Analysis Of Prognostic Factors Of Postoperative Visual Acuity And Evaluation Of Prognosis In Patients With Idiopathic Epiretinal Membrane:A Clinical Study

Part 1.Analysis of prognostic factors of postoperative visual acuity and evaluation of prognosis in patients with idiopathic epiretinal membranePurpose:To analyze the influence of preoperative factors affecting postoperative visual acuity and evaluation of prognosis in patients with idiopathic epiretinal membrane.Methods:This retrospective study reviewed 47 patients(47 eyes)who underwent a standard,3-port 23-gauge pars plana vitrectomy with internal limiting membrane peeling combined phacoemulsification and intraocular lens implantation between January 2015 and January 2019 in the Subei hospital,with a minimum follow-up of 6 months.Preoperative and postoperative spectral-domain optical coherence tomography scans were qualitatively and quantitatively evaluated.Best-corrected visual acuity(BCVA),central foveal thickness(CFT),ellipsoid zone disruption grading,ectopic inner foveal layer(EIFL)staging scheme,EIFL thickness and outer nuclear layer(ONL)thickness were observed before and after the operation.The patients were divided into two groups based on postoperative BCVA(BCVA≥0.5 and BCVA<0.5)at 6 months after surgery,and analysis of the preoperative factors associated with postoperative visual recovery.Referring to Kauffmann’s scoring method and to introduce a predictive score.Further,the receiver operating characteristic(ROC)curve was calculated to estimate the prediction efficiency of the predictive score.Results:(1)Surgical results:Postoperative BCVA was obviously improved,the CFT and EIFLthickness after operation were significantly lower than before surgery(P<0.001);Data for ellipsoid zone disruption grading and ONL thickness,which exhibits the statistical difference between before and after surgery(P=0.02,0.029).(2)Univariate analysis:Data for preoperative factors:duration of symptoms,preoperative BCVA,EZ disruption grading and EIFL staging scheme,which exhibit the statistical difference between two groups(P=0.01,0.01,0.001,0.009);Data for age,sex,ONL thickness,CFT,EIFL thickness,which exhibit no statistical difference between two groups(P=0.82.0.54,0.57,0.22,0.23).(3)Correlation analysis:preoperative BCVA was positively correlated with postoperative BCVA and 6-month BCVA gain(r=0.563,P<0.01:1;r=0.342,P=0.004).With the extension of the course of disease,the postoperative BCVA gradually decreased(r=0.545,P<0.001),there was no significant correlation between the course of disease and 6-month BCVA gain(P=0.99).(4)Multifactor analysis:duration of symptoms,preoperative BCVA,EZ disruption grading were closely related to postoperative visual recovery(P<0.05).(5)Predictive score:Area under the ROC curve of the 10-point predictive score for IERM patients is 0.843,SE=0.098,P=0.019,95%CI(0.651,1).Conclusions:(1)Combined cataract and idiopathic ERM surgery provides very good and sustainable visual results.(2)Duration of symptoms,preoperative BCVA and EZ disruption grading were associated with full visual recovery 6 months after surgery.(3)The predictive score is a reliable and practical method for selecting surgical timing and assessing prognosis.Part 2.Assessment of outcomes of idiopathic epiretinal membrane based on preoperative classification of the epiretinal membranePurpose:To classify the idiopathic epiretinal membrane on the basis of OCT and its application value in predicting visual acuity of patients after surgeryMethods:This retrospective study reviewed 66 patients(66 eyes)who underwent a standard.3-port 23-gauge pars plana vitrectomy with internal limiting membrane peeling combined phacoemulsification and intraocular lens implantation between January 2015 and June 2019 in the Subei hospital,with a minimum follow-up of 6 months.The patients were divided into three groups based on the preoperative EIFL staging scheme.We observed the BCVA,EIFL thickness,ONL thickness,and CFT before and after the operation.Results:Based on the EIFL staging scheme,7(11%)eyes were diagnosed as stage 2 ERM,45(68%)as stage 3 ERM,and 14(21%)as stage 4 ERM preoperatively.The BCVA of patients in all EIFL ERM stages increased at 6 months after surgery.There was no statistical difference in BCVA before and after surgery in the stage 2 ERM(P=0.426),and the difference in BCVA before and after surgery in stage 3 and stage 4 ERM was statistically significant(P<0.05).The final BCVA significantly improved in all EIFL ERM stages(P<0.05).However,earlier stages were associated with better visual outcomes both preoperatively and postoperatively(stage 2>stage 3>stage 4,P<0.001).Final best-corrected visual acuity 0.5 was reached in 71%of eyes with stage 2,52%with stage 3,and 0%with stage 4.There was no statistical difference in BCVA gain after surgery in all EIFL ERM stages(P>0.05).After the operation,CFT decreased in all EIFL ERM stages,and there was a statistical difference in CFT in stage 3 and stage 4 ERM before and after the operation(P<0.01).There was no statistical difference in CFT in stage 2 ERM before and after the operation(P=0.127).There was no statistical difference in the degree of decrease of CFT in all EIFL ERM stages after the operation(P>0.05).Conclusions:The EIFL staging scheme is an easy,fast,and reproducible method to evaluate visual outcomes with ERM surgery.Surgery on stage 2 ERM results in significantly better visual outcomes and a greater chance of reversibility in anatomical changes.