本文選題：特發(fā)性黃斑前膜　切入點(diǎn)：術(shù)后視力　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過(guò)對(duì)不同形態(tài)黃斑前膜的術(shù)前術(shù)后最佳矯正視力(best corrected visual acuity,BCVA)、OCT形態(tài)、黃斑中心凹厚度(central macular thickness,CMT)、光感受器細(xì)胞接頭處(photoreceptor inner segment/outer segment,IS/OS)連接狀態(tài)進(jìn)行比較,分析影響黃斑前膜術(shù)后視力的相關(guān)因素。方法:對(duì)2012年1月至2016年6月于我院確診為特發(fā)性黃斑前膜且行玻璃體切除聯(lián)合膜撕除術(shù)患者進(jìn)行回顧性分析。術(shù)前應(yīng)用頻域光學(xué)相干斷層掃描儀(spectral-domain optical coherence tomography,SD-OCT)對(duì)所有患者的后極部黃斑區(qū)視網(wǎng)膜行水平掃描,根據(jù)OCT掃描將不同黃斑形態(tài)特發(fā)性黃斑前膜38例38眼分為4型:彌散型(the diffuse type,DIF)22例22眼、囊樣水腫型(the cystoid macular edema,CME)6例6眼、假孔型(the pseudolamellar hole type,PLH)4例4眼、玻璃體黃斑牽拉型(the vitreomacular type,VMT)6例6眼。分別觀察性別,年齡,病程,術(shù)前、術(shù)后1個(gè)月、3個(gè)月、6個(gè)月OCT形態(tài),BCVA,CMT,IS/OS連接狀態(tài)及黃斑前膜復(fù)發(fā)情況,并根據(jù)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.一般情況:患者的年齡、性別、病程、術(shù)前IS/OS連接狀態(tài)四組之間無(wú)差異(P0.05);2.最佳矯正視力:術(shù)前四組患者BCVA存在差異(P=0.008),視力最好的為假孔型,其次為彌散型、囊樣水腫型及玻璃體黃斑牽拉型。術(shù)后6個(gè)月時(shí)彌漫型、囊樣水腫型及玻璃體黃斑牽拉型的BCVA較術(shù)前提高,差異具有統(tǒng)計(jì)學(xué)意義(DIF:p0.001,CME:p=0.027,VMT:p=0.027),而假孔型未見(jiàn)明顯提高(p=0.180)。術(shù)后6個(gè)月時(shí)四組BCVA無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);3.IS/OS連接狀態(tài):術(shù)前及術(shù)后1個(gè)月時(shí)四組患者的IS/OS連接狀態(tài)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),而術(shù)后3個(gè)月及6個(gè)月時(shí)四組之間存在差異(P0.05)。術(shù)前IS/OS連接狀態(tài)與術(shù)后BCVA具有相關(guān)性(P=0.010),術(shù)前IS/OS連接完整者其術(shù)后視力好于IS/OS不完整者。術(shù)后6個(gè)月IS/OS連接狀態(tài)與術(shù)后BCVA具有相關(guān)性(P0.001),術(shù)后6個(gè)月時(shí)IS/OS連接完整的視力要好于IS/OS不完整者;4.黃斑中心凹厚度:術(shù)前四組CMT之間存在差異(P=0.035),假孔型術(shù)前CMT明顯小于其它型。同術(shù)前相比,術(shù)后1、3、6個(gè)月時(shí)四組CMT均明顯減少,差異均有統(tǒng)計(jì)學(xué)意義(P0.001)。術(shù)前CMT與術(shù)前BCVA具有相關(guān)性(P=0.009),術(shù)前CMT越厚BCVA越差。術(shù)前CMT與術(shù)后6個(gè)月BCVA具有相關(guān)性(P=0.012),術(shù)前CMT越厚術(shù)后BCVA越差。術(shù)前術(shù)后CMT的改變與術(shù)前術(shù)后BCVA的改變呈正相關(guān)(P=0.032),即CMT改變?cè)蕉郆CVA變化越明顯。術(shù)后CMT與術(shù)后BCVA二者之間無(wú)相關(guān)性(P=0.135);5.黃斑形態(tài):術(shù)后黃斑形態(tài)分為四型:彌散型、囊樣水腫型、假孔型、正常型。術(shù)前術(shù)后黃斑形態(tài)具有相關(guān)性(P=0.003),術(shù)前彌散型術(shù)后6個(gè)月時(shí)大部分患者為彌散型,術(shù)前玻璃體黃斑牽拉型術(shù)后6個(gè)月時(shí)均顯示正常形態(tài);6.是否聯(lián)合白內(nèi)障摘除術(shù):術(shù)中是否聯(lián)合白內(nèi)障摘除其術(shù)后BCVA改變、CMT改變,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);7.復(fù)發(fā)情況:術(shù)后彌散型1例復(fù)發(fā),囊樣水腫型2例復(fù)發(fā),假孔型及玻璃體黃斑牽拉型無(wú)一例復(fù)發(fā)。結(jié)論:1.玻璃體切割聯(lián)合前膜撕除術(shù)治療特發(fā)性黃斑前膜可以改善患者術(shù)后視力;2.術(shù)前假孔型視力最好,其次為彌散型、囊樣水腫型及玻璃體黃斑牽拉型;3.術(shù)后6個(gè)月時(shí)假孔型視力與術(shù)前相比未見(jiàn)明顯提高,彌散型、囊樣水腫型、玻璃體黃斑牽拉型與術(shù)前相比視力提高;4.術(shù)前CMT,IS/OS連接狀態(tài)及CMT變化是影響特發(fā)性黃斑前膜術(shù)后視力的因素;5.術(shù)前黃斑形態(tài)可預(yù)測(cè)術(shù)后黃斑形態(tài),術(shù)前彌散型術(shù)后6個(gè)月時(shí)大部分患者為彌散型,術(shù)前玻璃體黃斑牽拉型術(shù)后6個(gè)月時(shí)均顯示正常形態(tài)。
[Abstract]:Objective: through the different forms of macular epiretinal membrane of preoperative and postoperative best corrected visual acuity (best corrected visual acuity, BCVA, OCT), foveal thickness (central macular, thickness, CMT), photoreceptor joints (photoreceptor inner segment/outer segment, IS/OS) connection status were compared, and analyzed the factors associated with macular the film visual acuity after surgery. Methods: from January 2012 to June 2016 in our hospital diagnosed as idiopathic epiretinal membrane and vitreous body resection combined with membrane peeling surgery patients were retrospectively analyzed. The application of spectral domain optical coherence tomography (spectral-domain optical coherence tomography before operation, SD-OCT) of all patients with the posterior pole of the retina in macular region the level of scanning, OCT scanning will be different according to the macular morphology of idiopathic macular epiretinal membrane in 38 eyes of 38 patients were divided into 4 types: diffuse type (the diffuse type, DIF) in 22 eyes of 22 cases, cyst 鏍鋒按鑲垮瀷(the cystoid macular edema,CME)6渚，

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