A classification of idiopathic epiretinal membrane based on foveal avascular zone area using optical coherence tomography angiography.

OBJECTIVE: To evaluate the characteristics and prognoses of idiopathic macular epiretinal membrane (iERM) using a classification based on the foveal avascular zone (FAZ) area. METHOD: IERMs were classified into four stages based on the FAZ area. Baseline FAZ-related parameters, pre-and postoperative central macular thickness (CMT), and best corrected visual acuity (BCVA) were observed and compared between different stages. The correlations of structural parameters with pre-and postoperative logMAR BCVA were analyzed. RESULTS: 162 iERM eyes were enrolled, including 105 eyes followed up for 12 months after surgery. The preoperative BCVA was better at the early stage. Postoperative BCVA at Stages 2 and 3 were better compared to Stage 4. The early stage was associated with thinner CMT pre-and postoperatively. However, there was no significant difference in CMT between postoperative Stages 1 and 2 or Stages 3 and 4. Preoperative logMAR BCVA was negatively correlated with FAZ area, perimeter, and FD-300 and was positively correlated with CMT and acircularity index (AI). CMT correlated positively with BCVA for each stage, except Stage 4; FAZ area, perimeter, and FD-300 had a negative correlation at Stage 1. Baseline BCVA and CMT positively correlated with BCVA at the last follow-up, while FAZ area and FD-300 were negatively correlated. Baseline BCVA had a positive correlation for each stage, except Stage 1; FD-300 had a negative correlation at Stages 2 and 3; CMT had a positive correlation at Stage 3. CONCLUSION: A classification based on the FAZ area was established innovatively. This classification can reflect the progression of iERM and is helpful to the postoperative prognosis.

(1) Classification based on FAZ area facilitate automation and consistency compared to the previous OCT-based qualitative grading.(2) With baseline FAZ stage advanced, thickened CMT and worsened BCVA was observed at baseline and 1-year post-operation. (3) Baseline FAZ area and FD-300 negatively correlated with logMAR BCVA at the last follow-up, reflecting the nonnegligible prognostic impact of macular vascular changes.

Influence of phacoemulsification on macular morphology in cataract patients with idiopathic macular epiretinal membrane / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the changes of the epiretinal membrane(ERM)stage, macular status and best corrected visual acuity(BCVA, LogMAR)in cataract patients with idiopathic macular epiretinal membrane(IERM)before and after cataract surgery.METHODS:We conducted a single center retrospective observational case series of patients that underwent sequential cataract and idiopatic ERM surgeries from March 2016 to May 2019 in Anyang Eye Hospital. Full data were obtained for 51 patients(54 eyes).Preoperative and postoperative 1mo ERM stage, central macular edema(CME), central macular thickness(CMT), macular volume(MV), ellipsoid zone disruption, occurrence of neurosensory detachment(NSD)and BCVA were analyzed.RESULTS:In this group of patients, 5 eyes(9%)had ERM grade 1, 23 eyes(43%)had ERM grade 2, 21 eyes(39%)had ERM grade 3, and 5 eyes(9%)had ERM grade 4 before surgery; ERM graded 1mo after surgery were keeping steady. Compared with before operation(0.45±0.16),there was no significant change in BCVA(0.47±0.17)at 1mo after operation(<i>P</i>>0.05), but the incidence of CME, ellipsoid band interruption and NSD were significantly higher than those before operation(<i>P</i><0.05). CONCLUSION: We suggest that phacoemulsification did not significantly accelerate ERM progression and affect BCVA, but patients underwent cataract surgery in the presence of epiretinal membranes need tight follow up to treat and control eventual macular infammatory changes and eventual prompt vitrectomy if BCVA was threatened.

Macular Retinal Sensitivity and Microvasculature Changes before and after Vitrectomy in Idiopathic Macular Epiretinal Membrane with Classification.

