| Objective To compare the differences of macular structure,visual function and histological features of the patients with different types of idiopathic macular epiretinal membrane,to evaluate the clinical application value of clinical classification based on OCT in preoperative visual acuity prediction,intraoperative decision and prognosis evaluation.and to analyze the appropriate surgical methods for the patients with idiopathic macular epiretinal membrane.Methods A retrospective study,50 patients with monocular idiopathic macular epiretinal membrane treated in Shanghai First People’s Hospital from July 2013 to October 2015 were analyzed,the patients were divided into two types according to OCT:(1)type 1: Cellophane maculopathy(CM);(2)type 2: macular pucker(MP).All patients were received 23 g vitrectomy,all by one surgeon,gas tamponade postoperatively.A comprehensive eye examinations were done preoperatively and during follow-up,difference of intraoperative performance,changes of macular structure and visual function of the patients before and after surgery were analyzed.The epiretinal membrane and the inner limiting membrane were histologically examed by transmission electron microscope(TEM).A prospective cohort study,45 patients with IERM were analyzed.All patients were received 23 g vitrectomy,all by one surgeon,gas tamponade postoperatively.Each patient was randomly divided into 2 groups:(1)group 1: inner limiting membrane peeling group;(2)group 2: Non inner limiting membrane peeling group.A comprehensive eye examinations were done preoperative surgery and during follow-up.To compare the changes of macular structure and visual function of patients with IERM in different types treated with different surgical methods and to analyze structure change of inner retinal region where inner limiting membrane was peeled.The Kolmogorov-Smironov test was used to test the normality and the measurement data of the normal distribution were tested by Student’s t test,or Mann-Whitney u non-parametric test,the qualitative data was tested by Pearson chi square test.The all above tests were with α= 0.05,P<0.05 was considered statistically significant.Results 50 IERM patients,type 1,23 cases,type 2,27 cases,comparative analysis of each period of patients with IERM before and after surgery,the visual acuity was significantly improved and retinal structure was significantly improved.The patients at last follow-up comparison,the Global loss volume(GLV %)of type 2 was significantly higher than type 1(respectively 16.64± 11.23,10.27 ± 7.63,P = 0.026 < 0.05),the difference was statistically significant.,the visual acuity(VA)improvement before and after surgery,VA of last follow-up,average light sensitivity of macular area in type 1 patients were significantly higher than that type 2,the difference was statistically significant.Epiretinal membrane of type 1 patients could be largely and completely peeled,usually closely adhesion with inner limiting membrane,the internal limiting membrane with ICG staining below often basically integrity,and epiretinal membrane of type 2 patients was usually difficult to peeling completely,fragile,hard to peeling clean,tight adhesion with internal limiting membrane,ICG staining inner limiting membrane below was often large deletion.The epiretinal membrane and the internal limiting membrane intraoperative were 21 cases.Internal limiting membrane specimen,in type 1,cellular fragments were rare and the collagen fibers were arranged regularly.In type 2,both retinal and vitreous interface were scattered with müller cells fragments,collagen fibers were arranged irregularly.Compared with type 2,the amount of cells and collagen fibers around the cells in type 1 were less.45 IERM patients,Type 1 patients with idiopathic macular epiretinal membrane were 21 cases,group 1,13 cases,group 2,8 cases,statistical analysis was done between the two groups preoperative and postoperative follow-up,we found that the upper and lower retinal thickness of outer ring(respectively 46.77±42.738,1.38±25.862,P=0.006.83.31±104.172,50.13±32.109,P=0.014,Unit:um)of group 1 was significantly more than the group 2,the difference was statistically significant.type 2,24 cases totally,group 1,15 cases,group 2,9 cases,the changes of the macular center and the temporal and the nasal side retinal thickness of the inner ring in group 1 were significantly higher than those in group 2 preoperative and postoperative follow-up(P<0.05).Part of patients appeared cystoid macular edema.DONFL phenomenon of inner retina with OCT enface mode appeared in part patients postoperative with vitrectomy combined with internal limiting membrane peeling,18 cases were positive,32 cases negative,the GCC thickness of positive patients decreased significantly than that of negative(respectively 92.29±17.71,79.74±11.42,P = 0.01,Unit:um),GLV% of the positive group was significantly higher than that of negative group(respectively 11.35±9.90,17.91 ±9.50,P = 0.027).Follow up time was(13.94±7.66)months.Conclusions Vitrectomy significantly improve macular structure,visual function of patients with IERM.There is a certain clinical application value of clinical classification based on OCT in preoperative visual acuity prediction,intraoperative decision and prognosis evaluation.The internal limiting membrane retention surgery may be more appropriate for patients with type 1 ERM,for patients of type 2 IERM,internal limiting membrane peeling may have some help to reduce retinal edema early,the influence to late visual function is also need further study. |
PDF Full Text Request