Lehpamer Brian P, Carvounis Petros E
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
Retina. 2015 Sep;35(9):1822-7. doi: 10.1097/IAE.0000000000000541.
To evaluate pars plana vitrectomy with membrane peel for symptomatic epiretinal membranes in eyes with preoperative best-corrected visual acuity of 20/50 or better.
Patients with symptomatic epiretinal membrane and 20/50 or better vision who underwent pars plana vitrectomy with membrane peel by a single surgeon at our institution between January 2007 and January 2014 were identified. The principal outcomes measured were best-corrected visual acuity and central subfield macular thickness at 1, 6, and 12 months of follow-up. Subjective improvement in patient symptoms and complications were also documented.
Thirty-three eyes of 33 consecutive patients were included in this retrospective case series. Mean preoperative best-corrected visual acuity was 20/40 and improved to 20/28 (P = 0.00008) at Month 12. Mean central subfield macular thickness improved from 437 μm preoperatively to 391 μm by Month 1 (P = 0.00006) and 388 μm at 12 months (P = 0.00142). Seventy-three percent (24 of 33) of patients (95% confidence interval: 55.6-85.1%) reported improvement of visual symptoms during the follow-up period. Of the 13 patients who were phakic preoperatively, 6 patients (46.1%, 95% confidence interval: 23.2-70.9%) underwent phacoemulsification surgery within 1 year of vitrectomy.
Patients experienced a gradual gain in acuity and improvement of symptoms after pars plana vitrectomy with membrane peel. Cataract progression necessitating cataract surgery is common in phakic patients.
评估对术前最佳矫正视力为20/50或更好的有症状视网膜前膜的眼睛行玻璃体切除术联合膜剥除术的效果。
确定2007年1月至2014年1月期间在我们机构由一名外科医生对有症状视网膜前膜且视力为20/50或更好的患者行玻璃体切除术联合膜剥除术的患者。主要测量的结果是随访1、6和12个月时的最佳矫正视力和黄斑中心凹厚度。还记录了患者症状的主观改善情况和并发症。
本回顾性病例系列纳入了33例连续患者的33只眼。术前平均最佳矫正视力为20/40,在第12个月时提高到20/28(P = 0.00008)。黄斑中心凹平均厚度从术前的437μm在第1个月时改善到391μm(P = 0.00006),在12个月时为388μm(P = 0.00142)。73%(33例中的24例)的患者(95%置信区间:55.6 - 85.1%)报告在随访期间视觉症状有所改善。在术前有晶状体的13例患者中,6例患者(46.1%,95%置信区间:23.2 - 70.9%)在玻璃体切除术后1年内接受了白内障超声乳化手术。
患者在玻璃体切除术联合膜剥除术后视力逐渐提高,症状得到改善。有晶状体患者中因白内障进展而需要进行白内障手术的情况很常见。