异常中心凹内层对特发性黄斑前膜术后视力的预测价值研究

Predictive value of ectopic inner foveal layers for visual acuity after idiopathic macular epiretinal membrane surgery

目的利用高分辨的频域光学相干层析成像(SD-OCT)技术,探究特发性黄斑前膜(IMEM)术前异常中心凹内层厚度(EIFLT)与术前、术后视力的相关性,找出预测IMEM术后视力恢复的可靠量化指标。方法基于SD-OCT图像4级分级方案对纳入本研究的93例(103眼)IMEM患者进行分级,除1级组外,2级、3级、4级组受试者均接受23 G微创玻璃体切除术,剥除黄斑前膜及内界膜,同时联合超声乳化吸除及人工晶状体植入术。分析术前EIFLT及其他OCT参数与术前、术后视力的相关性,建立术后视力的预测模型。结果除了年龄、外层黄斑厚度(OFT)在不同分级组之间差异无统计学意义外,其余术前参数在4组间均不全相同,差异有统计学意义(P<0.05)。与术后6个月最佳矫正视力(BCVA)存在线性关系的术前参数:2级组包括年龄、术前BCVA,3级组包括术前EIFLT、术前BCVA。采用多重共线性回归法建立患者术后BCVA的预测模型。结论不同分级组IMEM的视网膜结构参数不一样,需进行分级研究。术前EIFLT是IMEM患者术后视力恢复的负影响因素,无异常中心凹内层存在的2级IMEM是一个很好的手术时机。

Objective To explore the correlation between preoperative ectopic inner foveal layers thickness(EIFLT)and preoperative and postoperative visual acuity in idiopathic macular epiretinal membrane(IMEM)by high resolution spectral-domain optical coherence tomography(SD-OCT),so as to find out reliable quantitative indicators for predicting the postoperative visual acuity(VA)of IMEM.Methods One hundred of three eyes of 93 patients with IMEM included in this study were graded according to the 4-level grading scheme based on SD-OCT images.Except group 1,group 2,group 3 and group 4 were all treated with 23 G pars plana vitrectomy(PPV),with the removal of the macular epiretinal membrane and the inner limiting membrane,and the combination of phacoemulsification and intraocular lens implantation.The correlation between preoperative EIFLT and other OCT parameters and preoperative and postoperative VA were analyzed,in order to establish a predictive model for postoperative visual acuity.Results There was no significant difference in age and outer foveal thickness between different grading groups,the other preoperative parameters were different among the four groups,and the difference was statistically significant(P<0.05).There was a linear relationship between some preoperative parameters and postoperative best-corrected visual acuity(BCVA)at 6 months,group 2 included age and preoperative BCVA,group 3 included preoperative EIFLT and preoperative BCVA.The predictive model of postoperative BCVA was established by multiple collinear regression.Conclusions The retinal structural parameters of IMEM in different grading groups were different,so it is necessary to classify the IMEM.Preoperative EIFLT is a negative factor for postoperative VA recovery in patients with IMEM.Grade 2 without ectopic inner foveal layers(EIFL)is a good opportunity for operation.