玻璃体切割术后视网膜前膜残留边缘的光学相干断层扫描特征
CHARACTERISTICS OF EPIRETINAL MEMBRANE REMNANT EDGE BY OPTICAL COHERENCE TOMOGRAPHY AFTER PARS PLANA VITRECTOMY.
作者信息
Gaber Raouf, You Qi Sheng, Muftuoglu Ilkay Kilic, Alam Mostafa, Tsai Frank F, Mendoza Nadia, Freeman William R
机构信息
*Jacobs Retina Center, Shiley Eye Institute, University of California San Diego; and †Department of Ophthalmology, Tanta University, Tanta, Egypt.
出版信息
Retina. 2017 Nov;37(11):2078-2083. doi: 10.1097/IAE.0000000000001466.
PURPOSE
To evaluate the incidence, characteristics, and the progression of epiretinal membrane (ERM) remnant edge seen by optical coherence tomography after ERM peeling.
METHODS
A retrospective chart review was conducted for 86 eyes of 85 consecutive patients who were diagnosed with ERM and underwent pars plana vitrectomy for epiretinal membrane peeling between 2013 and 2014. Data collected and analyzed included age, gender, preoperative and postoperative visual acuity, use of indocyanine green dye to stain internal limiting membrane, tamponade used after vitrectomy, ERM edge boundaries, presence of cystoid macular edema, and central foveal thickness.
RESULTS
An ERM remnant edge was detected in 33/86 study eyes (38.4%) at the first postoperative optical coherence tomography scan. Compared with those without an ERM remnant, patients with an ERM remnant after surgery were significantly older at baseline and had a higher incidence of ERM recurrence at their last visit. They were not significantly different in terms of gender, preoperative and postoperative visual acuity, reduction of central foveal thickness from baseline, proportion of eyes with preoperative ERM elevation on optical coherence tomography, presence of macular edema before surgery, intraoperative use of indocyanine green staining for ILM peeling, or tamponade used. Based on the edge morphology, we classified the ERM remnant into three types: Type 1 was flat and blended with the retina (14/33 eyes, 42.4%), Type 2 was flat but stepped (17/33 eyes, 51.5%), and Type 3 was elevated (2/33 eyes, 6.0%). A significantly higher risk of ERM recurrence was seen in Type 2 and Type 3 ERM remnants (75% and 100%, respectively) than Type 1 ERM remnants (10%).
CONCLUSION
An ERM remnant edge was detected by optical coherence tomography after ERM peeling in 38.4% of eyes. The presence of a postoperative ERM edge was associated with a higher risk of ERM recurrence, particularly in Type 2 and Type 3 ERM remnants.
目的
评估视网膜前膜（ERM）剥除术后光学相干断层扫描（OCT）观察到的ERM残留边缘的发生率、特征及进展情况。
方法
对2013年至2014年间连续85例诊断为ERM并接受玻璃体视网膜手术剥除ERM的患者的86只眼进行回顾性病历分析。收集并分析的数据包括年龄、性别、术前及术后视力、术中使用吲哚菁绿染色内界膜情况、玻璃体切除术后使用的填充剂、ERM边缘界限、黄斑囊样水肿的存在情况以及中心凹厚度。
结果
术后首次OCT扫描时，86只研究眼中有33只（38.4%）检测到ERM残留边缘。与无ERM残留的患者相比，术后有ERM残留的患者基线时年龄显著更大，末次随访时ERM复发率更高。在性别、术前及术后视力、中心凹厚度较基线的降低幅度、术前OCT显示ERM隆起的眼的比例、术前黄斑水肿的存在情况、术中使用吲哚菁绿染色进行内界膜剥除或使用的填充剂方面，二者无显著差异。根据边缘形态，将ERM残留分为三种类型：1型为扁平且与视网膜融合（33只眼中的14只，42.4%），2型为扁平但呈阶梯状（33只眼中的17只，51.5%），3型为隆起型（33只眼中的2只，6.0%）。2型和3型ERM残留（分别为75%和100%）的ERM复发风险显著高于1型ERM残留（10%）。
结论
ERM剥除术后，38.4%的眼通过OCT检测到ERM残留边缘。术后ERM边缘的存在与ERM复发风险较高相关，尤其是2型和3型ERM残留。
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