【摘要】  目的：探討玻璃體手術(shù)治療特發(fā)性黃斑前膜聯(lián)合與未聯(lián)合眼內(nèi)注射曲安奈德行黃斑前膜剝離術(shù)的療效比較。方法：回顧性分析我院采用玻璃體切除術(shù)治療特發(fā)性黃斑前膜88例101眼的臨床資料。其中治療組51眼聯(lián)合曲安奈德注入，對(duì)照組50眼未注入曲安奈德。所有病例均采用標(biāo)準(zhǔn)三切口經(jīng)睫狀體平坦部玻璃體切除手術(shù)。治療組術(shù)中玻璃體切除完畢后行氣�惨航粨Q，待玻璃體腔無(wú)液體后注入曲安奈德(triamcinolone acetonide,TA)2.5mg染色，然后放入眼內(nèi)灌注液進(jìn)行黃斑前膜剝除術(shù)，其中28眼同時(shí)進(jìn)行了內(nèi)界膜撕除術(shù)。對(duì)照組玻璃體切除完畢后直接進(jìn)行黃斑前膜剝除。手術(shù)后隨訪3～24(平均17)mo。對(duì)最佳矯正視力(BCVA)、眼壓、黃斑結(jié)構(gòu)及手術(shù)并發(fā)癥進(jìn)行長(zhǎng)期療效觀察，分析其統(tǒng)計(jì)學(xué)意義。結(jié)果：隨訪3mo，治療組視力不同程度提高48眼(94.1%)，不變2眼(3.9%)，視力下降1眼(2.0%)。對(duì)照組視力提高46眼(92.0%)，不變2眼(4.0%)，下降2眼(4.0%)。治療組與對(duì)照組術(shù)后3mo BCVA差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.424，P>0.05);但術(shù)后6，12，24mo比較差異有統(tǒng)計(jì)學(xué)意義(t=4.528，P<0.05)。治療組合并視網(wǎng)膜內(nèi)界膜撕除28眼，對(duì)照組2眼。OCT顯示所有手術(shù)患者前膜均已消除，黃斑水腫不同程度逐漸減輕。隨訪期末治療組未見前膜復(fù)發(fā)，對(duì)照組9眼前膜再次復(fù)發(fā)。其他并發(fā)癥：治療組和對(duì)照組在術(shù)中和隨訪期末兩者比較有明顯差異(t=6.324,P<0.05)。治療組病例術(shù)中經(jīng)TA注入能更清晰地顯示出黃斑前膜的范圍，特別是殘留的微膜和未成熟膜，能更清晰地辨認(rèn)。必要時(shí)進(jìn)行二次剝膜，利于手術(shù)醫(yī)生操作，特別是手術(shù)技巧欠嫻熟的。早期手術(shù)治療有助于更好的視功能恢復(fù)，未見明顯不良反應(yīng)及其它并發(fā)癥，提高了手術(shù)成功率。兩組術(shù)前術(shù)后眼壓差異比較無(wú)統(tǒng)計(jì)學(xué)意義(t=1.324,P>0.05)。　結(jié)論：利用曲安奈德在玻璃體切除術(shù)中的良好可視性能有效識(shí)別特發(fā)性黃斑前膜范圍大小，剝除的完整性。術(shù)中能更清晰地辨認(rèn)、剝離，不易誤傷視網(wǎng)膜，手術(shù)效果更好，利于手術(shù)醫(yī)生操作。進(jìn)一步提高了手術(shù)安全性及成功率，縮短了手術(shù)時(shí)間，減少了手術(shù)并發(fā)癥，使手術(shù)小量化。并且相應(yīng)減輕了患者經(jīng)濟(jì)負(fù)擔(dān)。

【關(guān)鍵詞】  黃斑前膜;特發(fā)性;曲安奈德;玻璃體手術(shù);相干光斷層成像教育教學(xué)論文發(fā)表

　　Abstract�rAIM: To investigate therapeutic effect of vitrectomy and intravitreal triamcinolone acetonide(TA) in surgical removal of idiopathic epimacular membrane.METHODS: The data of 88 patients 101 eyes with vitrectomy and intravitreal TA with surgical removal of idiopathic epimacular membrane were reviewed and analyzed, among which 51 eyes in treatment group were injected TA and 50 eyes were not injected TA. After undergoing fluid�瞐ir�瞖xchange, all the eyes underwent a standard three port pars plana vitrectomy and then 2.5mg TA was injected to stain, and epiretinal membrane was removed after perfusate influxed, 28 eyes also were with internal limiting membrane peeling. Postoperative observa�瞭ion was 3��24(average 17) months. The visual acuity, complications of the surgery and foveal structural changes of macula were observed in long period and analyzed its statistic meaning.�rRESULTS: After observing the different degree of eyesight in treatment group for three months, the sight of 48(94.1%) eyes were improved , the vision of 2(3.9%) eyes were remained the same as before and that of 1 (1.9%) eye decreased. Compared with the other group, improved eyes were 46 (92.0%) , unchanged eyes were 2 (4.0%) and the eyesight of 2 (4.0%) eyes dereased. The difference of BCVA of two groups in three months had no statistical significance (t=1.424, P>0.05), whereas the compared difference of six, twelve and twenty�瞗our months was statistically significant (t=4.528; P<0.05). In treatment group, 28 eyes with removed of combined retina with inner limiting membrane, and in compared group that was 2 eyes. All epimacular membrane were disap�瞤eared on OCT after surgery and macular edema lessened gradually. There were obvious differences in other complications between two groups in operation and at end of observation(t=6.324; P<0.05). By the way, injecting TA in operation can show the scope of epiretinal membrane of macula more clearly. Especially the remain�瞖d trifled membrane and under�� mature membrane can be better recognized. When necessary, it is especially helpful for doctors who are not so proficient in skills to conduct the second dissecting membrane. Early treatment was good for better acuity, and to refrain from adverse effect or other complications, which improved the success of opera�瞭ion. The difference of