| Background and Purpose:Epiretinal membrane(ERM)is an avascular and cell proliferative membrane caused by the hyperplasia of the retina at the macular area.The pathological factors of ERM are various.According to pathological factors,ERM is classified as idiopathic epiretinal membrane and secondary epiretinal membrane.The main clinical manifestations of idiopathic macular epiretinal membrane include decreased visual acuity and dysmorphopisa.These symptoms affect the life quality of patients with idiopathic macular epiretinal membrane seriously.At present,vitrectomy is the only therapeutic measure for macular epiretinal membrane.However,there are many problems about the treatment of macular epiretinal membrane,including how to choose the time of surgery,why the macular structure cannot be returned to normal after operation and which preoperative factors affect the recovery of visual acuity after operation.Furthermore,whether there are more measures to improve the structure and function of macular remains unclear.This study aims to determine the factors influencing macular structure and visual function recovery and to evaluate the relationship between the changes of macular structure and the prognosis of visual function through reviewing the relationship between macular retinal structure and visual function change of the patients with idiopathic macular epiretinal membrane.On the other hand,we performed a randomized,double-blind and controlled study to observe the efficacy and safety of vitrectomy combined with anti-VEGF administration in the treatment of idiopathic macular epiretinal membrane,which provides an evidence for exploring more effective treatmentsMethods:The study is composed of two parts.First part is a retrospective analysis.We collected the preoperative and postoperative best corrected visual acuity as well as central foveal thickness of the patients that underwent vitrectomy on their idiopathic macular epiretinal membrane from January 2013 to December 2014 in our hospital.The correlation among best corrected visual acuity,central foveal thickness and average thickness of macular was analyzed.The patients were divided into two groups according to the defect of the Ellipsoid Zone.The length of Ellipsoid Zone defect was measured,and the differences of best corrected visual acuity,central foveal thickness and average thickness of macular between the two groups were compared.Second part is a prospective randomized double-blind trial.The patients diagnosed as idiopathic macular epiretinal membrane in our hospital were divided into two groups.The treatment group underwent vitrectomy combined with the intravitreal injection of anti-VEGF.The control group underwent vitrectomy to remove idiopathic epiretinal membrane.The change of best corrected visual acuity and central foveal thickness of the two groups at 1 month,3 month and 6 months after operation was analyzed.The multifocal electroretinogram change of the two groups at 6 months after operation was measured.Results:First part:(1)Macular edema was reduced in patients who underwent vitrectomy.The best corrected visual acuity of patients undergoing virectomy increased to(0.45 +.0.26),and central foveal thickness reduced to(+ 69.5)?m.(2)Preoperative best corrected visual acuity and preoperative average macular thickness was correlated(r=0.433,P=0.007).Postoperative best corrected visual acuity and postoperative central foveal thickness was correlated(r=0.363,P=0.025).Both postoperative central foveal thickness and the change of average macular thickness were correlated with the postoperative best corrected visual acuity(r=0.459,P=0.04;r=0.445,P =0.005).(3)The postoperative best corrected visual acuity of the patients with a continuous Ellipsoidal zone(0.35±0.25)was better than that of the patients with a discontinuous Ellipsoidal zone(0.59±0.23,P=0.005).Second part:(1)There was no significant difference between the treatment group and the control group in the change of best corrected visual acuity and central foveal thickness at 1 month,3 months and 6 months after virectomy.(2)There was no significant difference in the b wave amplitude of multifocal electroretinogram between the treatment group and the control group at 6 months of after virectomy.Conclusion:The postoperative central foveal thickness can be used to evaluate the the recovery of postoperative best corrected visual acuity.The patients with idiopathic macular epiretinal membrane should undergo virectomy before the Ellipsoidal zone becomes discontinuous.Compared with virectomy,vitrectomy combined with the intravitreal injection of anti-VEGF doesn't show any advantages in reducing macular edema and improving postoperative visual acuity. |
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