Wu Yubo, Chen Yiqi, Mao Jianbo, Ye Xin, Chen Huan, Xu Zhaokai, Shen Lijun
National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325027, Zhejiang Province, China.
Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
Ophthalmol Ther. 2024 Jan;13(1):221-236. doi: 10.1007/s40123-023-00837-3. Epub 2023 Nov 9.
Inner retinal dimples (IRDs) are frequently detected after internal limiting membrane (ILM) peeling. However, the distribution of IRDs and its effect on postoperative visual function remain unclear. We aim to quantify the distribution of IRDs after ILM peeling in different macular diseases and analyze its influence on postoperative visual function.
We retrospectively reviewed patients undergoing vitrectomy with ILM peeling and followed up until 12 months in our center. The distribution of IRDs were quantitatively determined using optical coherence tomography (OCT) and OCT angiography in a different sector of Early Treatment Diabetic Retinopathy Study grid. Visual function was evaluated by retinal sensitivity (RS) using microperimetry. Spearman correlation was performed between RS and IRDs within the same sectors. Multivariate linear regression analysis was performed to analyze the association between baseline characteristics and IRDs.
A total of 43 idiopathic macular hole (iMH) cases, 56 idiopathic epiretinal membrane (iERM) cases and 42 myopic foveoschisis (mFS) cases were included. IRDs increased gradually at ILM-peeled area, interrupting ganglion cell layer. Most IRDs were observed in temporal sector. A negative correlation was depicted between the increase of IRDs and the progress of RS at both perifovea and parafovea in iERM, but only at perifovea in iMH. No significant correlation between the change of IRDs and RS was found in mFS. Multivariable linear regression model showed that preoperative axial length was significantly associated with postoperative IRDs in all patients.
IRDs distributed mostly at temporal sector after ILM peeling, interrupting ganglion cell layer. IRD progression may influence postoperative RS only in iMH and iERM. Ophthalmologists may avoid temporal sector especially in eyes with normal axial length or strong ILM-ERM adherence.
内界膜（ILM）剥除术后常可检测到视网膜内层凹陷（IRD）。然而，IRD的分布及其对术后视功能的影响尚不清楚。我们旨在量化不同黄斑疾病患者ILM剥除术后IRD的分布，并分析其对术后视功能的影响。
我们回顾性分析了在本中心接受ILM剥除玻璃体切除术并随访至12个月的患者。使用光学相干断层扫描（OCT）和OCT血管造影在糖尿病视网膜病变早期治疗研究网格的不同区域定量测定IRD的分布。使用微视野计通过视网膜敏感度（RS）评估视功能。在同一区域内对RS和IRD进行Spearman相关性分析。进行多变量线性回归分析以分析基线特征与IRD之间的关联。
共纳入43例特发性黄斑裂孔（iMH）患者、56例特发性视网膜前膜（iERM）患者和42例近视性黄斑劈裂（mFS）患者。在ILM剥除区域IRD逐渐增加，中断神经节细胞层。大多数IRD出现在颞侧区域。在iERM中，IRD的增加与中心凹周围和旁中心凹处RS的进展呈负相关，但仅在iMH的中心凹周围呈负相关。在mFS中未发现IRD变化与RS之间存在显著相关性。多变量线性回归模型显示，术前眼轴长度与所有患者术后的IRD显著相关。
ILM剥除术后IRD大多分布在颞侧区域，中断神经节细胞层。IRD进展可能仅在iMH和iERM中影响术后RS。眼科医生应避免在颞侧区域进行操作，尤其是眼轴长度正常或ILM与ERM粘连紧密的眼睛。
