Storch M W, Khattab M H, Lauermann P, Krüger C, Ritzau-Tondrow U, Staudenmaier R, Callizo J, Hoerauf H
Augenklinik, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Ophthalmologe. 2019 Nov;116(11):1038-1045. doi: 10.1007/s00347-019-0936-9.
There is evidence that additional internal limiting membrane (ILM) removal reduces the recurrence rate after pucker surgery with a similar functional outcome. On the other hand, morphological changes of the inner retinal layers after ILM peeling have been described. The aim of this study was to compare the long-term data after vitrectomy with and without ILM delamination in order to uncover possible differences in morphological and functional results.
In a prospective study of 32 patients with idiopathic epiretinal membrane, 16 patients were randomized into each of 2 groups. Both groups underwent pars plana vitrectomy (ppV) with peeling of the epiretinal membrane. In group 1 no forced additional peeling of the ILM was performed and in group 2 the ILM or ILM residues were additionally removed after staining. The investigated parameters were visual acuity, central retinal thickness (CRT) in optical coherence tomography (OCT), metamorphopsia and surgical complications. The time points of the examinations were directly preoperative, after 1, 3 and 6 months and partly 8.4 years postoperatively.
In group 1 (n = 15) the preoperative mean visual acuity improved from 0.54 logMAR to 0.38 logMAR after 6 months postoperatively (n = 13). Of this group 6 patients could be examined in the long-term course and the visual acuity improved further to 0.32 logMAR after 8 years. The CRT decreased from 473 µm preoperatively to 235 µm in the long-term interval. In group 2 (n = 15) the mean visual acuity preoperatively was 0.47 logMAR and improved 6 months postoperatively (n = 13) to 0.38 logMAR and in the long-term examination (n = 5) to 0.1 logMAR. The CRT in this group decreased from 417 µm preoperatively to 278 µm in the long-term interval. In group 1 one recurrence occurred in the follow-up period, in group 2 none.
The study showed that there was no significant difference in visual acuity and CRT between the two groups neither after 6 months nor after 8 years of follow-up. The observed recurrence in the group without ILM delamination underlines the assumption that additional ILM peeling could reduce the recurrence rate.
有证据表明，在视网膜前膜手术中额外去除内界膜（ILM）可降低复发率，且功能结果相似。另一方面，已有文献描述了ILM剥除术后视网膜内层的形态学变化。本研究的目的是比较有和没有ILM分层的玻璃体切除术后的长期数据，以发现形态学和功能结果方面可能存在的差异。
在一项对32例特发性视网膜前膜患者的前瞻性研究中，16例患者被随机分为2组。两组均接受了玻璃体视网膜前膜剥除的玻璃体切除术（ppV）。第1组未进行额外的ILM强制剥除，第2组在染色后额外去除ILM或ILM残留物。研究参数包括视力、光学相干断层扫描（OCT）中的中央视网膜厚度（CRT）、视物变形和手术并发症。检查时间点为术前、术后1个月、3个月和6个月，部分患者在术后8.4年。
第1组（n = 15）术前平均视力从0.54 logMAR提高到术后6个月的0.38 logMAR（n = 13）。该组中有6例患者接受了长期随访，8年后视力进一步提高到0.32 logMAR。CRT从术前的473 µm降至长期随访时的235 µm。第2组（n = 15）术前平均视力为0.47 logMAR，术后6个月（n = 13）提高到0.38 logMAR，长期随访（n = 5）时提高到0.1 logMAR。该组CRT从术前的417 µm降至长期随访时的278 µm。第1组在随访期间发生1例复发，第2组无复发。
研究表明，两组在随访6个月和8年后，视力和CRT均无显著差异。未进行ILM分层的组中观察到的复发强调了额外的ILM剥除可降低复发率的假设。
