| Part1.Comparison of microstructure and prognosis of macular area between idiopathic and diabetic macular epiretinal membranePurpose:To compare the macular microstructures between idiopathic macular epiretinal membranes(iERM)and diabetic macular epiretinal membranes(dERM)at the baseline and the distinction before and after pars plana vitrectomy(PPV),and to evaluate the surgical prognosis of the two macular epiretinal membranes(ERM)types.Methods:This retrospective study reviewed 46 patients(46 eyes)who underwent PPV with ERM and internal limiting membrane(ILM)peeling of iERM and dERM between September 2019 and July 2020 in Subei People’s Hospital.Among them,the iERM group had 26 cases(26 eyes)and the dERM group had 20 cases(20 eyes).Best corrected visual acuity(BCVA),central macular thickness(CMT),ectopic inner foveal layers(EIFL)grade,EIFL status,EIFL thickness,ellipsoid zone(EZ)grade,photoreceptor outer segment(PROS)length,and intraretinal cysts(IC)status were observed before and after surgery.The macular microstructures of the iERM group and the dERM group at baseline,the changes of BCVA and macular microstructures of the two groups before and after surgery,and the prognosis of the two groups were compared.Results:(1)Baseline:The preoperative LogMAR BCVA of the iERM group was 0.52(0.30,0.92),which was better than that of the dERM group 0.70(0.52,0.96),but the difference was not statistically significant(U=182.00,P=0.081).The preoperative CMT in the iERM group was higher than that in the dERM group,the difference was statistically significant(t=0.284,P=0.012).The preoperative PROS length of the iERM group was longer than that of the dERM group,and the difference was statistically significant(t=2.806,P=0.009).Two groups of preoperative ERM EIFL grade difference were statistically significant(t=1 53.00,P=0.012),characterized by the iERM group appeared more EIFL cases than the dERM group,and the difference was statistically significant(χ2=6.470,P=0.011).(2)The iERM group:BCVA in the iERM group was significantly improved after surgery compared with that before surgery,the difference was statistically significant(Z=-3.187,P=0.001).CMT after surgery was significantly lower than that before surgery,and the difference was statistically significant(t=6.259,P<0.001).Postoperative macular area tended to return to normal,postoperative EIFL classification compared with preoperative difference was statistically significant(U=144.00,P=0.001),the postoperative appear EIFL eye number reduced significantly(χ2=5.200,P=0.023).The thickness of EIFL after surgery was significantly lower than that before surgery,and the difference was statistically significant(U=67.00,P=0.040).(3)The dERM group:BCVA in the dERM group improved significantly after surgery compared with that before surgery,the difference was statistically significant(χ2=-2.963,P=0.003).CMT after surgery was lower than that before surgery,and the difference was statistically significant(t=4.235,P<0.001).The morphology of macular area after the operation tended to return to normal,and the difference of EIFL grade after the surgery was statistically significant(U=116.00,P=0.023).Postoperative eyes with EIFL reduced,but there was no statistically significant difference(χ2=1.905,P=0.168).(4)Prognosis comparison:BCVA in the iERM group was better than that in the dERM group after surgery,the difference was statistically significant(U=136.50,P=0.006).Postoperative EZ integrity grade between the two groups showed statistically significant difference(U=171.00,P=0.031).The decrease of CMT in the iERM group was greater than that in the dERM group,and the difference was statistically significant(U=157.00,P=0.022).Conclusion:(1)Both the iERM and the dERM caused different degrees of damage to the microstructure of macular area,but the dERM was more prone to visual impairment.(2).PPV combined with ERM and ILM peeling can improve the visual acuity of the iERM and the dERM patients,CMT and EIFL grading can also be significantly improved,but the early changes of the outer microstructure of macular area are not obvious.(3)After PPV combined with ERM and ILM peeling,the visual acuity of the iERM affected eyes was better than that of the dERM,the decrease of CMT was greater than that of the dERM,and the integrity of EZ in macular area was restored faster.Part2.Comparison of microcirculation in macular area of idiopathic and diabetic macular epiretinal membranePurpose:The study used optical coherence tomography angiography(OCTA)to observe the microcirculation in macular area of iERM,dERM and normal controls and macular microcirculation before and after the operation.And to evaluate the operative prognosis of the two types of ERM.Methods:This retrospective study reviewed 24 patients(24 eyes)who underwent PPV with ERM and internal limiting membrane(ILM)peeling of iERM and dERM between April 2020 and July 2020 in Subei People’s Hospital.Among them,the iERM group had 12 cases(12 eyes)and the dERM group had 12 cases(12 eyes).At the same time,16 contralateral healthy eyes of iERM patients treated in the Department of Ophthalmology of Subei People’s Hospital from September 2019 to July 2020 who underwent PPV combined with ERM and ILM peeling were collected as normal control group.The macular microcirculation status of iERM,dERM and the control group at baseline was investigated,including BCVA,the foveal avascular zone(FAZ)area,and the macular vascular density(MVD).The changes of BCVA and macular microcirculation in the two groups before and after operation were observed and the prognosis of the two groups was compared.Results:(1)Baseline:LogMAR BCVA in the iERM group was higher than that in control group,and the difference was statistically significant(P<0.001).The dERM group was also significantly higher than control group(P<0.001).The iERM group was lower than dERM group,but the difference was not statistically significant(P=1.000).The area of FAZ in the iERM group was smaller than that in control group,and the difference was statistically