Brinkmann Max P, Michels Stephan, Brinkmann Carolin, Rommel Felix, Ranjbar Mahdy, Graf Johansen Nicole, Becker Matthias
Department of Ophthalmology, Stadtspital Waid und Triemli Zürich, Zurich, Switzerland.
Department of Ophthalmology, University of Zürich, Zurich, Switzerland.
Int J Retina Vitreous. 2021 Jan 14;7(1):7. doi: 10.1186/s40942-020-00279-0.
Clinical studies have shown that epiretinal membranes (ERM) as well as abnormalities of the central foveal bouquet (CB) can be classified in different stages according to their morphological appearance. Furthermore, visual acuity correlates with the different stages of these features. The present study evaluated how these findings change after the surgical removal of the ERM and their impact on functional outcomes.
In this retrospective study eyes with ERM were evaluated by SD-OCT scans before and after pars plana vitrectomy (PPV) with macular ERM and internal limiting membrane (ILM) peeling. CB abnormalities were classified according to their morphological appearance from stage 0 (no abnormalities) to stage 3 (acquired vitelliform lesion). ERMs were classified ranging from stage 0 (absence of ERM) to stage 4 (ERM with significant anatomic disruption of macula). Changes in morphology were correlated with visual acuity before and after surgery.
151 eyes were included into the study. Before surgery 27.2% (n = 41) of eyes showed CB abnormalities with stage 1 being the most common (11.9%, n = 18). Before surgery ERM was seen in all patients. The most common form was stage 1 (28.5%, n = 43), followed by stage 3 (27.8%, n = 42) and 2 (25.2%, n = 38). Only 18.5% (n = 28) presented with stage 4 ERM. The mean BCVA was 0.42 (logMAR) before and increased to 0.19 (logMAR) 8 weeks after vitrectomy (95% CI 0.20-0.28; p < 0.001). Patients who suffered from CB abnormalities had less increase in BCVA than patients who had no evidence of CB (0.28 vs. 0.14 logMAR; p < 0.001). Of all the patients with CB abnormalities at baseline, 68% had lower CB grading after the surgery (n = 28; 95% CI; p < 0.001). All patients showed an improvement of their ERM grading, with 98.7% reaching stage 0 (n = 151 vs. n = 149; 95% CI; p < 0.001).
The study indicates that the presence of CB abnormalities correlates with worse visual function. They are furthermore associated with worse visual outcomes after PPV with ERM and ILM peeling. These findings are valuable for deciding on PPV in patients with ERM.
临床研究表明，视网膜前膜（ERM）以及中央凹束（CB）异常可根据其形态外观分为不同阶段。此外，视力与这些特征的不同阶段相关。本研究评估了手术切除ERM后这些发现如何变化以及它们对功能结果的影响。
在这项回顾性研究中，对患有ERM的眼睛在进行黄斑ERM和内界膜（ILM）剥除的玻璃体切割术（PPV）前后进行了光谱域光学相干断层扫描（SD-OCT）评估。CB异常根据其形态外观从0期（无异常）到3期（获得性卵黄样病变）进行分类。ERM从0期（无ERM）到4期（ERM伴黄斑明显解剖结构破坏）进行分类。形态学变化与手术前后的视力相关。
151只眼睛纳入研究。手术前，27.2%（n = 41）的眼睛显示CB异常，其中1期最为常见（11.9%，n = 18）。所有患者术前均可见ERM。最常见的类型是1期（28.5%，n = 43），其次是3期（27.8%，n = 42）和2期（25.2%，n = 38）。只有18.5%（n = 28）表现为ERM 4期。术前平均最佳矫正视力（BCVA）为0.42（logMAR），玻璃体切割术后8周增至0.19（logMAR）（95%CI 0.20 - 0.28；p < 0.001）。患有CB异常的患者BCVA的提高低于无CB异常证据的患者（0.28对0.14 logMAR；p < 0.001）。基线时所有CB异常的患者中，68%术后CB分级降低（n = 28；95%CI；p < 0.001）。所有患者的ERM分级均有改善，98.7%达到0期（n = 151对n = 149；95%CI；p < 0.001）。
该研究表明，CB异常的存在与较差的视觉功能相关。它们还与PPV联合ERM和ILM剥除术后较差的视觉结果相关。这些发现对于决定ERM患者是否进行PPV具有重要价值。
