Zhmurin R, Grajewski L, Krause L
Department of Ophthalmology of the Municipal Hospital Dessau, Academic Teaching Hospital with University Departments of the Brandenburg Medical School Theodor Fontane, Brandenburg, Germany.
Charité-Universitätsmedizin, Berlin, Germany.
J Ophthalmol. 2022 Aug 25;2022:1895498. doi: 10.1155/2022/1895498. eCollection 2022.
The aim of this retrospective study with short, differently dispersed follow-up is to record the relationships between the pathologies of the individual foveal layers, measured by spectral domain optical coherence tomography (SD-OCT), and to investigate their influence on pre- and postoperative best-corrected decimal far visual acuity (BCVA) by phacovitrectomy for epiretinal membrane (ERM) in comorbidity with cataract. 208 eyes of 173 patients with symptomatic idiopathic ERM and moderate cataract were included.
In all OCT morphological stages of ERM, as well as in their combination with macular lamellar hole (MLH) and vitreomacular traction (VMT), a significant difference in the thickness of the individual fovea layers was found. In addition, the entire fovea thickening led to the proportional thickening of the individual fovea layers ( < 0.001). The larger the central foveolar (CFT, = -0.238, =0.002), maximum foveal (MFT, = -0.267, =0.001), and ONL thickness ( = -0.16, =0.044) were preoperatively, the worse the initial visual acuity was at all OCT stages of ERM. This was even more significant in the presence of a tractive component in the case of MLH or VMT ( < 0.001). In ERM without a traction component, only ONL thickening led to significant postoperative visual acuity reduction ( = -0.163, =0.047). The foveolar retinal thickening (CFT and MFT) of the pure ERM is directly associated with distortion of the retinal layers ( = 0.292, < 0.001 and = 0.287, < 0.001) as well as with separation of the ERM ( = 0.168, =0.034 and = 0.187, =0.018). When ERM was combined with tractive component, CFT, ONL, and INL thickness correlated (positively) with the integrity of ellipsoid zone ( = 0.342, < 0.05) and external limiting membrane ( = 0.548, < 0.001).
ONL thickening in ERM without a tractive component serves as a limited prognostic factor of postoperative visual acuity decrease. The preoperative BCVA in the groups of ERM with traction component showed significant correlation with CFT as well as with the thickness of individual foveal layers. VMT in ERM correlates with the disintegration of the ellipsoid zone.
本项回顾性研究随访时间短且分布各异，旨在记录通过光谱域光学相干断层扫描（SD - OCT）测量的各黄斑层病变之间的关系，并研究其对合并白内障的视网膜前膜（ERM）行晶状体玻璃体切除术前后最佳矫正小数远视力（BCVA）的影响。纳入了173例有症状的特发性ERM合并中度白内障患者的208只眼。
在ERM的所有OCT形态学阶段，以及它们与黄斑板层裂孔（MLH）和玻璃体黄斑牵引（VMT）的组合中，发现各黄斑层厚度存在显著差异。此外，整个黄斑增厚导致各黄斑层成比例增厚（<0.001）。术前中心凹视网膜厚度（CFT，= - 0.238，=0.002）、最大黄斑厚度（MFT，= - 0.267，=0.001）和神经节细胞层厚度（= - 0.16，=0.044）越大，在ERM的所有OCT阶段初始视力越差。在MLH或VMT存在牵引成分的情况下，这种情况更为显著（<0.001）。在无牵引成分的ERM中，仅神经节细胞层增厚导致术后视力显著下降（= - 0.163，=0.047）。单纯ERM的黄斑视网膜增厚（CFT和MFT）与视网膜层变形直接相关（=0.292，<0.001和=0.287，<0.001）以及与ERM分离相关（=0.168，=0.034和=0.187，=0.018）。当ERM合并牵引成分时，CFT、神经节细胞层和内核层厚度与椭圆体带的完整性（=0.342，<0.05）和外界膜（=0.548，<0.001）呈正相关。
无牵引成分的ERM中神经节细胞层增厚是术后视力下降的有限预后因素。有牵引成分的ERM组术前BCVA与CFT以及各黄斑层厚度显著相关。ERM中的VMT与椭圆体带的解体相关。