significant(P<0.001).The dERM group was also significantly smaller than the control group(P=0.020).The iERM group was smaller than the dERM group,but the difference was not statistically significant(P=0.536).The superficial macular vascular density(SVD)of the iERM group was lower than that of the control group,and the difference was not statistically significant(P=1.000).The dERM group was also lower than control group,but the difference was not statistically significant(P=0.570).The whole SVD of the iERM group was higher than that of the dERM group,but the difference was not statistically significant(P=0.105).The deep macular vascular density(DVD)in the iERM group was significantly lower than that in the control group(P<0.001).The dERM group was significantly lower than the control group(P=0.008).The iERM group was lower than the dERM group,but the difference was not statistically significant(P=0.448).The foveal SVD of the iERM group was higher than that of control group,and the difference was statistically significant(P<0.001).The dERM group was higher than the control group,but the difference was not statistically significant(P=0.166).The foveal SVD of the iERM group was significantly higher than that of the dERM group(P=0.007).The foveal DVD of the iERM group was higher than that of control group,and the difference was statistically significant(P=0.008).The dERM group was higher than the control group,but the difference was not statistically significant(P=0.402).The iERM group was higher than the dERM group,but the difference was not statistically significant(P=0.359).The SVD of parafovea in the iERM group was lower than that in control group,and the difference was not statistically significant(P=0.251).The dERM group was significantly lower than the control group(P=0.014).The iERM group was higher than the dERM group,but the difference was not statistically significant(P=0.760).Parafoveal DVD in the iERM group was lower than that in control group,and the difference was statistically significant(P<0.001).The dERM group was significantly lower than the control group(P=0.009).The iERM group was lower than the dERM group,but the difference was not statistically significant(P=0.913).(2)The iERM group:The area of FAZ after surgery was larger than that before surgery,but the difference was not statistically significant(Z=-1.334,P=0.182).The whole SVD after surgery was lower than that before surgery,but the difference was not statistically significant(t=1.431,P=0.180).The whole postoperative DVD was significantly higher than that before surgery(t=-4.216,P=0.001).Postoperative parafoveal DVD was significantly higher than that before(t=-2.682,P=0.021).(3)The dERM group:The area of FAZ after surgery increased,but the difference was not statistically significant(Z=-1.790,P=0.388).The whole SVD after surgery was higher than that before surgery,but the difference was not statistically significant(t=-0.573,P=0.578).The postoperative whole DVD was higher than that before surgery,but the difference was not statistically significant(t=-1.030,P=0.325).(4)Prognosis comparison:The FAZ area of the iERM group was smaller than that of the dERM group,but the difference was not statistically significant(U=45.000,P=0.128).Postoperative SVD in the iERM group was lower than that in the dERM group,but the difference was not statistically significant(t=-0.578,P=0.569).There was no significant difference in the whole postoperative DVD between the iERM group and the dERM group(t=0.285,P=0.778).Conclusion:(1)Both iERM and dERM can damage the microcirculation of macular area to varying degrees,resulting in decreased FAZ area,increased foveal blood flow density,and decreased parafoveal blood flow density.(2)PPV combined with ERM and ILM peeling can improve postoperative DVD of iERM patients,but the improvement of FAZ area and SVD is not significant;(3)PPV combined with ERM and ILM peeling did not significantly improve the postoperative FAZ area and MVD in patients with dERM.Part3.Histopathological comparison between the internal limiting membrane of the idiopathic and diabetic macular epiretinal membranePurpose:To compare the histological morphology of ILM specimens removed from the eyes of iERM and dERM patients during operation and to explore the pathogenesis of the two diseases.Methods:A total of 8 cases(8 eyes)of iERM and dERM patients treated in the Department of Ophthalmology of Subei People’s Hospital from September 2019 to September 2020 were collected in the research.Among them,5 cases(5 eyes)were in the iERM group and 3 cases(3 eyes)were in the dERM group.Hematoxylin-eosin staining(HE)and immuno-histochemical staining were performed for intraoperatively removed ILM specimens,including CD68,glial fibrillary acidic protein(GFAP),and alpha smooth muscle actin(a-SMA)staining.Results:After HE staining,the ILM specimens of 5 patients with iERM showed uniform red staining membrane structure,which was multilayer wavy.One side of ILM was smooth,the other side was rough,and a few cells were scattered on it.After HE staining,3 cases of dERM patients showed a small amount of broken red stained membranous structures,closely adhered to a large number of hyalinocytes,and a small number of cells were scattered on ILM.GFAP expression was positive in all specimens,including the iERM group(5 eyes,100.00%)and the dERM group(3 eyes,100.00%).The iERM group(1 eye,20.00%)and the dERM group(3 eyes,100.00%)expressed a positive CD68.α-SMA expression was positive in the iERM group(3 eyes,75.00%),and in the dERM group(3 eyes,100.00%).One case in the iERM group was not stained for α-SMA because the sample size was too small.Conclusion:(1)The number and type of cells in ILM tissue of the iERM patients were less than that of th dERM patients.(2)The existence of glial cells and myofibroblasts could be observed in the ILM tissues of both iERM and dERM patients,and the existence of macrophages could be observed in the ILM tissues of dERM patients. |
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