目的：探讨白内障超声乳化人工晶体植入术联合玻璃体切割黄斑前膜剥除术治疗老年性白内障合并特发性黄斑前膜的临床疗效。方法选取2012年2月—2013年2月于台州恩泽医疗中心诊断为老年性白内障合并特发性黄斑前膜并接受联合手术治疗的患者37例（37眼），采用白内障超声乳化人工晶体植入术联合玻璃体切割黄斑前膜剥除术，术后随访至少6个月以上，光学相干断层扫描测量分析黄斑中心凹部位视网膜厚度和结构变化，并记录矫正视力及视物变形、术后并发症等情况。结果37眼均予一期植入后房型人工晶体，黄斑前膜完整剥除，术后视力改善率91.9%（34/37）；术前存在视物变形18例，术后视物变形改善12例，视物变形消失6例。术后6个月视力（0.43±0.17）较术前（0.22±0.16）提高（t＝11.467，P＜0.01）。术后黄斑区视网膜平均厚度为（275.68±80.38）μm较术前的（483.05±141.94）μm下降（t＝14.223，P＜0.01）。未发生视网膜脱离、黄斑裂孔及黄斑前膜复发等并发症。结论白内障超声乳化人工晶体植入术联合玻璃体切割黄斑前膜剥除术治疗老年性白内障合并特发性黄斑前膜可明显改善视力、安全有效，值得临床推广。%Objective Toexploretheclinicalcurativeeffectofphacoemulsification(PEA),intraocularlens(IOL) implantation combined with pars plana vitrectomy ( PPV ), macular membrane ( MEM ) peeling on age related cataract concomitantwithidiopathicepiretinalmembrane(IMEM).Methods 37patients(37eyes)withagerelatedcataract concomitant with IMEM admitted to Taihou Enze Medical Center from February 2012 to February 2013 were selected. The patients were given combined surgeries of PEA,IOL implantation,PPV and MEM peeling. All the patients were given follow up for at least six months. Macular thickness and morphologic changes were observed by optical coherence tomography ( OCT ). Postoperative best -corrected visual acuity( BCVA),interocular pressure,the severity of metamorphopsia and postoperative complicationswererecorded.Results PosteriorchamberIOLwasimplantedandEMEwasentirelyremovedinalleyes(n=37) during the primary operation. The postoperative BCVA improved in 91. 9%(34/37)of cases. 18 cases had metamorphopsia,and it was improved in 12 cases and disappeared in 6 cases postoperatively. After a six month follow -up,the average BCVA was (0. 43 ± 0. 17)postoperatively,there was a significant increase in BCVA compared with the preoperative BCVA of(0. 22 ±0. 16)(t =11. 467,P <0. 01). Mean macular thickness of the eyes were(483. 05 ± 141. 94)μm preoperatively and (275. 68 ±80. 38)μm postoperatively,showing a statistically significant difference(t =14. 223,P <0. 01). No adverse reactionslikeretinaldetachment,macularholeandMEMrecurrencewerefound.Conclusion CombinedsurgeryofPEA,IOL implantation and PPV,MEM peeling in the treatment of age related cataract concomitant with IMEM is safe and effective,and is worthy of clinical promotion.
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