Abstract：
BACKGROUND: Idiopathic epiretinal membrane (iERM) is a common disorder of the vitreomacular interface characterized by decreased visual acuity and metamorphopsia. This study aimed to analyze the association between the anatomical change of the retina and functional outcomes in iERM patients so as to derive the prognostic factors of visual acuity (VA) and metamorphopsia.
METHODS: Forty-five patients (one eye per patient; 45 eyes in total) who underwent pars plana vitrectomy and membrane peeling for iERM by a single surgeon were enrolled in this retrospective study. The results on best-corrected visual acuity (BCVA) and metamorphopsia as well as retinal images were obtained before the surgery and 1, 3, 6 months after the surgery. The BCVA and retinal microstructure, including central retinal thickness (CRT), ganglion cell layer (GCL) thickness, inner nuclear layer (INL) and outer nuclear layer + outer plexiform layer (ONL+OPL), and continuity of photoreceptor inner/outer segment (IS/OS) junction before and after iERM surgery were compared using paired samples t-test (continuous variables) or Chi-square test (categorical variables). Multiple regression analysis was carried out to explore the association among BCVA, M-score, and the parameters derived from optical coherence tomography.
RESULTS: Compared with preoperative data, a significant improvement in BCVA was observed 1, 3, and 6 months postoperatively (t = 5.37, p < 0.0001; t = 7.29, p < 0.0001; t = 6.44, p < 0.0001 for 1, 3, and 6 months postoperatively, respectively), whereas the M-score only decreased significantly 3 and 6 months after the surgery (t = 2.36, p = 0.02; t = 5.00, p < 0.0001, respectively). In comparison with the baseline, the CRT, INL, and ONL+OPL thickness showed a significant decrease at each postoperative follow-up time, and GCL thickness (t = 3.86, p = 0.0002) and IS/OS disruption ratio (χ2 = 4.86, p = 0.027) were markedly reduced only 6 months postoperatively. Six-month postoperative BCVA was considerably associated with preoperative CRT and ONL+OPL thickness, as well as postoperative CRT, ONL+OPL thickness, and severity of IS/OS disruption. Moreover, the M-score after surgery was markedly correlated with both the preoperative and postoperative INL and CRT thickness.
CONCLUSIONS: Both VA and M-score in iERM patients were significantly improved after vitrectomy. Pre- and post-operative CRT was significantly associated with both postoperative BCVA and M-score. Besides, pre- and post-operative INL thickness was correlated to postoperative metamorphopsia, and postoperative BCVA was associated with postoperative ONL+OPL thickness and IS/OS integrity.
METHODS: Forty-five patients (one eye per patient; 45 eyes in total) who underwent pars plana vitrectomy and membrane peeling for iERM by a single surgeon were enrolled in this retrospective study. The results on best-corrected visual acuity (BCVA) and metamorphopsia as well as retinal images were obtained before the surgery and 1, 3, 6 months after the surgery. The BCVA and retinal microstructure, including central retinal thickness (CRT), ganglion cell layer (GCL) thickness, inner nuclear layer (INL) and outer nuclear layer + outer plexiform layer (ONL+OPL), and continuity of photoreceptor inner/outer segment (IS/OS) junction before and after iERM surgery were compared using paired samples t-test (continuous variables) or Chi-square test (categorical variables). Multiple regression analysis was carried out to explore the association among BCVA, M-score, and the parameters derived from optical coherence tomography.
RESULTS: Compared with preoperative data, a significant improvement in BCVA was observed 1, 3, and 6 months postoperatively (t = 5.37, p < 0.0001; t = 7.29, p < 0.0001; t = 6.44, p < 0.0001 for 1, 3, and 6 months postoperatively, respectively), whereas the M-score only decreased significantly 3 and 6 months after the surgery (t = 2.36, p = 0.02; t = 5.00, p < 0.0001, respectively). In comparison with the baseline, the CRT, INL, and ONL+OPL thickness showed a significant decrease at each postoperative follow-up time, and GCL thickness (t = 3.86, p = 0.0002) and IS/OS disruption ratio (χ2 = 4.86, p = 0.027) were markedly reduced only 6 months postoperatively. Six-month postoperative BCVA was considerably associated with preoperative CRT and ONL+OPL thickness, as well as postoperative CRT, ONL+OPL thickness, and severity of IS/OS disruption. Moreover, the M-score after surgery was markedly correlated with both the preoperative and postoperative INL and CRT thickness.
