Li Juan, Cheng Fangyuan, Li Zhaohui, Wang Liang
Department of Ophthalmology，Wuhu Eye Hospital, Wuhu, Anhui, China.
BMC Ophthalmol. 2025 Jan 30;25(1):54. doi: 10.1186/s12886-025-03889-0.
To evaluate the associations between anatomical changes and visual outcomes after membrane peeling in eyes with different stages of idiopathic epiretinal membrane (iERM) using optical coherence tomography angiography (OCTA).
All iERM eyes were graded into four stages based on the presence of ectopic inner foveal layers (EIFL) and underwent 23-gauge vitrectomy combined with ERM and internal limiting membrane (ILM) peeling, while their fellow eyes were treated as the control group. OCTA was used to measure retinal thickness(RT), foveal avascular zone (FAZ)-related parameters and superficial and deep capillary plexus (SCP and DCP) layers using 6 × 6 mm scans before, 1 month and 3 months after surgery. In addition, best corrected visual acuity (BCVA), metamorphopsia and macular features were assessed.
Forty-six subjects were included in this study. In comparison to the preoperative data, visual acuity and metamorphopsia improvement was statistically significant in four stages(P < 0.05) and the higher stage (3 and 4) achieved more pronounced improvements (P = 0.002). For higher stage, RT reduced with an increase in stage(P < 0.001), superficial and deep foveal vessel density (SFVD and DFVD) and parafoveal vessel density (PRVD) in SCP declined remarkably, FAZ area was enlarged obviously, FAZ perimeter (PERIM), foveal vessel density (FD) and PRVD in DCP increased significantly after surgery (P < 0.05). Similar to high-stage patients, those with stage 2 iERMs demonstrated a decreasing trend in central macular thickness (CMT), paraRT (parafoveal thickness), SFVD, and DFVD(P < 0.05). Nevertheless, no notable alterations were observed in other indicators. Distinct from other groups, only CMT and FD increased slightly in stage 1 iERMs (P < 0.05). Post-LogMAR BCVA and LogMAR BCVA-d (pre-LogMAR BCVA -3-month post-LogMAR BCVA) were positively correlated with preoperative stages, CMT, pre-LogMAR BCVA, SFVD, and vascular tortuosity(P < 0.05). but negatively correlated with FAZ area and DFVD (P < 0.05). Preoperative and postoperative metamorphopsia had a certain positive correlation with preoperative CMT (P < 0.05).
According to OCTA analysis, different EIFL stages of iERMs showed significantly functional and anatomic differences before and after membrane peeling. Low-stage patients have better post-op visual function, while high-stage patients benefit more from surgery. It also demonstrated EIFL staging system contribute doctors to manage iERMs.
使用光学相干断层扫描血管造影（OCTA）评估不同阶段特发性视网膜前膜（iERM）患者行膜剥除术后解剖结构变化与视觉效果之间的关联。
根据异位性中心凹内层（EIFL）的存在情况，将所有iERM患眼分为四个阶段，并接受23G玻璃体切除术联合视网膜前膜和内界膜（ILM）剥除术，而对侧眼作为对照组。使用OCTA在手术前、术后1个月和3个月进行6×6mm扫描，测量视网膜厚度（RT）、中心凹无血管区（FAZ）相关参数以及浅表和深层毛细血管丛（SCP和DCP）层。此外，评估最佳矫正视力（BCVA）、视物变形和黄斑特征。
本研究纳入了46名受试者。与术前数据相比，四个阶段的视力和视物变形改善均具有统计学意义（P<0.05），且较高阶段（3期和4期）的改善更为显著（P=0.002）。对于较高阶段，RT随着分期增加而降低（P<0.001），SCP中浅表和深层中心凹血管密度（SFVD和DFVD）以及中心凹旁血管密度（PRVD）显著下降，FAZ面积明显增大，手术后DCP中的FAZ周长（PERIM）、中心凹血管密度（FD）和PRVD显著增加（P<0.05）。与高分期患者相似，2期iERM患者的中心黄斑厚度（CMT）、旁中心凹视网膜厚度（parafoveal thickness，paraRT）、SFVD和DFVD也呈下降趋势（P<0.05）。然而，其他指标未见明显变化。与其他组不同，1期iERM患者仅CMT和FD略有增加（P<0.05）。术后对数最小分辨角视力（LogMAR BCVA）和LogMAR BCVA差值（术前LogMAR BCVA - 术后3个月LogMAR BCVA）与术前分期、CMT、术前LogMAR BCVA、SFVD和血管迂曲度呈正相关（P<0.05），但与FAZ面积和DFVD呈负相关（P<0.05）。术前和术后的视物变形与术前CMT呈一定正相关（P<0.05）。
根据OCTA分析，不同EIFL分期的iERM在行膜剥除术前、后显示出明显的功能和解剖差异。低分期患者术后视觉功能较好，而高分期患者从手术中获益更多。这也表明EIFL分期系统有助于医生管理iERM。
