The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria.
Ophthalmology. 2010 Apr;117(4):798-805. doi: 10.1016/j.ophtha.2009.08.034. Epub 2010 Jan 4.
To assess prognostic factors in epiretinal membrane (ERM) surgery using spectral-domain (SD) optical coherence tomography (OCT).
Prospective, interventional case series.
Forty-one patients.
Patients with a diagnosis of ERM were examined with spectral-domain and time-domain (TD) OCT before and after surgery.
Main outcome measures were functional results and predefined OCT patterns. Cofactors analyzed were the type of ERM, the duration and grading of subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, and age. A multivariate regression analysis was performed.
Thirty-nine patients (95%) showed an improved or stable best-corrected distance visual acuity (DVA) at 3 months, whereas 36 patients (88%) showed an improved or stable best-corrected near visual acuity (NVA) at 3 months. Significant correlations (P>0.4) were found between the course of central retinal thickness (CRT) assessed using SD OCT and TD OCT (P<0.02). No clinically relevant correlations (P<0.3) were seen between CRT and VA (P>0.1). Baseline DVA and NVA were found to be significant prognostic values for the postoperative decrease in CRT in both OCT systems (P<0.04) as well as for the visual outcomes (P<0.007) at 3 months. In addition, the integrity of the junction between the photoreceptor inner segment and outer segment (IS/OS) significantly influenced the visual outcomes at 3 months (P<0.038). The baseline profile of the internal limiting membrane (ILM) significantly influenced the NVA at 3 months (P<0.009), whereas the postoperative foveal contour significantly influenced the DVA at 3 months (P<0.025). The type of ERM, subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, or age had no significant influence on patient outcome (P>0.05). Compared with TD OCT, SD OCT allowed for a more precise differentiation between the ERM and the retinal surface and for a better evaluation of the IS/OS line.
Besides the baseline VA, the integrity of the IS/OS line, better visualized by SD OCT, can be used to predict the functional outcomes after surgery. Additionally, analyzing the ILM profile and the foveal contour may help to understand limited visual outcomes after surgery.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
使用谱域（SD）光学相干断层扫描（OCT）评估视网膜内膜（ERM）手术的预后因素。
前瞻性、干预性病例系列。
41 名患者。
在手术前后，使用谱域和时域（TD）OCT 对诊断为 ERM 的患者进行检查。
主要观察指标为功能结果和预定义的 OCT 模式。分析的协变量是 ERM 的类型、主观变形的持续时间和分级、同时进行的白内障手术、使用的染料类型、手术持续时间、性别和年龄。进行了多变量回归分析。
39 名患者（95%）在 3 个月时显示最佳矫正远视力（DVA）改善或稳定，而 36 名患者（88%）在 3 个月时显示最佳矫正近视力（NVA）改善或稳定。使用 SD-OCT 评估的中心视网膜厚度（CRT）与 TD-OCT 之间存在显著相关性（P>0.4）（P<0.02）。在 CRT 和 VA 之间未发现具有临床意义的相关性（P<0.3）（P>0.1）。在两种 OCT 系统中，基线 DVA 和 NVA 被发现是术后 CRT 下降的显著预后值（P<0.04），以及 3 个月时的视觉结果（P<0.007）（P<0.007）。此外，光感受器内节和外节（IS/OS）之间的连接完整性显著影响 3 个月时的视觉结果（P<0.038）。内界膜（ILM）的基线形态显著影响 3 个月时的 NVA（P<0.009），而术后中心凹轮廓显著影响 3 个月时的 DVA（P<0.025）。ERM 的类型、主观变形、同时进行的白内障手术、使用的染料类型、手术持续时间、性别或年龄对患者结局无显著影响（P>0.05）。与 TD-OCT 相比，SD-OCT 可以更精确地区分 ERM 和视网膜表面，并更好地评估 IS/OS 线。
除了基线 VA 外，通过 SD-OCT 更好地可视化的 IS/OS 线完整性也可用于预测术后功能结果。此外，分析 ILM 形态和中心凹轮廓可能有助于理解术后视力受限的原因。
作者在本文讨论的任何材料中均没有专有的或商业利益。
