日常临床实践中的视网膜前膜手术：一项拟议管理方案的结果
Epiretinal Membrane Surgery in Daily Clinical Practice: Results of a Proposed Management Scheme.
作者信息
Pareja Jesús, Coronado Alba, Contreras Inés
机构信息
Clínica Rementería, Madrid, Spain.
Instituto Provincial de Oftalmología-HGU Gregorio Marañón, Madrid, Spain.
出版信息
J Ophthalmol. 2019 Jan 10;2019:8246858. doi: 10.1155/2019/8246858. eCollection 2019.
PURPOSE
To report the results of the epiretinal membrane (ERM) management guidelines followed in our center.
METHODS
Patients with ERM seen between 2014 and 2015, with ≥2 years follow-up or who had undergone ERM surgery, were included. Corrected visual acuity (VA), lens status, and ERM configuration were recorded at each visit. Our guidelines for ERM are if VA is ≥20/30, observation is recommended unless there is moderate/intense metamorphopsia. Vitrectomy is recommended during follow-up if there is a drop >one line in VA with changes in ERM configuration. If VA at diagnosis is <20/30, vitrectomy is recommended. If visual loss is thought to be due to cataract, phacoemulsification is performed first and visual status reevaluated.
RESULTS
Ninety-nine eyes of 94 patients were included; 52 eyes underwent vitrectomy, and 47 eyes were monitored. From eyes with VA at diagnosis <20/30 (41 eyes), 8 eyes underwent isolated phacoemulsification: VA improved to ≥20/30. Vitrectomy was recommended but refused by 4 patients. The other 29 eyes underwent vitrectomy. Of the 58 eyes with VA at diagnosis ≥20/30, 5 underwent surgery due to metamorphopsia. Eighteen eyes underwent vitrectomy during follow-up. VA improved a mean of 0.13 logMAR (SD 0.30) after vitrectomy. There were no differences in mean VA improvement between eyes that underwent vitrectomy within six months of diagnosis (0.24, SD 0.32) and those that underwent surgery more than six months after diagnosis (mean 0.17, SD 0.17), =0.106. Three eyes developed postsurgical complications with visual loss: persistent macular edema in one eye, two consecutive retinal detachments in one eye, and a central visual defect in another eye. At the end of follow-up, VA was similar in the observation group (0.14, SD 0.14) and in the vitrectomy group (0.16, SD 0.28), =0.528.
CONCLUSIONS
Our proposed guidelines lead to visual preservation in most patients while limiting surgery and its possible complications.
目的
报告我们中心遵循的视网膜前膜（ERM）治疗指南的结果。
方法
纳入2014年至2015年间就诊的ERM患者，这些患者随访时间≥2年或已接受ERM手术。每次就诊时记录矫正视力（VA）、晶状体状态和ERM形态。我们的ERM治疗指南是，如果VA≥20/30，除非有中度/重度视物变形，建议观察。如果随访期间VA下降超过一行且ERM形态有变化，建议行玻璃体切除术。如果诊断时VA<20/30，建议行玻璃体切除术。如果认为视力丧失是由白内障引起的，先进行超声乳化白内障吸除术，然后重新评估视力状况。
结果
纳入94例患者的99只眼；52只眼接受了玻璃体切除术，47只眼进行了监测。诊断时VA<20/30的41只眼中，8只眼仅接受了超声乳化白内障吸除术：VA提高到≥20/30。4例患者建议行玻璃体切除术但被拒绝。其他29只眼接受了玻璃体切除术。诊断时VA≥20/30的58只眼中，5只眼因视物变形接受了手术。18只眼在随访期间接受了玻璃体切除术。玻璃体切除术后VA平均提高0.13 logMAR（标准差0.30）。诊断后6个月内行玻璃体切除术的眼（0.24，标准差0.32）与诊断后6个月以上行手术的眼（平均0.17，标准差0.17）的平均VA改善无差异，P = 0.106。3只眼出现术后视力丧失并发症：1只眼持续性黄斑水肿，1只眼连续两次视网膜脱离，另1只眼中心视力缺损。随访结束时，观察组（0.14，标准差0.14）和玻璃体切除组（0.16，标准差0.28）的VA相似，P = 0.528。
结论
我们提出的指南可使大多数患者保留视力，同时限制手术及其可能的并发症。
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