玻璃体切割联合黄斑前膜及内界膜剥除术后患者黄斑中心凹视网膜厚度、无血管区面积及微血管密度的变化

Changes in macular thickness,foveal avascular zone area,and vessel density after vitrectomy with epiretinal membrane and internal limiting membrane

目的应用光学相干断层扫描血管成像(OCTA)探讨玻璃体切割联合黄斑前膜及内界膜剥除术后患者黄斑中心凹视网膜厚度(CMT)、黄斑中心凹无血管区(FAZ)面积及黄斑中心凹与旁中心凹浅层、深层视网膜微血管密度的变化。方法本研究为前瞻性病例分析,选取2018年11月至2019年11月于我院就诊且经OCT确诊的黄斑前膜患者26例26眼,所有患者均行常规23 G三切口闭合式玻璃体切割联合黄斑前膜及内界膜剥除术,术后检测患眼最佳矫正视力(BCVA),应用OCTA检测患眼CMT、黄斑FAZ面积及黄斑中心凹与旁中心凹浅层、深层视网膜微血管密度,对所得数据进行统计学分析。结果术前患眼BCVA(logMAR)为0.69±0.28,术后3 d、1周、1个月、3个月、6个月BCVA(logMAR)分别为0.51±0.40、0.48±0.37、0.42±0.89、0.43±0.38、0.37±0.37,术后较术前均明显改善,差异均有统计学意义(均为P<0.01)。术后3 d、1周、1个月、3个月、6个月患眼CMT分别为(401.04±63.53)μm、(408.49±58.94)μm、(406.67±63.75)μm、(378.80±38.93)μm和(384.72±37.11)μm,均显著低于术前的(458.14±82.13)μm,差异均有统计学意义(均为P<0.01)。患眼术前与术后各时间黄斑FAZ面积相比,差异均无统计学意义(均为P>0.05)。仅在术后3 d,黄斑中心凹深层视网膜微血管密度从术前的(37.52±8.34)%升至(44.78±8.31)%,差异有统计学意义(P<0.05),其他时间点视网膜微血管密度与术前相比均无明显变化(均为P>0.05)。结论应用OCTA可以对玻璃体切割联合黄斑前膜及内界膜剥除术治疗黄斑前膜的疗效进行客观评价,术后患眼视网膜形觉功能恢复较快而黄斑区结构及血流恢复缓慢。

Objective To investigate the preoperative and postoperative central macular thickness(CMT),foveal avascular zone(FAZ)area,and microvessel density in the superficial and deep layers of the macular fovea and parafovea among patients with idiopathic macular epiretinal membrane after vitrectomy with epiretinal membrane and internal limiting membrane peeling using optical coherence tomography angiography(OCTA).Methods This was a prospective observational case series of 26 eyes of 26 patients who were diagnosed as idiopathic macular epiretinal membrane by optical coherence tomography(OCT)from November 2018 to November 2019.All patients underwent conventional 23G three-incision closed vitrectomy with epiretinal membrane and internal limiting membrane peeling.Best-corrected visual acuity(BCVA),CMT,FAZ area,as well as superficial capillary plexus(SCP)density and deep capillary plexus(DCP)density in the foveal and parafoveal region were evaluated and analyze statistically.Results Compared with preoperative data(0.69±0.28)logMAR,BCVA were(0.51±0.40)logMAR,(0.48±0.37)logMAR,(0.42±0.89)logMAR,(0.43±0.38)logMAR,and(0.37±0.37)logMAR,respectively 3 days,1 week,1 month,3 months and 6 months after operation,and postoperative BCVA significantly improved compared with preoperative data(all P<0.01).Compared with preoperative data(458.67±82.13)μm,CMT were(401.04±63.53)μm,(408.49±58.94)μm,(406.67±63.75)μm,(378.80±38.93)μm,and(384.72±37.11)μm 3 days,1 week,1 month,3 months and 6 months after operation,respectively,and postoperative CMT was dramatically decreased(all P<0.01).Compared with the preoperative data,no significant differences were statistical in the FAZ area at all time-points after operation(all P>0.05).The deep capillary plexus density in the foveal significantly increased from(37.52±8.34)%before operation into(44.78±8.31)%in idiopathic macular epiretinal membrane eyes at 3 days after surgery(P<0.05),whereas no significant differences were found in the superficial and the deep vessel density of foveal and parafoveal region in other time points(all P>0.05).Conclusion OCTA provides a better tool to evaluate the surgical prognosis of patients with idiopathic macular epiretinal membrane after vitrectomy with epiretinal membrane and internal limiting membrane peeling.Visual functional recovery might be faster than the rebuild of macular architecture and the circulation of retinal vascular network after surgery.