Ulrich Jan Niklas
Department of Ophthalmology, University of North Carolina at Chapel Hill, United States.
Open Ophthalmol J. 2017 Jan 31;11:5-10. doi: 10.2174/1874364101711010005. eCollection 2017.
Diabetes mellitus remains the leading cause of blindness among working age Americans with diabetic macular edema being the most common cause for moderate and severe vision loss.
To investigate the anatomical and visual benefits of pars plana vitrectomy with inner limiting membrane peeling in patients with nontractional diabetic macular edema as well as correlation of integrity of outer retinal layers on spectral domain optical coherence tomography to visual outcomes.
We retrospectively reviewed the charts of 42 diabetic patients that underwent vitrectomy with internal limiting membrane peeling for nontractional diabetic macula edema. The integrity of outer retinal layers was evaluated and preoperative central macular thickness and visual acuity were compared with data at 1 month, 3 months and 6 months postoperatively. The student t-test was used to compare the groups.
31 eyes were included. While no differences were seen at 1 and 3 months, there was significant improvement of both central macular thickness and visual acuity at the 6 months follow up visit compared to preoperatively (357, 427 microns; p=0.03. 20/49, 20/82; p=0.03) . Patients with intact external limiting membrane and ellipsoid zone had better preoperative vision than patients with outer retinal layer irregularities (20/54, 20/100; p=0.03) and greater visual gains postoperatively (20/33, p<0.001 20/81; p=non-significant).
Pars plana vitrectomy with internal limiting membrane peeling can improve retinal anatomy and visual acuity in patients with nontractional diabetic macular edema. Spectral domain optical coherence tomography may help identify patients with potential for visual improvement.
糖尿病仍然是美国工作年龄人群失明的主要原因，糖尿病性黄斑水肿是中度和重度视力丧失的最常见原因。
探讨在非牵引性糖尿病性黄斑水肿患者中行玻璃体切割联合内界膜剥除术的解剖学和视觉益处，以及光谱域光学相干断层扫描检测的视网膜外层完整性与视觉预后的相关性。
我们回顾性分析了42例因非牵引性糖尿病性黄斑水肿接受玻璃体切割联合内界膜剥除术的糖尿病患者的病历。评估视网膜外层的完整性，并将术前中心黄斑厚度和视力与术后1个月、3个月和6个月的数据进行比较。采用学生t检验比较各组数据。
纳入31只眼。虽然在术后1个月和3个月时未观察到差异，但与术前相比，在6个月随访时中心黄斑厚度和视力均有显著改善（分别为357、427微米；p = 0.03。视力分别为20/49、20/82；p = 0.03）。外界膜和椭圆体带完整的患者术前视力优于视网膜外层不规则的患者（20/54、20/100；p = 0.03），术后视力提高幅度更大（20/33，p < 0.001；20/81；p无统计学意义）。
玻璃体切割联合内界膜剥除术可改善非牵引性糖尿病性黄斑水肿患者的视网膜解剖结构和视力。光谱域光学相干断层扫描有助于识别视力可能改善的患者。
