目的:探讨玻璃体手术治疗特发性黄斑前膜联合与未联合眼内注射曲安奈德行黄斑前膜剥离术的疗效比较。方法:回顾性分析我院采用玻璃体切除术治疗特发性黄斑前膜88例101眼的临床资料。其中治疗组51眼联合曲安奈德注入,对照组50眼未注入曲安奈德。所有病例均采用标准三切口经睫状体平坦部玻璃体切除手术。治疗组术中玻璃体切除完毕后行气-液交换,待玻璃体腔无液体后注入曲安奈德(triamcinolone acetonide,TA)2.5mg染色,然后放入眼内灌注液进行黄斑前膜剥除术,其中28眼同时进行了内界膜撕除术。对照组玻璃体切除完毕后直接进行黄斑前膜剥除。手术后随访3~24(平均17)mo。对最佳矫正视力(BCVA)、眼压、黄斑结构及手术并发症进行长期疗效观察,分析其统计学意义。结果:随访3mo,治疗组视力不同程度提高48眼(94.1%),不变2眼(3.9%),视力下降1眼(2.0%)。对照组视力提高46眼(92.0%),不变2眼(4.0%),下降2眼(4.0%)。治疗组与对照组术后3mo BCVA差异无统计学意义(t=1.424,P>0.05);但术后6,12,24mo比较差异有统计学意义(t=4.528,P<0.05)。治疗组合并视网膜内界膜撕除28眼,对照组2眼。OCT显示所有手术患者前膜均已消除,黄斑水肿不同程度逐渐减轻。随访期末治疗组未见前膜复发,对照组9眼前膜再次复发。其他并发症:治疗组和对照组在术中和随访期末两者比较有明显差异(t=6.324,P<0.05)。治疗组病例术中经TA注入能更清晰地显示出黄斑前膜的范围,特别是残留的微膜和未成熟膜,能更清晰地辨认。必要时进行二次剥膜,利于手术医生操作,特别是手术技巧欠娴熟的。早期手术治疗有助于更好的视功能恢复,未见明显不良反应及其它并发症,提高了手术成功率。两组术前术后眼压差异比较无统计学意义(t=1.324,P>0.05)。结论:利用曲安奈德在玻璃体切除术中的良好可视性能有效识别特发性黄斑前膜范围大小,剥除的完整性。术中能更清晰地辨认、剥离,不易误伤视网膜,手术效果更好,利于手术医生操作。进一步提高了手术安全性及成功率,缩短了手术时间,减少了手术并发症,使手术小量化。并且相应减轻了患者经济负担。

·AIM: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-air-exchange,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-tion 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.·RESULTS: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-four 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-peared 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-ed 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-tion.The difference of eyes pressure in and after operation had no statistical significance(t=1.324,P>0.05).·CONCLUSION:Making good use of the visibility of TA in cutting operation,doctors can recognize the scope of special epiretinal membrane of macula and complement of dissecting clearly.Vitrectomy and intravitreal triam-cinolone with surgical removal of idiopathic epimacular membrane may improve operation safety,success rate,shorten operation time,decrease complications,minimize operation procedures and diminish patients’ fees.·