基于SD-OCT建立新的前膜分级法评估IMEM对年龄相关性白内障患者术后视功能的影响

Evaluate the effect of idiopathic macular epiretinal membrane on visual functional prognosis of cataract patients based on the new classification method for macular epiretinal membrane by SD-OCT

目的:在单纯白内障术前,根据频域光学相干断层扫描技术(SD-OCT)显示年龄相关性白内障合并特发性黄斑前膜(IMEM)的患眼黄斑中心凹内部精细结构的紊乱程度建立新的IMEM分级法,评估其用于预测年龄相关性白内障患者的视功能预后的价值。方法:选取2017-10/2018-11在暨南大学附属深圳市眼科医院因年龄相关性白内障单纯行超声乳化白内障摘除联合人工晶状体植入术,术前眼底检查发现合并IMEM者64例80眼,根据SD-OCT显示的IMEM对黄斑中心凹内部精细结构的破坏程度将IMEM分为4级。对合并各级IMEM的患者术前、术后3mo的最佳矫正视力(BCVA,LogMAR)、平均视敏度(MS)、黄斑中心凹厚度(CMT)、黄斑前膜进展率进行对比分析。结果:在SD-OCT图像上,随着合并的IMEM分级的增高,前膜越明显,患者的黄斑中心凹凹部丢失和内部结构紊乱越严重。白内障术前及术后3mo的患眼BCVA随着所合并的IMEM分级升高而增加(F=37.72、26.43,均P<0.001)。白内障术前及术后3mo的患眼MS随着所合并的IMEM分级升高而降低(F=43.77、28.96,均P<0.001)。术后3mo CMT的改变和黄斑前膜进展率并不一致,合并各级IMEM的患眼CMT与术前均无差异(P>0.05),但黄斑前膜进展率呈显著上升趋势(χ2趋势=12.59,P<0.001)。结论:借助于SD-OCT对年龄相关性白内障合并的IMEM进行新的精细分级,可以更精准地预测该类患者单纯行白内障手术术后的视功能恢复情况。

AIM:To evaluate the disruption degree of macular fovea structure by pre-operation SD-OCT examination and establish a new method of IMEM.Thus,to analysis the value of this method for predicting the visual functional prognosis of cataract patients complicated with idiopathic macular epiretinal membrane(IMEM)after cataract surgery alone.METHODS:Totally 64 patients(80 eyes)diagnosed as cataract with IMEM,who simply underwent phaco cataract extraction combined with intraocular lens implantation were included in this study.These patients were admitted in Shenzhen Eye Hospital from October 2017 to November 2018.IMEM was divided into 4 stages based on the damage degree of macular fovea structure by pre-operative SD-OCT examination.The best corrected visual acuity(BCVA),mean retinal sensitivities(MS),central macular thickness(CMT)and the progression rate of IMEM in all the patients were compared and analyzed before and 3mo after the cataract operation.RESULTS:With the IMEM grade rised,the epiretinal membranes became more obvious,the disruption of retinal layers and loss of the foveal depression became more serious on the SD-OCT image.The LogMAR BCVA of pre-operation and 3mo after cataract surgery progressively rised with the increasing of IMEM grade,and the differences were statistically significant(F=37.72,26.43,P<0.001).Otherwise,The MS of pre-operation and 3mo after cataract surgery progressively declined with the increasing of IMEM grade,and the differences were statistically significant(F=43.77,28.96,P<0.001).The change of CMT was not consistent with the progression rate of IMEM in 3mo after operation.There was no significant difference in CMT(P>0.05),but the progression rate of IMEM was increased significantly with the IMEM grading(χ2Trend=12.59,P<0.001).CONCLUSION:The new classification method was created for IMEM by SD-OCT will help to predict the visual functional prognosis for cataract patients complicated with IMEM after cataract surgery.