Yanık Özge, Aydın Ellialtıoğlu Pınar, Demirel Sibel, Batıoğlu Figen, Özmert Emin
Department of Ophthalmology, Ankara University School of Medicine, 06620 Ankara, Turkey.
Diagnostics (Basel). 2023 Feb 20;13(4):797. doi: 10.3390/diagnostics13040797.
Idiopathic epiretinal membrane (iERM) surgery is one of the most commonly performed vitreoretinal surgeries, and the issue of internal limiting membrane (ILM) peeling in ERM surgery is still controversial. The aims of this study are to evaluate the changes in retinal vascular tortuosity index (RVTI) after pars plana vitrectomy for the iERM using optical coherence tomography angiography (OCTA) and to assess whether ILM peeling has an additional effect on RVTI reduction.
This study included25 eyes of 25 iERM patients who underwent ERM surgery. The ERM was removed without ILM peeling in 10 eyes (40.0%), and the ILM was peeled in addition to the ERM in 15 eyes (60.0%). The existence of the ILM after ERM peeling was checked with second staining in all eyes. Best corrected visual acuity (BCVA) and 6 × 6 mm en-face OCTA images were recorded before surgery and at the first month postoperatively. A skeleton model of the retinal vascular structure was created following Otsu binarization of en-face OCTA images using ImageJ software (1.52U). RVTI was calculated as the ratio of each vessel length to its Euclidean distance on the skeleton model using the Analyze Skeleton plug-in.
The mean RVTI declined from 1.220 ± 0.017 to 1.201 ± 0.020 ( = 0.036) in eyes with ILM peeling and from 1.230 ± 0.038 to 1.195 ± 0.024 in eyes without ILM peeling ( = 0.037). There was no difference between the groups in terms of postoperative RVTI ( = 0.494). A statistically significant correlation was found between postoperative RVTI and postoperative BCVA (rho = 0.408, = 0.043).
The RVTI is an indirect indicator of the traction created by the iERM on retinal microvascular structures, and it was effectively reduced after iERM surgery. The postoperative RVTIs were similar in cases who underwent iERM surgery with or without ILM peeling. Therefore, ILM peeling may not have an additive effect on the loosening of microvascular traction and thus may be reserved for recurrent ERM surgeries.
特发性视网膜前膜（iERM）手术是最常开展的玻璃体视网膜手术之一，而ERM手术中内界膜（ILM）剥除问题仍存在争议。本研究旨在使用光学相干断层扫描血管造影（OCTA）评估iERM行玻璃体切割术后视网膜血管迂曲指数（RVTI）的变化，并评估ILM剥除对RVTI降低是否有额外作用。
本研究纳入25例接受ERM手术的iERM患者的25只眼。10只眼（40.0%）在不剥除ILM的情况下切除ERM，15只眼（60.0%）在切除ERM的同时剥除ILM。所有眼均通过二次染色检查ERM剥除后ILM的存在情况。术前及术后第1个月记录最佳矫正视力（BCVA）和6×6mm的OCTA正面图像。使用ImageJ软件（1.52U）对OCTA正面图像进行大津法二值化处理后创建视网膜血管结构的骨架模型。使用“分析骨架”插件计算骨架模型上每条血管长度与其欧几里得距离的比值作为RVTI。
剥除ILM的眼中，平均RVTI从1.220±0.017降至1.201±0.020（P = 0.036）；未剥除ILM的眼中，平均RVTI从1.230±0.038降至1.195±0.024（P = 0.037）。两组术后RVTI无差异（P = 0.494）。术后RVTI与术后BCVA之间存在显著的统计学相关性（rho = 0.408，P = 0.043）。
RVTI是iERM对视网膜微血管结构产生牵引力的间接指标，iERM手术后其有效降低。iERM手术中有无剥除ILM的病例术后RVTI相似。因此，ILM剥除可能对微血管牵引力的松解无额外作用，可保留用于复发性ERM手术。
