特发性黄斑前膜内层视网膜不规则指数与手术后视功能的相关性研究

Correlation of inner-retinal irregularity index with visual function before and after surgery in idiopathic macular epiretinal membrane

目的观察特发性黄斑前膜(IMEM)患眼手术前后内层视网膜不规则指数(IRII)的变化及其与视功能的相关性。方法回顾性系列研究。2017年3月至2018年5月于解放军中部战区总医院眼科检查确诊的IMEM患者46例46只眼纳入研究。均行BCVA、视物变形度(M)、扫频光源OCT检查。BCVA检查采用国际标准视力表进行,记录时换算为logMAR视力。平均IRII为1.255±0.048;平均logMAR BCVA为0.63±0.21;平均M值为0.68±0.38;平均黄斑中心凹视网膜厚度(CMT)为(353.57±73.92)μm;平均内层视网膜厚度(IRT)为(181.50±40.91)μm。椭圆体带(EZ)完整、不完整分别为17、29只眼。所有患眼均行25G经睫状体平坦部三切口闭合式玻璃体切割手术,同时剥除视网膜前膜及内界膜。观察手术后1、3、6、12个月IRII、M值、BCVA、CMT、IRT及EZ变化情况,同时分析手术前后IRII与M值、BCVA之间的相关性。手术前后BCVA、M值、CMT、IRT比较采用单因素重复测量资料的方差分析;手术前后IRII与BCVA、M值、CMT、IRT及EZ完整性之间的相关性分析均采用Spearman秩相关分析。结果手术后12个月,平均IRII、logMAR BCVA分别为1.175±0.032、0.47±0.16,较手术前明显改善,差异有统计学意义(F=22.273、5.453,P<0.001、<0.001);平均M值(F=20.109)、CMT(F=14.273)、IRN(F=13.665)较手术前明显降低,差异有统计学意义(P<0.001、0.001、<0.001);EZ完整性较手术前明显改善,差异有统计学意义(χ2=12.715,P<0.001)。Spearman相关性分析结果显示,手术前IRII与手术前M值、CMT呈正相关(r=0.951、0.701,P<0.001、<0.001);与手术后M值、logMAR BCVA、CMT及EZ完整性呈正相关(r=0.650、0.369、0.720、0.293;P<0.001、<0.001,P=0.048);与手术前logMAR BCVA及EZ完整性无相关性(r=0.283、0.001,P=0.056、0.996)。结论IMEM患眼手术前IRII与手术后BCVA、M值明显相关。

Objective To observe the changes of the inner-retinal irregularity index (IRII) of eyes with idiopathic macular epiretinal membrane (IMEM) before and after surgery and its correlation with visual function.Methods retrospective series of studies. From March 2017 to May 2018, 46 IMEM patients (46 eyes) diagnosed in the Department of Ophthalmology of Central Theater Command General Hospital were included in the study. BCVA, visual deformation degree (M), OCT inspection with swept source were all performed. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logMAR visual acuity for record. The average IRII was 1.255±0.048, the average logMAR BCVA was 0.63±0.21, the average M value was 0.68±0.38, the average of central macular thickness (CMT) was 353.57±73.92 μm, the average inner retinal layer thickness (IRT) was 181.50±40.91 μm. The complete and incomplete ellipsoid zone (EZ) were 17 and 29 eyes, respectively. All eyes underwent a 25G three-incision closed vitrectomy through the flat part of the ciliary body, and the epiretinal membrane and inner limiting membrane were removed at the same time. The changes of IRII, M value, BCVA, CMT, IRT and EZ were observed at 1, 3, 6, and 12 months after surgery, and the correlation were analyzed between IRII and M value and BCVA before and after surgery. Single-factor repeated measurement data analysis of variance was used for the comparison of BCVA, M value, CMT, and IRT before and after surgery. Spearman rank correlation analysis were adopted for the correlation analysis between IRII and BCVA, M value, CMT, IRT and EZ integrity before and after surgery.Results Twelve months after surgery, the average IRII and logMAR BCVA were 1.175±0.032 and 0.47±0.16, respectively. Compared with those before surgery, they were significantly improved, and the difference was statistically significant (F=22.273, 5.453;P<0.001, <0.001). The average M value (F=20.109), CMT (F=14.273), IRN (F=13.665) were significantly lower than those before the operation, and the difference was statistically significant (P<0.001, 0.001, <0.001). The integrity of EZ was significantly improved compared with that before surgery, and the difference was statistically significant (χ2=12.715, P<0.001). The results of correlation analysis showed that preoperative IRII was positively correlated with preoperative M value and CMT (r=0.951, 0.701;P<0.001, <0.001). It was positively correlated with postoperative M value, logMAR BCVA, CMT and EZ integrity (r=0.650, 0.369, 0.720, 0.293;P<0.001,<0.001, P=0.048). It was not correlated with preoperative logMAR BCVA and EZ integrity (r=0.283, 0.001;P=0.056, 0.996).Conclusion The IRII of IMEM eyes before surgery is significantly correlated with the BCVA and M values after surgery.