Xu Zhaokai, Mao Jianbo, Lao Jimeng, Deng Xinyi, Liu Chenyi, Xu Jiahao, Wu Sulan, Chen Yiqi, Shen Lijun
Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China.
Chicago College of Optometry, Midwestern University, Downers Grove, Illinois, USA.
Ophthalmologica. 2021;244(6):569-580. doi: 10.1159/000517523. Epub 2021 Jul 23.
To observe retinal sensitivity (RS) and microvasculature changes in preoperative and postoperative idiopathic macular epiretinal membrane (iERM) with optical coherence tomography (OCT) classification by microperimetry (MP) and optical coherence tomography angiography (OCTA).
In this retrospective study, 53 eyes of 53 patients affected with iERM were enrolled and 35 iERM eyes underwent pars plana vitrectomy associated with internal limiting membrane peeling. All iERM eyes were evaluated and graded by OCT. According to the thickness of the fovea relative to the surrounding macula from OCT radial line scans, we classified iERM into 3 grades. MP was used to measure RS of macular within 20° centered on the fovea and fixation stability (FS). OCTA was used to measure the superficial and deep capillary plexus (DCP) layers using 6 mm × 6 mm scans. Measurements were taken at the baseline visit and 3-month postoperation. Evaluated factors included: best corrected visual acuity, RS, FS, vessel density.
Eyes with iERM had worse RS than control eyes (p < 0.0001), especially in higher grade iERM eyes. And higher grade iERM eyes had a marked increase foveal vessel density (FVD) (p < 0.0001) in superficial capillary plexus (SCP) and DCP, and a significant decrease parafoveal vessel density (Para VD) in DCP. After surgery, there was no difference in RS and FS than preoperation (p > 0.05), whether in grade 1 or 2 iERM eyes. However, in OCTA analyses, grade 1 iERM eyes had less whole vessel density (WVD) and perifoveal vessel density (Peri VD) in SCP, than preoperation (p < 0.05). And grade 1 iERM eyes had higher Para VD and Peri VD in DCP (p < 0.05), than preoperative OCTA results. Grade 2 iERM eyes had less WVD, FVD, and Peri VD in SCP, than preoperation (p < 0.05). After surgery, in grade 2 iERM eyes, there was a positive correlation between whole retinal sensitivity and WVD (p < 0.05) in SCP. And there were positive correlations between Para RS and Para VD (p < 0.05), Peri RS and Peri VD (p < 0.05) in SCP.
Classification helps to reveal different changes in iERM eyes. Higher grade iERM eyes had worse RS and microvasculature changes. MP and OCTA play an important role in assessing iERM and help surgical decisions for patients with iERM.
采用微视野计（MP）和光学相干断层扫描血管造影（OCTA），通过光学相干断层扫描（OCT）分类观察特发性黄斑视网膜前膜（iERM）术前和术后的视网膜敏感度（RS）及微血管变化。
在这项回顾性研究中，纳入了53例患有iERM的患者的53只眼，其中35只iERM眼接受了玻璃体切割联合内界膜剥除术。所有iERM眼均通过OCT进行评估和分级。根据OCT径向线扫描中黄斑中心凹相对于周围黄斑的厚度，将iERM分为3级。MP用于测量以黄斑中心凹为中心的20°范围内黄斑的RS和注视稳定性（FS）。OCTA用于使用6mm×6mm扫描测量浅表和深层毛细血管丛（DCP）层。在基线访视和术后3个月进行测量。评估因素包括：最佳矫正视力、RS、FS、血管密度。
iERM眼的RS比对照眼差（p<0.0001），尤其是在高级别iERM眼中。高级别iERM眼的浅表毛细血管丛（SCP）和DCP中的黄斑血管密度（FVD）显著增加（p<0.0001），而DCP中的黄斑旁血管密度（Para VD）显著降低。手术后，无论是1级还是2级iERM眼，RS和FS与术前相比均无差异（p>0.05）。然而，在OCTA分析中，1级iERM眼的SCP中的全血管密度（WVD）和黄斑周围血管密度（Peri VD）比术前减少（p<0.05）。并且1级iERM眼的DCP中的Para VD和Peri VD高于术前OCTA结果（p<0.05）。2级iERM眼的SCP中的WVD、FVD和Peri VD比术前减少（p<0.05）。手术后，在2级iERM眼中，SCP中的全视网膜敏感度与WVD之间存在正相关（p<0.05）。并且SCP中的旁中心凹RS与Para VD（p<0.05）、周边RS与Peri VD（p<0.05）之间存在正相关。
分类有助于揭示iERM眼中的不同变化。高级别iERM眼的RS和微血管变化更差。MP和OCTA在评估iERM中起重要作用，并有助于为iERM患者做出手术决策。
