目的：分析玻璃体切除黄斑前膜剥除术联合与不联合内界膜(ILM)剥除对特发性黄斑前膜(IMEM)患者脉络膜厚度、视力和视物变形的影响。

方法：前瞻性研究。收集2016-01/2020-01在本院诊治的IMEM患者88例88眼，按随机数字表法分两组：观察组44眼接受玻璃体切除黄斑前膜剥除术联合内界膜剥除治疗，对照组44眼仅接受玻璃体切除黄斑前膜剥除术治疗。比较两组患者手术前后脉络膜厚度、视力和视物变形、黄斑中心凹厚度(CMT)、椭圆体区连续性(EZ)及并发症。

结果：与术前比较，两组患者术后3、6mo时的黄斑中心凹脉络膜厚度(SFCT)、距黄斑中心凹鼻侧1 000μm处脉络膜厚度(NFCT)及距黄斑中心凹颞侧1 000μm处脉络膜厚度(TFCT)均明显下降(P<0.05)，但两组间比较无差异(P>0.05)； 与术前比较，两组患者最佳矫正视力(BCVA)改善，光敏感度(MS)上升，观察组患者黄斑暗点数(SP)上升，对照组患者SP下降，观察组术后1、3、6mo时的MS明显低于对照组，SP高于对照组(均P<0.05)； 与术前比较，两组患者术后3、6mo时的水平和平均M评分较术前均明显下降(均P<0.05)，但组间无差异(P>0.05)； 两组术后1、3、6mo时的CMT较术前均明显下降，观察组术后3、6mo时的CMT均高于对照组(均P<0.05)，EZ连续比例及并发症发生率组间比较均无差异(P>0.05)。

结论：玻璃体切除黄斑前膜剥除治疗IMEM时，无论是否联合ILM剥除均可取得良好的视力并改善视物变形，且对脉络膜厚度的影响及安全性相当； 但联合ILM剥除具更低的光敏感度和更高的暗点数，术后CMT更厚，并未体现出显著优越性。

AIM: To analyze the effects of vitrectomy and macular epiretinal membrane dissection combined with or without internal limiting membrane(ILM)peeling on choroid thickness, vision and metamorphopsia in patients with idiopathic macular epiretinal membrane(IMEM).

METHODS: Totally 88 patients(88 eyes)with IMEM admitted to the hospital were selected between January 2016 and January 2020. They were divided into group A and group B by random number table method with 44 eyes in each group. Patients in group A were treated with vitrectomy and macular epiretinal membrane dissection combined with ILM peeling, while patients in group B were treated with vitrectomy and macular epiretinal membrane dissection. The choroid thickness, vision, metamorphopsia, central macular thickness(CMT), ellipsoid zone(EZ)continuity were compared between the two groups.

RESULTS: Compared with preoperative, the sub-foveal choroidal thickness(SFCT), choroidal thickness 1 000μm from nasal side central of fovea(NFCT)and choroidal thickness 1 000μm from temporal side central of fovea(TFCT)were significantly reduced in the two groups at 3mo and 6mo after operation(P<0.05), but there was no statistically significant difference between the groups(P>0.5). Compared with preoperative, the best corrected visual acuity(BCVA)LogMAR was reduced, while mean sensitivity(MS)was increased in the two groups. The number of scotoma points(SP)increased in group A and decreased in group B. Group A had significantly lower MS and higher SP than group B at 1mo, 3mo, and 6mo after operation(P<0.05). Compared with preoperative, the M scores(Angle of view when horizontal and vertical variability begins to disappear)and average M scores of the two groups were significantly reduced at 3mo and 6mo after operation, without statistically significant differences between the groups(P>0.05). Compared with preoperative, CMT was significantly reduced in the two groups at 1, 3 and 6mo after operation. The ratio of EZ continuity in group A at 1mo after operation was significantly lower than that before operation. The CMT of group A was larger than that of group B at 3mo and 6mo after operation(P<0.05). No statistically significant differences were found in the ratio of EZ continuity and the incidence of complications between the groups(P>0.05).

CONCLUSION: Vitrectomy and macular epiretinal membrane dissection combined with or without ILM peeling both can improve vision and metamorphopsia in patients with IMEM, with similar effects on choroid thickness and safety. However, combined use of ILM peeling will lower MS and increase SP as well as CMT. Therefore, it has no significant advantages in the treatment of patients with IMEM.

河北省卫生和计划生育委员会科研基金项目(No.20181304)