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Abstract：
BACKGROUND: Diabetic macular edema (DME), a chronic microvascular complication of diabetes, is a leading cause of visual impairment and blindness. Pars plana vitrectomy (PPV) can restore the normal macular structure and reduce macular edema, whereas internal limiting membrane (ILM) peeling is used to treat tractional macular diseases. Despite the advantages, there is limited research on the combined effects of PPV with ILM peeling.
OBJECTIVE: To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness (CMT), best-corrected visual acuity (BCVA), cystoid macular edema (CME) volume, and complications in patients with DME.
METHODS: Eighty-one patients (92 eyes) diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone (control group: 41 patients, 47 eyes) or PPV + ILM peeling (stripping group: 40 patients, 45 eyes); a single surgeon performed all surgeries. The two groups were compared preoperatively and 1 and 3 months postoperatively.
RESULTS: Preoperatively, both groups had comparable values of CMT, BCVA, and CME volume (P > 0.05). After surgery (both 1 and 3 months), both groups showed significant reductions in CMT, BCVA, and CME volume compared to preoperative levels, with the stripping group showing more significant reductions compared to the control group (P < 0.05). Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time, and interaction effects for CMT, BCVA, and CME volume (P < 0.05). There were no significant differences in the incidence of complications between the groups (retinal detachment: control = 2, stripping = 1; endophthalmitis: Control = 4, stripping = 1; no cases of secondary glaucoma or macular holes; χ 2 = 0.296, P = 0.587).
CONCLUSIONS: PPV with ILM peeling can significantly improve the visual acuity of patients with DME, reduce CMT, and improve CME with fewer complications.
OBJECTIVE: To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness (CMT), best-corrected visual acuity (BCVA), cystoid macular edema (CME) volume, and complications in patients with DME.
METHODS: Eighty-one patients (92 eyes) diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone (control group: 41 patients, 47 eyes) or PPV + ILM peeling (stripping group: 40 patients, 45 eyes); a single surgeon performed all surgeries. The two groups were compared preoperatively and 1 and 3 months postoperatively.
RESULTS: Preoperatively, both groups had comparable values of CMT, BCVA, and CME volume (P > 0.05). After surgery (both 1 and 3 months), both groups showed significant reductions in CMT, BCVA, and CME volume compared to preoperative levels, with the stripping group showing more significant reductions compared to the control group (P < 0.05). Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time, and interaction effects for CMT, BCVA, and CME volume (P < 0.05). There were no significant differences in the incidence of complications between the groups (retinal detachment: control = 2, stripping = 1; endophthalmitis: Control = 4, stripping = 1; no cases of secondary glaucoma or macular holes; χ 2 = 0.296, P = 0.587).
CONCLUSIONS: PPV with ILM peeling can significantly improve the visual acuity of patients with DME, reduce CMT, and improve CME with fewer complications.
摘要：
背景：糖尿病性黄斑水肿（DME），糖尿病的慢性微血管并发症，是视力障碍和失明的主要原因。平坦部玻璃体切除术(PPV)可恢复正常黄斑结构,减轻黄斑水肿,而内界膜（ILM）剥离用于治疗牵引性黄斑疾病。尽管有优势,关于PPV与ILM剥离的联合作用的研究有限。
目的：观察PPV联合ILM剥离对术后中央黄斑厚度（CMT）的影响，最佳矫正视力（BCVA），黄斑囊样水肿（CME）体积，DME患者的并发症。
方法：2022年1月至12月在北京山曲良乡医院诊断为DME的81例（92只眼）随机分为单纯PPV（对照组41例，47只眼）或PPV+ILM剥离（剥离组：40例，45眼）；一名外科医生进行了所有手术。比较两组术前及术后1、3个月。
结果：术前，两组的CMT值具有可比性，BCVA,和CME体积(P>0.05)。手术后（1个月和3个月），两组均显示CMT显着降低，BCVA,和CME体积与术前水平相比，剥离组较对照组降低更显著(P<0.05)。对组内差异的进一步重复测量ANOVA分析揭示了组和时间的显着影响，和CMT的相互作用效应，BCVA,和CME体积(P<0.05)。两组并发症发生率差异无统计学意义（视网膜脱离：对照=2，剥离=1；眼内炎：对照=4，剥离=1；无继发性青光眼或黄斑裂孔病例；χ2=0.296，P=0.587）。
结论：PPV联合ILM剥离可显著提高DME患者的视力，减少CMT，并以更少的并发症改善CME。
目的：观察PPV联合ILM剥离对术后中央黄斑厚度（CMT）的影响，最佳矫正视力（BCVA），黄斑囊样水肿（CME）体积，DME患者的并发症。
方法：2022年1月至12月在北京山曲良乡医院诊断为DME的81例（92只眼）随机分为单纯PPV（对照组41例，47只眼）或PPV+ILM剥离（剥离组：40例，45眼）；一名外科医生进行了所有手术。比较两组术前及术后1、3个月。
结果：术前，两组的CMT值具有可比性，BCVA,和CME体积(P>0.05)。手术后（1个月和3个月），两组均显示CMT显着降低，BCVA,和CME体积与术前水平相比，剥离组较对照组降低更显著(P<0.05)。对组内差异的进一步重复测量ANOVA分析揭示了组和时间的显着影响，和CMT的相互作用效应，BCVA,和CME体积(P<0.05)。两组并发症发生率差异无统计学意义（视网膜脱离：对照=2，剥离=1；眼内炎：对照=4，剥离=1；无继发性青光眼或黄斑裂孔病例；χ2=0.296，P=0.587）。
结论：PPV联合ILM剥离可显著提高DME患者的视力，减少CMT，并以更少的并发症改善CME。
