Konstantinidis Lazaros, Berguiga Marouen, Beknazar Evgueny, Wolfensberger Thomas J
Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland.
Retina. 2009 Sep;29(8):1119-27. doi: 10.1097/IAE.0b013e3181ac23da.
To report both the functional and anatomic outcome and safety profile of 23-gauge pars plana vitrectomy combined with membrane peeling and intravitreal injection of triamcinolone acetonide in eyes with idiopathic macular epiretinal membranes.
Retrospective study of 39 consecutive patients who underwent 23-gauge transconjunctival sutureless vitrectomy, membrane peeling, and intravitreal triamcinolone acetonide injection for an idiopathic macular epiretinal membrane between February 2007 and February 2008. Minimum follow-up was 6 months.
Thirty-nine eyes of 39 patients were included in the study. The mean follow-up was 7 +/- 2.2 months (range, 6-15 months). Twenty-two eyes (56%) were pseudophakic and 17 (44%) were phakic at the time of surgery. Five of the phakic eyes (29.4%) had worsening of cataracts during the follow-up period. Mean preoperative intraocular pressure was 14 +/- 3.5 mmHg. At the final follow-up, mean intraocular pressure was 14.5 +/- 2.7 mmHg, which did not differ significantly from the intraocular pressure at baseline (P = 0.14, two-tailed t-test). Five (13%) patients needed topical antiglaucoma treatment. Mean preoperative best-corrected visual acuity (BCVA) was 0.28 decimal equivalent (20/71 Snellen equivalent; logarithm of the minimum angle of resolution 0.54 +/- 0.2, range: 1.0-0.2) and improved significantly (P < 0.0001, two-tailed t-test) to a mean of 0.6 decimal equivalent (20/33 Snellen equivalent; logarithm of the minimum angle of resolution 0.22 +/- 0.16, range: 0.6-0) at the final follow-up. The BCVA improved by a mean of 3.2 +/- 2.1 lines (range: 0-8). Twenty-nine patients (74%) demonstrated a gain of > or =3 lines. Mean central macular thickness was 456 +/- 77 microm (mean +/- SD) at baseline, which was significantly reduced at the final follow-up to 327 +/- 79 microm (mean +/- SD; P < 0.0001, two-tailed t-test). Average central macular thickness reduction was 131 +/- 77 microm (mean +/- SD; range: 36-380 microm). A subgroup analysis of 15 selected cases, which had central macular thickness and BCVA measurements after the first postoperative week, demonstrated that 84% of the total final reduction in central macular thickness and 84% of the total final improvement in BCVA occurred already during the first postoperative week.
Twenty-three-gauge sutureless transconjunctival vitrectomy is a safe and effective technique for the treatment of idiopathic macular epiretinal membranes. The concomitant administration of intravitreal triamcinolone acetonide after pars plana vitrectomy may speed up and improve the anatomic and functional outcome.
报告23G经结膜无缝线玻璃体切除术联合内界膜剥除及玻璃体内注射曲安奈德治疗特发性黄斑视网膜前膜的功能、解剖学转归及安全性。
回顾性研究2007年2月至2008年2月间连续39例因特发性黄斑视网膜前膜接受23G经结膜无缝线玻璃体切除术、内界膜剥除及玻璃体内注射曲安奈德的患者。最小随访期为6个月。
39例患者的39只眼纳入研究。平均随访时间为7±2.2个月（范围6 - 15个月）。手术时22只眼（56%）为人工晶状体眼，17只眼（44%）为晶状体眼。5只晶状体眼（29.4%）在随访期间白内障加重。术前平均眼压为14±3.5 mmHg。末次随访时，平均眼压为14.5±2.7 mmHg，与基线眼压相比差异无统计学意义（P = 0.14，双侧t检验）。5例（13%）患者需要局部抗青光眼治疗。术前平均最佳矫正视力（BCVA）为0.28（小数视力，相当于20/71 Snellen视力；最小分辨角对数为0.54±0.2，范围：1.0 - 0.2），末次随访时显著提高（P < 0.0001，双侧t检验）至平均0.6（小数视力，相当于20/33 Snellen视力；最小分辨角对数为0.22±0.16，范围：0.6 - 0）。BCVA平均提高3.2±2.1行（范围：0 - 8行）。29例（74%）患者视力提高≥3行。基线时黄斑中心平均厚度为456±77μm（平均值±标准差），末次随访时显著降至327±79μm（平均值±标准差；P < 0.0001，双侧t检验）。黄斑中心平均厚度减少131±77μm（平均值±标准差；范围：36 - 380μm）。对15例术后第1周后进行黄斑中心厚度和BCVA测量的病例进行亚组分析显示，黄斑中心厚度最终总减少量的84%及BCVA最终总改善量的84%在术后第1周内已出现。
23G无缝线经结膜玻璃体切除术是治疗特发性黄斑视网膜前膜的一种安全有效的技术。玻璃体切除术后联合玻璃体内注射曲安奈德可能加快并改善解剖学和功能学转归。
