目的：探究20G三通道经睫状体平坦部玻璃体切除术和25G经结膜无缝合玻璃体切除术治疗特发性黄斑前膜的疗效，为特发性黄斑前膜的微创治疗提供理论依据。

方法：采用病历资料回顾性分析的方式进行疗效研究。选取 2014-01/2016-12于我院眼科治疗的特发性黄斑前膜患者60例60眼。根据不同手术方式进行分组，将采用20G三通道经睫状体平坦部玻璃体切除术治疗的患者28例28眼设为对照组，采用25G经结膜无缝合玻璃体切除术治疗的患者32例32眼设为观察组，经术后3mo的随访评价两组患者治疗后视力、OCT检查结果、舒适度，并记录手术时间、并发症以及复发情况。

结果：观察组手术时间为18～25(平均20±2.15)min，对照组手术时间为22～35(平均28±2.07)min，两组患者手术时间比较差异有统计学意义(P<0.05)。末次随访时，两组患者视力均较术前提高，无视力下降。观察组视力提高患者比例为69%，显著高于对照组(50%)，差异有统计学意义(χ²=7.287，P<0.05)，术前两组患者眼压比较无统计学意义，术后1d两组患者眼压均较术前降低，差异有统计学意义(F_时间=31.34，P<0.01； F_组别=17.43，P<0.01)，术后7d， 1mo与术前比较差异无统计学意义(P>0.05)； 术前两组患者OCT检查黄斑厚度比较差异无统计学意义。术后7d，1、3mo OCT检查两组患者黄斑前膜均消失，黄斑厚度较术前比较均减少，黄斑水肿消退或者减轻，差异有统计学意义(P<0.05)，术后3mo时，两组患者均未发现黄斑前膜复发。术后7d，1、3mo两组间黄斑厚度比较差异均无统计学意义。术后1d，对照组患者均存在异物感、肿胀、流泪、疼痛等眼部不适，其中 20眼有结膜充血、水肿，考虑结膜缝线造成眼部不适，给予对症治疗后症状缓解。观察组中有12眼轻度结膜充血水肿，4眼切口处点状出血，5眼出现低眼压，眼压为6～8mmHg，未做特殊处理，术后7d出血均自行消除，水肿减轻，眼压恢复正常。观察组患者均未出现异物感，肿胀等眼部不适症状。所有患者末次随访时两组患者均未发现医源性视网膜脱离、白内障、眼内炎等严重并发症发生。

结论： 20G三通道经睫状体平坦部玻璃体切除术和25G经结膜无缝合玻璃体切除术治疗特发性黄斑前膜疗效相当，但25G经结膜无缝合玻璃体切除术手术时间短，患者舒适度更好。

METHODS: Medical records were retrospectively analyzed to explore curative effect. From January 2014 to December 2016, 60 patients(60 eyes)with idiopathic macular pucker in our hospital for eye treatment were selected. They were grouped according to different operation way, in 28 patients(28 eyes)using three-channel 20G pars plana vitrectomy as the control group, 32 patients(32 eyes)with 25G no-suture conjunctival vitrectomy as observation group. Two groups of patients were evaluated at 3mo after treatment for visual acuity, OCT examination, comfort, and we recorded the operation time, complications and recurrence.

RESULTS: The operating time of observation group was 18-25min, average 20±2.15min, the control group was 22-35min, 28±2.07min on average,the difference was statistically significant(P<0.05). At the time of the last follow-up, visual acuity of two groups improved compared with preoperative, without vision decrease. In observation group vision improved in 69%, significantly higher than that of control group(50%), difference was statistically significant(χ²=7.287, P<0.05). Preoperative intraocular pressure of two groups was not significantly different. intraocular pressure of two group at postoperative 1d reduced compared with preoperative(F_time=31.34, P<0.01; F_group=17.43, P<0.01). There was no statistically significant difference at 7d and 1mo compared with preoperative(P>0.05). Preoperative OCT on macular thickness of the two groups had no statistically significant difference. At 7d, 1 and 3mo after treatment, epiretinal membranes disappeared in all patients, and the macular thickness reduced, the macular edema relieved(P<0.05). At postoperative 3mo, two groups of patients were found no recurrence of epiretinal membranes. At 7d, 1 and 3mo after treatment, differences between the two groups on macular thickness had no statistical significance. At postoperative 1d, in the control group there were foreign body sensation, swelling, and tears, pain and discomfort, 20 patients with eye conjunctival congestion, edema, conjunctival suture to cause discomfort, the symptoms relieved after treatment. In observation group, 12 patients with mild conjunctival congestion and edema, dotted hemorrhage at the wound in 4 eyes, 5 eyes appeared lower intraocular pressure(6-8mmHg). without special treatment, Postoperative bleeding and edema stopped at 7d, intraocular pressure returned to normal. Patients of observation group did not have foreign body sensation, swelling and discomfort symptoms. At the time of the last follow-up, in the two groups, no iatrogenic retinal detachment, cataract, endophthalmitis and other serious complications occurred.

CONCLUSION: The 20G of three-channel pars plana vitrectomy and 25G the no-suture conjunctival vitrectomy are equal for idiopathic macular epiretinal membrane, 25G vitrectomy operation time is short with better patient comfort.