Study On The Relationship Between Retinal Microstructural Changes And Visual Function After Idiopathic Epiretinal Membrane Surgery

Objectives:To observe the changes of retinal microstructure after idiopathic macular epiretinal membrane surgery,analyze the relationship between retinal microstructure and visual function,and compare and analyze the correlation between EIFL stage and various measurement parameters,so as to provide clinical reference for reasonable selection of operation time and prediction of operation effect.Methods:This study is a retrospective series of case observation study.By measuring the visual deformation assessment scale(M-chart table),macular fovea thickness(CFT),macular microstructure changes(COST line of lateral cone,missing diameter of elliptical band(EZ),thickness of ganglion cells-inner plexiform layer(GC-IPL),degree of retinal inner layer tissue disorder(DRIL),EIFL staging and other examination data to evaluate the correlation between macular microstructure changes and visual function recovery and the effect of EIFL surgery staging on visual function recovery.Twenty-six patients(26 eyes)with idiopathic epimacular membrane diagnosed in the affiliated Eye Hospital of Nanchang University from May 2022 to August 2022 were collected.There were 10 males(10 eyes)and 16 females(16 eyes).All patients underwent 23 G transconjunctival minimally invasive vitrectomy combined with anterior macular membrane and ILM removal.Intraocular pressure(IOP),BCVA and OCT were examined before and after operation.According to the results of OCT,the patients were divided into two stages,three stages and four stages.The visual distortion of the patients before and after operation was quantitatively examined by M-charts table.The related results of M-charts were recorded,M-sore values were recorded,and M-sore values,CFT,COST line,EZ deletion diameter,GC-IPL thickness and DRIL were recorded before and 1,3 and 6 months after operation.The normal distribution of parameters is expressed by X ±s,and the data of non-normal distribution is expressed by median(1,4,3,and 4 digits).SPSSStatistics25.0 statistical software is used for statistical analysis.Results:1.A total of 26 patients were included in the study,including 10 males(38%)and 16 females(62%),with an average age of(63.27±0.96)years and preoperative intraocular pressure of(13.01±2.21),including 9 patients in stage 2,14 in stage 3,and 3 in stage 4.The patients recovered well after surgery.There were no postoperative complications such as endophthalmitis,ocular hypertension,retinal detachment and proliferative vitreoretinopathy.2.BCVA(log MAR)at 1 month,3 months and 6 months after surgery were significantly improved compared with the preoperative baseline,with statistical significance(P < 0.05).3.The changes of visual deformability: the visual deformability at 1,3 and 6months after operation was significantly better than that before operation(Xray 52.26,P < 0.05),and there was significant difference at 3 and 6 months after operation(P <0.05).The difference at 6 months after operation was statistically significant compared with that at 1 month after operation(P < 0.05).The changes of visual deformation at different time points before and after operation were correlated with microstructure CFT,Cos line and GC-IPL.4.According to the EIFL staging plan,BCVA of stage 2,3 and 4 patients was significantly improved 1,3 and 6 months after surgery compared with that before surgery(P < 0.05).Pairwise comparison showed that BCVA of stage 2 patients was more significantly improved than that of stage 3 and 4 patients,and the difference was statistically significant(0.006,0.002,P < 0.05).There was no significant difference in the improvement of BCVA between stage 3 patients and stage 4 patients(0.402,P < 0.05).5.Correlation analysis between postoperative microstructure(CFT,COST line,GC-IPL,DRIL、EZ)and BCVA: The results showed that DRIL length、EZ and CFT at each time point before and after surgery were significantly correlated with BCVA recovery,with statistical significance(P < 0.05).While COST line and GC-IPL had no correlation with BCVA before and 1 month after surgery,the difference was not statistically significant,There was a significant correlation between COST line,GC-IPL and BCVA recovery at 3 and 6 months after operation,and the difference was statistically significant.(P < 0.05).Conclusion:1.The recovery of DRIL length,CFT and EZ in macular area after operation was related to the increase of BCVA,while the recovery of Cox line and GC-IPL in the later stage could further improve BCVA.The degree of retinal inner layer disorder(DRIL)can be used as a biomarker to predict the postoperative visual acuity in patients with i ERM.At the same time,the postoperative macular microstructure CFT,cost line and GC-IPL have significant influence on the improvement of visual distortion after operation.2.EIFL staging scheme can be used to evaluate the visual acuity prognosis of i ERM surgery,which is beneficial to the choice of operation time for patients.The postoperative visual acuity improvement of patients with EIFL2 stage is more significant and the prognosis is better.