CONCLUSIONS: Both VA and M-score in iERM patients were significantly improved after vitrectomy. Pre- and post-operative CRT was significantly associated with both postoperative BCVA and M-score. Besides, pre- and post-operative INL thickness was correlated to postoperative metamorphopsia, and postoperative BCVA was associated with postoperative ONL+OPL thickness and IS/OS integrity.
摘要：
背景：特发性视网膜前膜（iERM）是一种常见的玻璃体视网膜界面疾病，其特征是视力下降和变形。本研究旨在分析iERM患者视网膜解剖改变与功能结局之间的关系，从而得出视力（VA）和变形视神经的预后因素。
方法：这项回顾性研究纳入了45例患者（每个患者一只眼；总共45只眼），这些患者接受了由一名外科医生进行的平坦部玻璃体切除术和iERM膜剥离。手术前和手术后1、3、6个月获得了最佳矫正视力（BCVA）和变形视的结果以及视网膜图像。BCVA和视网膜微结构,包括中央视网膜厚度（CRT），神经节细胞层（GCL）厚度，内部核层(INL)和外部核层+外部丛状层(ONL+OPL),使用配对样本t检验（连续变量）或卡方检验（分类变量）比较iERM手术前后的光感受器内/外节（IS/OS）连接的连续性。进行多元回归分析以探讨BCVA，M-score,和光学相干层析成像得出的参数。
结果：与术前数据相比，术后1、3和6个月观察到BCVA的显着改善（t=5.37，p<0.0001；t=7.29，p<0.0001；t=6.44，p<0.0001术后1、3和6个月，分别)，而M评分仅在手术后3个月和6个月显著降低(t=2.36,p=0.02;t=5.00,p<0.0001)。与基线相比，CRT,INL,术后各随访时间ONL+OPL厚度均有明显下降,GCL厚度（t=3.86，p=0.0002）和IS/OS破坏率（χ2=4.86，p=0.027）仅在术后6个月显着降低。术后6个月BCVA与术前CRT和ONL+OPL厚度显著相关,以及术后CRT，ONL+OPL厚度，以及IS/OS中断的严重程度。此外，术后M评分与术前和术后INL和CRT厚度均显著相关.
结论：玻璃体切除术后iERM患者的VA和M评分均明显改善。术前和术后CRT与术后BCVA和M评分显着相关。此外,术前和术后INL厚度与术后变形相关，术后BCVA与术后ONL+OPL厚度和IS/OS完整性相关。
方法：这项回顾性研究纳入了45例患者（每个患者一只眼；总共45只眼），这些患者接受了由一名外科医生进行的平坦部玻璃体切除术和iERM膜剥离。手术前和手术后1、3、6个月获得了最佳矫正视力（BCVA）和变形视的结果以及视网膜图像。BCVA和视网膜微结构,包括中央视网膜厚度（CRT），神经节细胞层（GCL）厚度，内部核层(INL)和外部核层+外部丛状层(ONL+OPL),使用配对样本t检验（连续变量）或卡方检验（分类变量）比较iERM手术前后的光感受器内/外节（IS/OS）连接的连续性。进行多元回归分析以探讨BCVA，M-score,和光学相干层析成像得出的参数。
结果：与术前数据相比，术后1、3和6个月观察到BCVA的显着改善（t=5.37，p<0.0001；t=7.29，p<0.0001；t=6.44，p<0.0001术后1、3和6个月，分别)，而M评分仅在手术后3个月和6个月显著降低(t=2.36,p=0.02;t=5.00,p<0.0001)。与基线相比，CRT,INL,术后各随访时间ONL+OPL厚度均有明显下降,GCL厚度（t=3.86，p=0.0002）和IS/OS破坏率（χ2=4.86，p=0.027）仅在术后6个月显着降低。术后6个月BCVA与术前CRT和ONL+OPL厚度显著相关,以及术后CRT，ONL+OPL厚度，以及IS/OS中断的严重程度。此外，术后M评分与术前和术后INL和CRT厚度均显著相关.
结论：玻璃体切除术后iERM患者的VA和M评分均明显改善。术前和术后CRT与术后BCVA和M评分显着相关。此外,术前和术后INL厚度与术后变形相关，术后BCVA与术后ONL+OPL厚度和IS/OS完整性相关。
