Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ophthalmol Retina. 2022 Apr;6(4):308-317. doi: 10.1016/j.oret.2021.10.008. Epub 2021 Oct 27.
To investigate OCT-based biomarkers of visual acuity (VA) in eyes with idiopathic epiretinal membranes (ERMs) undergoing surgical intervention.
To assess the surgical outcomes of pars plana vitrectomy (PPV) and membrane peel (MP) surgery in eyes with idiopathic ERM and to identify potential imaging-based biomarkers of vision outcomes.
Retrospective, consecutive case series of eyes with idiopathic ERM that underwent PPV and MP surgery between January 1, 2017, and January 1, 2019. A previously described ERM grading scale was utilized for OCT analysis. The primary outcome was VA at postoperative month 6 and at final follow-up. The secondary outcome was the association of OCT structural features, including ectopic inner foveal layers (EIFLs), inner microcystoid changes, and ellipsoid zone (EZ) disruption, with VA outcomes.
A total of 322 eyes with idiopathic ERM were included. The mean (± standard deviation) follow-up was 506.6 ± 324.6 days after MP surgery. VA improved from logarithm of the minimal angle of resolution value of 0.49 ± 0.27 (Snellen 20/61) before MP surgery to 0.41 ± 0.30 (Snellen 20/51, P < 0.001) at 6 months after MP surgery and to 0.31 ± 0.29 (Snellen 20/41, P < 0.001) at the final follow-up. A total of 21 (6.5%) eyes were graded as stage 1, 38 (11.8%) as stage 2, 188 (58.4%) as stage 3, and 75 (23.3%) as stage 4, with higher ERM stages associated with worse pre-MP VA (P < 0.001). The presence of inner microcystoid changes was associated with worse pre-MP VA (P = 0.04). Stage 4 ERM characteristics (P = 0.03), the presence of EZ disruption (P = 0.01) at month 3, and the presence of inner microcystoid changes at month 3 (P = 0.02) were associated with worse VA at 6 months. The presence of EIFL was not associated with the 6-month or final VA on multivariate analysis. When analyzed within defined age groups, patients older than 80 years had worse final VA (P = 0.02) and were more likely to have inner microcystoid changes on OCT (P = 0.01).
VA improvement was noted after surgery in eyes with idiopathic ERM across all stages. Preoperative stage 4 characteristics were associated with worse VA at 6 months. Postoperative inner microcystoid changes and EZ disruption at month 3 were additional OCT biomarkers associated with worse 6-month and final VA outcomes.
探讨特发性视网膜内界膜（ERM）患者手术前后光学相干断层扫描（OCT）相关的视力（VA）生物标志物。
评估特发性 ERM 患者行玻璃体切除术联合内界膜剥除术（PPV+MP）的手术效果，并寻找潜在的与视力结果相关的影像学生物标志物。
回顾性连续病例系列研究，纳入 2017 年 1 月 1 日至 2019 年 1 月 1 日期间接受 PPV+MP 手术的特发性 ERM 患者。采用先前描述的 ERM 分级量表进行 OCT 分析。主要结局是术后 6 个月和最终随访时的 VA。次要结局是 OCT 结构特征（包括异位内凹层、内微囊样改变和椭圆体带（EZ）中断）与 VA 结局的相关性。
共纳入 322 只特发性 ERM 眼。MP 手术后的平均（±标准差）随访时间为 506.6±324.6 天。VA 从 MP 术前的最小分辨角对数视力值 0.49±0.27（Snellen 20/61）提高到术后 6 个月的 0.41±0.30（Snellen 20/51，P<0.001），最终随访时提高到 0.31±0.29（Snellen 20/41，P<0.001）。21 只眼（6.5%）为 1 期，38 只眼（11.8%）为 2 期，188 只眼（58.4%）为 3 期，75 只眼（23.3%）为 4 期，ERM 分期越高，术前 VA 越差（P<0.001）。术前存在内微囊样改变与 VA 差相关（P=0.04）。4 期 ERM 特征（P=0.03）、术后 3 个月 EZ 中断（P=0.01）和术后 3 个月内微囊样改变（P=0.02）与术后 6 个月的 VA 差相关。多变量分析显示，存在异位内凹层与 6 个月或最终 VA 无关。在按年龄分组分析时，年龄大于 80 岁的患者最终 VA 更差（P=0.02），且 OCT 上更易出现内微囊样改变（P=0.01）。
特发性 ERM 患者手术前后 VA 均有改善，各期均如此。术前 4 期特征与术后 6 个月 VA 差相关。术后 3 个月时出现的内微囊样改变和 EZ 中断是与 6 个月和最终 VA 结果相关的另外两个 OCT 生物标志物。
