Pan Ting, Bian Cunxin, Fang Yuan, Wang Jingfan, Xu Yidan, Xie Ping, Hu Zizhong
Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu Province, China.
Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
BMC Ophthalmol. 2025 Feb 11;25(1):74. doi: 10.1186/s12886-024-03832-9.
Pars plana vitrectomy (PPV) is an effective treatment of vitreoretinal diseases, while some studies reported visual field defects after surgery. The aim of this study was to evaluate the protective effects of modified vitrectomy surgical conditions on peripapillary microvasculature and retinal nerve fiber layer (RNFL) changes using optical coherence tomography angiography (OCTA).
This was a retrospectively study and the medical records of 37 patients diagnosed with iERM or iMH underwent PPV with ILM peeling were retrospectively reviewed. Patients were divided into two groups according to different surgical conditions. Peripapillary OCTA images were acquired at pre-operation, 1 week, 1 month, and 3 months post-operation. Best corrected visual acuity (BCVA) was recorded. Intraocular pressure (IOP) was measured with Goldman applanation tonometer. Fisher's exact test, the Mann-Whitney U test, t test, and repeated-measures analysis of variance (RM-ANOVA) were used to analyze our data.
The primary metrics found was the radial peripapillary capillary (RPC) small vessel density. The RPC in the protective group was significantly increased compared with the control group after surgery. At 3 months after vitrectomy, the mean and superior quadrant peripapillary RNFL thickness in the protective group was significantly higher than those in the control group. BCVA was improved in both groups at 3 months after surgery. BCVA and IOP did not differ significantly between these two groups pre- and post-operation.
Vitrectomy with ILM peeling may cause peripapillary microvascular and RNFL damage. The application of a modified surgical conditions may do some help in the recovery of peripapillary blood flow and peripapillary RNFL thickness.
玻璃体切割术（PPV）是治疗玻璃体视网膜疾病的有效方法，但一些研究报道了术后视野缺损。本研究旨在使用光学相干断层扫描血管造影（OCTA）评估改良玻璃体切割手术条件对视乳头周围微血管和视网膜神经纤维层（RNFL）变化的保护作用。
这是一项回顾性研究，对37例诊断为特发性黄斑前膜（iERM）或特发性黄斑裂孔（iMH）并接受内界膜（ILM）剥除的PPV患者的病历进行回顾性分析。根据不同手术条件将患者分为两组。在术前、术后1周、1个月和3个月采集视乳头周围OCTA图像。记录最佳矫正视力（BCVA）。使用Goldmann压平眼压计测量眼压。采用Fisher精确检验、Mann-Whitney U检验、t检验和重复测量方差分析（RM-ANOVA）对数据进行分析。
主要指标为视乳头周围放射状毛细血管（RPC）小血管密度。术后保护组的RPC较对照组显著增加。玻璃体切割术后3个月，保护组视乳头周围RNFL厚度的平均值和上象限显著高于对照组。两组术后3个月BCVA均有所改善。两组术前和术后的BCVA和眼压无显著差异。
ILM剥除的玻璃体切割术可能导致视乳头周围微血管和RNFL损伤。改良手术条件的应用可能有助于视乳头周围血流和视乳头周围RNFL厚度的恢复。
