Analysis Of Related Factors Affecting Postoperative Visual Acuity In Patients With Different Morphous Of Idiopathic Macular Epiretinal Membranes

Objective:The purpose of this study is Based on the preoperative and postoperative best corrected visual acuity ? the OCT morphous ? central macular thickness ? the photoreceptor inner segment/outer segment connection state to elucidate the factors affecting visual acuity after idiopathic macular epiretinal membrane surgery.Method:Retrospective analysis of 38 cases(38eyes)who were diagnosed Idiopathic macular epiretinal membrane in our hospital from January 2012 to march 2016,All the patients underwent pars plana vitrectomy with epimacular membrane removal.Best-corrected visual acuity(BCVA),OCT morphou,CMT and IS/OS were assessed before and at 1,3 and 6months after surgery.Thirty-eight eyes of 38 patients were divided into four groups based on morphologic differences in epiretinal membrane on OCT: 22 cases in diffuse,6 in cystoid macular edema,4 in pseudolamellar hole,and 6 in vitreomacular.Result:1.There was no significant differences in age,sex,the duration from onset and preoperative IS/OS status among the 4 groups(P>0.05).2.the BCVA:There was a significant difference in preoperative BCVA among four groups(P=0.008).Preoperative visual acuity was best in the PLH type,followed by the DIF,CME,and VMT.Post-operative visual acuity improved greatly in all three types except for PLH(DIF: p <0.001,CME: p = 0.027,VMT: p = 0.027 PLH=0.180).No significant differences in BCVA were observed in all four groups at 6 months after surgery(P = 0.305).3.IS / OS connection status:There was no significant difference in IS / OS status among the four groups preoperative and 1 month after operation(P> 0.05),There was a significant difference among the four groups at 3 months and 6 months after surgery(P <0.05).The Preoperative IS / OS connection status was associated with postoperative BCVA(P = 0.010),Preoperative IS / OS integrity was better for postoperative visual acuity than IS / OS damage.BCVA correlated with IS / OS connection status at 6 months(P <0.001),The visual acuity of IS / OS integrity was better than that of IS / OS damage at 6 months postoperative.4.The CMT;Significant difference was observed among the four groups in CMT(P = 0.035),the thickness of PLH was significantly smaller than that of other types.Compared with the preoperative,the CMT in the four groups was significantly decreased at 1,3 and 6 months after operation(P <0.001).BCVA was associated with Preoperative CMT(p = 0.009),The higher the CMT was,the worse BCVA was.Preoperative CMT was associated with BCVA at 6 months postoperatively(P = 0.012).There was a positive correlation between CMT change and BCVA change(P = 0.032),The more changes of CMT after operation the more obvious the improvement of BCVA.There was no significant correlation between postoperative BCVA and CMT(p = 0.135).5.Macular mophous :Postoperative macular contour were classified into the following 4 types: DIF type,CME type,PLH type,normal type.there was a significant relationship between pre-and postoperative macular contour(P = 0.003),The preoperative DIF-type membranes had a tendency to have a DIF-type appearance postoperatively,VMT type showed normal contour.6.The CE/IOL:There was no significant difference in BCVA changes and CMT changes whether cataract extraction was performed or not(p>0.05)7.The Recurrence :There were 1 cases of DIF and 2 cases of CME with the recurrence.No recurrence was observed in PLH and VMT.Conclusion:1.Postoperative visual acuity in Idiopathic macular epiretinal membranes patients can be improved by Primary pars plana vitrectomy with membrane peeling2.Preoperative visual acuity was best in the PLH type,followed by the DIF,CME,and VMT types in that order.3.Post-operative visual acuity improved greatly in all three types except for PLH4.Preoperative CRT,IS / OS connection status and CTR changes were important factors affecting the visual acuity after Idiopathic macular epiretinal membranes Surgery5.Macular contour of preoperative may help to predict postoperative macular contour.The preoperative DIF-type membranes had a tendency to have a DIF-type appearance postoperatively,VMT type showed normal contour at 6 month after.