removal.
In 7 of 15 eyes (47%) in the ILM-removed group, the visual acuity improved by 0.2 or more log of the minimum angle of resolution (log MAR) units and remained unchanged in 8 eyes (53%). In the ILM-preserved group, the final visual acuity improved in 9 of 15 eyes (60%) and remained unchanged in 6 eyes (40%). The difference in visual acuity between the two groups after 11 months the surgery was not significant (Fisher's exact test, p=0.4938). In the ILM-removed group, the final retinal thickness decreased by more than 20% of the preoperative retinal thickness in 12 of 15 eyes (80%), remained unchanged in 2 of 15 eyes (13%), and increased in 1 of 15 eyes (7%). In the ILM-preserved group, the final retinal thickness decreased in 13 of 15 eyes (87%) and remained unchanged in 2 of 15 eyes (23%). The differences in the changes in the retinal thickness between the two groups were not statistically significant (Fisher's exact test, p=0.5945).
Vitrectomy in eyes with diabetic macular edema without ILM removal was as effective in reducing the retinal thickness and improving the visual acuity as eyes with ILM removal. We conclude that ILM need not be removed to treat eyes with diabetic macular edema.
比较在糖尿病性黄斑水肿患者的玻璃体切除术中，切除或不切除内界膜（ILM）对视力和视网膜厚度的影响。
对29例接受玻璃体切除术治疗糖尿病性黄斑水肿的患者的30只眼进行了一项前瞻性病例对照研究。15只眼在玻璃体切除术中切除了ILM，15只眼未切除ILM。
在切除ILM组的15只眼中，有7只眼（47%）视力提高了0.2或更多最小分辨角对数（log MAR）单位，8只眼（53%）视力保持不变。在保留ILM组中，15只眼中有9只眼（60%）最终视力提高，6只眼（40%）视力保持不变。术后11个月两组间视力差异无统计学意义（Fisher精确检验，p = 0.4938）。在切除ILM组中，15只眼中有12只眼（80%）最终视网膜厚度较术前减少超过20%，15只眼中有2只眼（13%）保持不变，15只眼中有1只眼（7%）增加。在保留ILM组中，15只眼中有13只眼（87%）最终视网膜厚度减少，15只眼中有2只眼（23%）保持不变。两组间视网膜厚度变化的差异无统计学意义（Fisher精确检验，p = 0.5945）。
在糖尿病性黄斑水肿患者中，不切除ILM的玻璃体切除术在降低视网膜厚度和提高视力方面与切除ILM的手术效果相同。我们得出结论，治疗糖尿病性黄斑水肿无需切除ILM。
