目的：研究玻璃体切割联合黄斑前膜撕除术对特发性黄斑前膜(IMEM)患者视力、黄斑中心凹厚度(CMT)和视物变形程度的影响。

方法：对31例31眼IMEM患者实施玻璃体切割联合黄斑前膜撕除术进行治疗，并检查患者手术前后BCVA、CMT、椭圆体带(IS/OS)连续性和黄斑形态，评估治疗效果并研究BCVA与手术前后黄斑结构形态之间的关系，分析其可能对手术结果造成的影响因素。

结果：患者术前平均BCVA和CMT分别为0.59±0.14和429.35±86.17μm，术后6mo时分别降低至0.38±0.09和304.87±62.54μm(P<0.05)。术后患者视物变形程度逐渐减轻，且术后1、3、6mo时患者视物变形程度低于术前水平(P<0.008)。术后1mo时患者IS/OS连续比例为65%，与术前(52%)比较无差异(P>0.008)，术后3、6mo时IS/OS连续比例分别为81%和90%，与术前比较有差异(P<0.008)，术后1、3、6mo时正常型黄斑形态患者比例为26%、52%和77%，与术前比较有差异(P<0.008)，术后6mo时正常型黄斑形态患者比例与术后1mo比较有差异(P<0.008)。IMEM患者术后BCVA与术前IS/OS连续性、术前黄斑形态、术后IS/OS连续性和术后黄斑形态均呈明显负相关性(P<0.05)，与术前BCVA、术后CMT呈明显正相关性(P<0.05)。

结论：玻璃体切割联合黄斑前膜撕除术治疗可明显降低IMEM患者CMT，改善IS/OS完整性和黄斑形态，从而提高患者视力，减轻视物变形程度。

METHODS: Totally 31 cases(31 eyes)of patients with IMEM were treated with vitrectomy combined with macular epiretinal membrane peeling, and the best corrected visual acuity(BCVA), CMT, ellipsoid zone(IS/OS)connectivity and macular morphology were examined before and after operation. The treatment effect was assessed, and the relationship between BCVA, macular structure and morphology before and after operation was studied. All the factors that might affect the surgical outcomes were analyzed.

RESULTS: The mean BCVA and CMT were 0.59±0.14 and 429.35±86.17μm respectively before operation, and were decreased to 0.38±0.09 and 304.87±62.54μm at 6mo after operation(P<0.05). The metamorphopsia degree after operation was gradually decreased, and the metamorphopsia degree at 1, 3 and 6mo after operation was lower than before operation(P<0.008). At 1mo after operation, the IS/OS connectivity ratios were 65%, and there was no significant difference compared with that before operation with 52%(P>0.008). The ratio of IS/OS connectivity was 81% and 90% at 3mo and 6mo after operation, and the difference was statistically significant compared with that before operation(P<0.008). There was significant difference in the macular morphology at different time after operation(P<0.008). The proportions of patients with normal macular morphology at 1, 3 and 6mo after operation were 26%, 52% and 77% respectively, and the differences were statistically significant compared with before operation(P<0.008). Pearson or Spearman correlation analysis showed postoperative BCVA in IMEM patients was positively correlated with preoperative BCVA and postoperative CMT(P<0.05), but that was negatively correlated with preoperative macular morphology, preoperative and postoperative IS/OS connectivity and postoperative macular morphology(P<0.05).

CONCLUSION: Vitrectomy combined with macular epiretinal membrane peeling can significantly reduce the CMT of patients with IMEM, and improve the IS/OS connectivity and macular morphology, so as to improve the visual acuity and reduce the metamorphopsia degree.