摘要目的：观察不同手术方法治疗继发性黄斑前膜的效果。方法回顾性分析继发性黄斑前膜手术52例（52眼）的临床资料。 A组（26眼）行经睫状体平坦部的三切口玻璃体切除＋黄斑前膜剥除＋玻璃体内注药（雷珠单抗0．5mg／0．05ml）术，B组（26眼）行经睫状体平坦部的三切口玻璃体切除＋黄斑前膜剥除＋气液交换＋C3 F8（20％）注入术，对手术前后最佳矫正视力（ BCVA）、黄斑形态及手术并发症等进行了临床观察。结果随访4～14个月。随访期末A组BCVA提高20眼，视力不变5眼，下降1眼，术后BCVA 与术前相比，差异有统计学意义（t＝4．125，P ＝0．00035）。随访期末B组BCVA提高18眼，视力不变6眼，下降2眼。术后BCVA 与术前相比，差异有统计学意义（t＝3．817，P ＝0．00052）。两组相比手术后视力改善程度差异无统计学意义（z＝0．661，P＝0．24），两组手术前后黄斑中心神经上皮层厚度（ CMT）差异均有统计学意义。但A组术后CMT改善较快。并发症：A组术中视网膜少许出血6眼，手术后发生玻璃体积血1眼；周边牵引性小裂孔3眼，激光治疗后恢复1眼，再次手术2眼。 B组术中少许视网膜出血8眼，手术后发生玻璃体积血4眼；周边牵引性小裂孔3眼，均采用激光治疗。随访期内B 组复发前膜2眼，均发生于玻璃体积血吸收以后。结论两种手术方式均可有效治疗继发性黄斑前膜。 A组手术方式可较快改善CMT，较少发生术后玻璃体积血，减少黄斑前膜复发。 B组手术方式对于术后发生的牵引性裂孔可以更有效治疗。

abstractsObjective To observe the efficacy of different surgical methods for secondary macular epiretinal membrane ( SEM ) .Methods Clinical data of 52 eyes of 52 cases with SEM who underwent surgical treatment were retrospectively analysed .Patients in group A ( 26 eyes ) underwent pars plana vitrectomy+membrane peeling +intravitreal injection of luncentis (0.5 mg/0.05 ml) .Patients in group B (26 eyes) underwent pars plana vitrectomy +membrane peeling +fluid-air exchange +C3F8(20%) gas tamponade.Postoperative changes in best corrected visual acuity ( BCVA), macular morphology and the complications were observed .Results The follow-up time was 4-14 months.In group A, the BCVA improved in 20 eyes after the operation , it was unchanged in 5 eyes and decreased in 1 eye, the post-operative BCVA improved comparing with the preoperative one (t=4.125,P=0.00035).In group B, the BCVA improved in 18 eyes after the operation , unchanged in 6 eyes and decreased in 2 eyes, the post-operative BCVA improved comparing with the preoperative one (t=3.817,P=0.00052).The difference in vision improvement between the two groups was not statistically significant (z =0.661,P =0.24).The thickness of neuroepithelium in the central macular area ( CMT) was statistically improved after the surgery in both the two groups .But the improvement of CMT was faster in group A .In group A, small amount of retinal hemorrhage happened in 6 eyes during the surgery , and vitreous hemorrhage occurred in 1 eye after the surgery.Prepheral retinal hole occurred in 3 eyes , in which one eye was cured by laser treatment , and the other two eyes needed secondary surgery .In group B, small amount of retinal hemorrhage happened in 8 eyes during the surgery , and vitreous hemorrhage occurred in 4 eyes after the surgery .Prepheral retinal hole occurred in 3 eyes, and were cured in all 3 eyes by laser treatment.Epiretinal membrane(EM)was seen in 2 eyes during follow-up time in group B , which ocurred after vitreous hemorrhage absorption .Conclusion Both the two kinds of operation can cure SEM effectively .The surgical method of group A can improve the CMT faster, reduce the risk of vitreous hemorrhage and epiretinal membrane recurrence .The surgical method of group B can cure the tractional retinal hole effectively .