| Objective:To evaluate preoperation and postoperative changes in the microstructure of the macular area and to assess contributing factors in postoperative visual improvement using swept-source optical coherence tomography(SS-OCT)and optical coherence tomography angiography(OCTA)in patients with idiopathic epiretinal membrane(i ERM)after surgery.Methods:Thirty i ERM patients(30 eyes)who were surgically treated in our hospital from May 2019 to October 2020 were selected for clinical research.All patients underwent best-corrected visual acuity,anterior segment,fundus,SS-OCT,and OCTA examinations.The TSV25 G system was used to perform vitrectomy combined with macular epidermal and internal limiting membrane exfoliation.Observation was performed before,1 week,1 month and 3 months of after surgery,patient’s best corrected visual acuity,central foveal thickness(CFT),macular retinal neuroepithelial volume,continuous ectopic inner foveal layers(CEIFL),the area of the foveal avascular zone(FAZ)of the superficial capillary plexus and the FAZ acircularity index(AI)of the superficial capillary plexus;analyze the correlation between the above indicators and BCVA before and 3 months after surgery.The measurement data are expressed by means ± standard deviation,and the counting data are expressed by frequency or rate.The measurement data at different time points are compared.When the data obeys the normal distribution and the variance is uniform,single-factor repeated measures analysis of variance is used,otherwise,the Friedman test is used.In the correlation analysis,Pearson correlation is used if the data obeys the normal distribution,and Spearman correlation is used if the data does not obey the normal distribution.P < 0.05 was considered to be statistically significant.Results:1.Comparing the difference of Log MAR BCVA at different time points before and after the operation.The results show that the difference is statistically significant(P<0.001).Further pairwise comparisons show that the visual acuity after operation is gradually improved,and the differences between the pairwise comparisons at different time points are statistically significant(P<0.05).2.Comparing the difference of CEIFL at different time points before and after the operation,the results show that the difference is statistically significant(P<0.001).Further pairwise comparisons show that the level of CEIFL gradually decreases after the operation,and the difference between the pairwise comparisons at different time points is statistically significant.(P<0.05).Preoperative CEIFL was positively correlated with Log MAR BCVA 3 months after operation,suggesting that the larger the CEIFL before operation,the worse the visual acuity in 3 months after operation.3.Comparing the difference of CFT at different time points before and after the operation,the results show that the difference is statistically significant(P<0.001).Further pairwise comparisons show that the CFT level at 1 week after operation is lower than that before operation,1 month and 3 after operation.The CFT level of 1 month after the operation is lower than that before and 1 week after the operation.The above-mentioned differences are statistically significant(P<0.05).The CFT level 3months after the operation is lower than 1 month after the operation,but the difference is not statistically significant(P>0.05).Preoperative CFT is positively correlated with Log MAR BCVA 3 months after operation,suggesting that the larger the preoperative CFT,the worse the visual acuity in 3 months after operation.4.Comparing the differences in the volume of the retinal neuroepithelial layer at different time points before and after the operation,the results showed that the difference is statistically significant(F=19.900,P<0.001).Further pairwise comparisons showed that the difference was 1 month and 3 months after the operation.The volume level of the retinal neuroepithelial layer in the macular area is lower than that before and 1 week after the operation,and the volume level of the retinal neuroepithelial layer in the macular area was lower than 1 month after the operation.The above differences are statistically significant(P <0.05).The volume level of the retinal neuroepithelial layer in the macular area at 1 week after surgery is lower than that before surgery,but the difference is not statistically significant P(>0.05).The volume of the retinal neuroepithelial layer in the macular region before surgery is positively correlated with Log MAR BCVA at 3 months after surgery,suggesting that the larger the volume of the retinal neuroepithelial layer in the macular region before surgery,the worse the visual acuity in 3 months after surgery.5.Comparing the difference of FAZ area at different time points before and after the operation,the results show that the difference is statistically significant(P<0.001).Further pairwise comparisons show that the FAZ area level at 1 month and 3 months after surgery is higher than that before and after surgery.1 week after surgery,the FAZ area level of 3 months after operation is higher than that of 1 month after operation.The above-mentioned differences are statistically significant(P<0.05).The FAZ area level of 1 week after operation is higher than before operation,but the difference is not statistical significance(P>0.05).The preoperative FAZ area is negatively correlated with the Log MAR BCVA 3 months after the operation,indicating that the larger the preoperative FAZ area,the better the visual acuity 3months after the operation.6.Comparing the difference of AI at different time points before and after the operation,the results show that the difference is statistically significant(P<0.001).Further pairwise comparisons show that the AI levels at 1week,1 month and 3 months after surgery are higher than those before surgery.The AI at 3 months after surgery is higher than that at 1 week and 1 month after surgery.The above-mentioned differences are statistically significant(P<0.05).The difference in AI at 1 week and 1 month after surgery was compared,but the difference is not statistical significance(P>0.05).Preoperative AI was negatively correlated with Log MAR BCVA at 3 months after surgery,suggesting that the greater the preoperative AI,the better the visual acuity at 3 months after surgery.Conclusions:Significant differences in Log MAR BCVA,CEIFL,CFT,the volume of the retinal neuroepithelial layer,FAZ area,and AI before and after surgery for vitrectomy combined with anterior macular membrane peeling and internal limiting membrane peeling for i ERM patients.Three months after surgery,Log MAR BCVA was positively correlated with preoperative Log MAR BCVA,CEIFL,CFT,and macular retinal neuroepithelial volume,and negatively correlated with preoperative superficial capillary plexus FAZ area and AI.The smaller the volume of CEIFL,CFT,and the retinal neuroepithelial layer in the macular region before surgery,the better the best corrected visual acuity in 3 months after surgery;the better the visual acuity before surgery,the larger the FAZ area,and the larger the AI,the best corrected visual acuity in 3 months after surgery The better.Therefore,BCVA,CEIFL,CFT,macular retinal neuroepithelial volume,FAZ area,and AI before surgery can be used as predictive indicators of postoperative visual acuity for idiopathic macular epithelium. |
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