| Objective: To observe the changes of central macular thickness(CMT),avascular area of the fovea(FAZ),retinal blood flow density,the morphological structure of the macular area and their correlation with visionin patients after surgery with idiopathic macular epiretinal membrane(IMEM)by optical coherence tomography angiography(OCTA).Methods: Prospective research.Thirty IMEM patients(30 eyes)admitted to the Ophthalmology Department of the First Affiliated Hospital of Bengbu Medical College from June 2019 to October 2020 were selected,including 13 males and 17 females,aged 56-79 years.All patients underwent 25 G vitrectomy(pars plana vitrectomy,PPV)combined with epidermal macular resection,and performed best corrected visual acuity(BCVA)and OCTA examinations 1 week,1 month,and 3months after surgery,To compare the BCVA,CMT,FAZ area,vessel density of superficial capillary plexus(SVD),vessel density of deep capillary plexus(DVD),and the morphological structure of the macular area before and after surgery.And analyze the correlation between these observation indicators.Analysis of variance was used for intra-group comparison,and Pearson correlation analysis was used for correlation analysis.Results: 1.The average BCVA(Log MAR)of the patients at 1 week after operation was 0.81±0.31,which was lower than that of 0.79±0.33 before operation.The P value was 0.104.It was 0.75±0.23 and 0.67±0.24 at 1 month and 3 months after operation,respectively.The P value was 0.153 and 0.000 respectively,and the difference was statistically significant at 3 months after the operation.52.The average CMT of the patients at 1 week,1 month and 3 months after operation was 426.37±90.58μm,373.30±57.298μm,299.27±47.28μm,which were significantly reduced compared with 493.43±107.37μm before operation.The P values were 0.014,0.004,0.004.0.007,the difference was statistically significant compared with the preoperative difference.3.The average FAZ area of patients was 0.15±0.08mm2,0.17±0.09mm2,0.18±0.08mm2 at 1 week,1 month,and 3 months after operation,which was larger than 0.13±0.06mm2 before operation,and the P value was 0.435,respectively.0.252,0.041,the difference was statistically significant at 3 months after the operation.4.The average SVD of patients was(48.72±10.51)%,(50.53±10.29)%,and(51.50±11.01)% at 1 week,1 month,and 3 months after surgery,which was larger than that before surgery(47.37±10.95)%,P values were 0.282,0.032,0.005,and the difference was statistically significant at 1 month and 3 months after surgery.5.The average DVD of patients was(36.15±8.93)%,(36.49±9.53)%,(37.73±8.02)% at 1 week,1 month,and 3 months after surgery,which was slightly higher than that of(35.32±10.70)% before surgery.Increased,but the P values were 0.301,0.514,0.197,and the differences were not statistically significant.6.Repeated-measure analysis of variance was performed on the observed indicators.The results showed that the overall differences in the areas of BCVA,CMT,FAZ and SVD in IMEM patients at 1 week,1 month,and 3 months after surgery were statistically significant,with P values of 0.028 and 0.028,respectively.0.000,0.000,0.000,there is no statistically significant difference in DVD 1 week,1month,and 3 months after operation in IMEM patients compared with the preoperative,P value is 0.217.7.Preoperative BCVA was significantly positively correlated with preoperative CMT(r=0.878,P<0.05);preoperative BCVA was significantly negatively correlated with preoperative FAZ area(r=-0.857,P<0.05);preoperative CMT and preoperative The FAZ area is negatively correlated(r=-0.956,P<0.05).There was a significant positive correlation between BCVA 3 months after operation and CMT 3 months after operation(r=0.736,P<0.05);BCVA 3 months after operation was significantly negatively correlated with FAZ area 3 months after operation(r=-0.572,P <0.05);CMT 3 months after operation was negatively correlated with FAZ area 3 months after operation(r=-0.751,P<0.05).There was a significant positive correlation between BCVA and preoperative CMT 3 months after operation(r=0.651,P<0.05);3 months after operation,BCVA was negatively correlated with preoperative FAZ area(r=-0.627,P<0.05).8.The morphology and structure of the fovea of the 30 patients with IMEM gradually recovered after the operation,and the macular edema was significantly reduced compared with before the operation.Conclusion: 1.PPV combined with anterior macular resection surgery can effectively improve the vision of IMEM patients.2.OCTA showed that CMT thinned,FAZ area increased,SVD increased,macular edema was reduced,and the morphology and structure of the macular area were significantly improved after IMEM eye with PPV combined with macular peeling.3.The larger the FAZ area of IMEM patients,the smaller the CMT and the better the vision.Changes in retinal capillaries in IMEM patients may cause changes in vision.4.When IMEM patients have clinical symptoms,surgical treatment should be performed in time,which is conducive to the recovery of postoperative vision.5.OCTA can accurately reflect the changes in the macular area of IMEM patients,and can play an important role in the non-invasive diagnosis of IMEM,the selection of the best operation timing and postoperative follow-up. |
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