Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France.
Graefes Arch Clin Exp Ophthalmol. 2021 Aug;259(8):2139-2147. doi: 10.1007/s00417-021-05110-6. Epub 2021 Feb 24.
To describe the structural changes observed postoperatively in epiretinal membranes (ERM), in particular the alterations in the central cone bouquet (CB), and to identify prognostic factors that might predict postoperative outcome.
We included 125 eyes of 117 patients who underwent idiopathic ERM removal with at least a 6-month follow-up. For each patient, spectral-domain optical coherence tomography (SD-OCT) was performed and best-corrected visual acuity (BCVA) was measured, before and after surgery.
Before surgery, 44 eyes (35.2%) presented CB alterations: 65.9% a cotton ball sign, 15.9% a foveolar detachment and 18.2% a pseudovitelliform lesion. Median BCVA increased from 20/63 to 20/32 post-operatively (p = .001) with a mean follow-up of 17 months. The disappearance of CB alterations after surgery was observed in 97.7% of eyes. In stage 3 and 4 ERM, ectopic inner foveal layers persisted in 76.7% of eyes after surgery. Postoperative BCVA was correlated with change in central macular thickness and initial BCVA and was not correlated with the presence of preoperative CB alteration, the initial stage of ERM, the presence of postoperative dissociated optical nerve fiber layer, and the disappearance of ectopic inner fiber layers. The combination of cataract surgery and capsulotomy did not seem to change visual outcome and seemed to accelerate visual recovery. Incidentally, general anesthesia was correlated with final BCVA.
ERM surgery allowed a significant gain in BCVA and the disappearance of CB alterations in the great majority of cases. CB alteration did not show to be associated with poor visual prognosis.
描述内界膜（ERM）术后观察到的结构变化，特别是中央圆锥束（CB）的改变，并确定可能预测术后结果的预后因素。
我们纳入了 117 例 125 只眼，这些眼均接受了特发性 ERM 切除术，并至少随访 6 个月。对每位患者进行频域光学相干断层扫描（SD-OCT）检查，并在术前和术后测量最佳矫正视力（BCVA）。
术前，44 只眼（35.2%）出现 CB 改变：65.9%棉球状征，15.9% 黄斑中心凹脱离，18.2%假性类玻璃体病变。术后 BCVA 中位数从 20/63 增加到 20/32（p=0.001），平均随访 17 个月。术后 97.7%的眼 CB 改变消失。在 3 期和 4 期 ERM 中，术后异位内层黄斑中心凹持续存在于 76.7%的眼中。术后 BCVA 与黄斑中心厚度变化和初始 BCVA 相关，与术前 CB 改变的存在、ERM 的初始阶段、术后分离的神经纤维层的存在以及异位内层纤维层的消失无关。白内障手术联合囊切开术似乎并未改变视力预后，反而似乎加速了视力恢复。此外，全身麻醉与最终 BCVA 相关。
ERM 手术可显著提高 BCVA，且大多数情况下 CB 改变会消失。CB 改变与不良视力预后无关。