PURPOSE: To observe retinal sensitivity (RS) and microvasculature changes in preoperative and postoperative idiopathic macular epiretinal membrane (iERM) with optical coherence tomography (OCT) classification by microperimetry (MP) and optical coherence tomography angiography (OCTA). METHODS: In this retrospective study, 53 eyes of 53 patients affected with iERM were enrolled and 35 iERM eyes underwent pars plana vitrectomy associated with internal limiting membrane peeling. All iERM eyes were evaluated and graded by OCT. According to the thickness of the fovea relative to the surrounding macula from OCT radial line scans, we classified iERM into 3 grades. MP was used to measure RS of macular within 20° centered on the fovea and fixation stability (FS). OCTA was used to measure the superficial and deep capillary plexus (DCP) layers using 6 mm × 6 mm scans. Measurements were taken at the baseline visit and 3-month postoperation. Evaluated factors included: best corrected visual acuity, RS, FS, vessel density. RESULTS: Eyes with iERM had worse RS than control eyes (p < 0.0001), especially in higher grade iERM eyes. And higher grade iERM eyes had a marked increase foveal vessel density (FVD) (p < 0.0001) in superficial capillary plexus (SCP) and DCP, and a significant decrease parafoveal vessel density (Para VD) in DCP. After surgery, there was no difference in RS and FS than preoperation (p > 0.05), whether in grade 1 or 2 iERM eyes. However, in OCTA analyses, grade 1 iERM eyes had less whole vessel density (WVD) and perifoveal vessel density (Peri VD) in SCP, than preoperation (p < 0.05). And grade 1 iERM eyes had higher Para VD and Peri VD in DCP (p < 0.05), than preoperative OCTA results. Grade 2 iERM eyes had less WVD, FVD, and Peri VD in SCP, than preoperation (p < 0.05). After surgery, in grade 2 iERM eyes, there was a positive correlation between whole retinal sensitivity and WVD (p < 0.05) in SCP. And there were positive correlations between Para RS and Para VD (p < 0.05), Peri RS and Peri VD (p < 0.05) in SCP. CONCLUSIONS: Classification helps to reveal different changes in iERM eyes. Higher grade iERM eyes had worse RS and microvasculature changes. MP and OCTA play an important role in assessing iERM and help surgical decisions for patients with iERM.

[Prediction of postoperative visual acuity in cataract patients with idiopathic macular epiretinal membrane by hand-held retinal optometer and optical coherence tomography].

OBJECTIVE: To investigate the value of hand-held retinal optometer and optical coherence tomography (OCT) in predicting postoperative visual acuity in patients with age-related cataract and idiopathic macular epiretinal membrane. METHODS: We retrospectively analyzed the data of patients undergoing phacoemulsification combined with intraocular lens implantation for age-related cataract in our hospital from January, 2019 to April, 2020.Preoperative examination detected idiopathic macular epiretinal membrane in 45 of the patients (52 eyes) with lens opacity grade C2N2P1 according to LOCSⅡ lens opacity classification criteria.Based on the thickness of the macular fovea, the eyes were divided into group A (9 eyes) with macular thickness < 300 µm by OCT examination, group B (25 eyes) with macular thickness of 300 to 400 µm, and group C (18 eyes) with macular thickness >400 µm.The best corrected visual acuity and retinal visual acuity before operation and the best corrected visual acuity on the first day and at 3 months after the surgery were compared among the 3 groups.The consistency between the preoperative retinal vision and the best corrected vision at 3 months after the surgery was analyzed. RESULTS: The best corrected visual acuity at one day and 3 months after the surgery differed significantly from that before the surgery in all the 3 groups (P < 0.05).The best corrected visual acuity recovered to 0.3-0.5 in most of the patients in the 3 groups. Thirty-one (91.18%) of the patients with a macular thickness less than 400 µm had a visual acuity≥0.3 after cataract surgery, as compared with only 14 patients (77.78%) among those with a macular thickness >400 µm.There was a positive linear correlation between preoperative retinal visual acuity and best corrected visual acuity at 3 months after the surgery (r=0.830, P < 0.05). CONCLUSIONS: For patients with cataract and idiopathic macular epiretinal membrane, phacoemulsification combined with intraocular lens implantation can improve postoperative vision.Hand-held retinal optometer can accurately assess postoperative vision in patients with stage C2N2P1 cataract.Patients with a macular thickness >400 µm caused by idiopathic macular epiretinal membrane are likely to have poor postoperative visual outcomes.

Assessment of macular microvasculature features before and after vitrectomy in the idiopathic macular epiretinal membrane using a grading system: An optical coherence tomography angiography study.

PURPOSE: To evaluate pre- and postoperative microvasculature features in eyes with different idiopathic macular epiretinal membrane (iERM) classifications using optical coherence tomography angiography (OCTA). METHODS: In this retrospective study, 100 eyes with iERM were enrolled; 62 eyes underwent pars plana vitrectomy (PPV). All iERM eyes were evaluated and graded using optical coherence tomography (OCT). According to the thickness of the fovea relative to the surrounding macula from OCT radial line scans, we classified iERM into three grades. Optical coherence tomography angiography (OCTA) was used to measure the foveal avascular zone (FAZ)-related parameters and the superficial and deep capillary plexus layers using 3 × 3 mm scans. Measurements were taken at baseline and 3 months postoperatively. Best corrected visual acuity (BCVA), vessel density (VD), FAZ area, FAZ perimeter (PERIM), acircularity index (AI), and foveal vessel density (FD) were evaluated. RESULTS: Idiopathic macular epiretinal membrane (iERM) eyes with a higher grade had a lower FAZ area and perimeter (p < 0.0001), higher foveal vessel density (FVD) both in the superficial capillary plexus (SCP) (p < 0.0001) and in the deep capillary plexus (DCP) (p < 0.05), and a lower parafoveal vessel density (PRVD) in the DCP (p < 0.0001). The macular vessel density ratio (MVR = FVD/PRVD) increased with an increase in grade both in the SCP and in the DCP (p < 0.0001). For grade 1 iERM eyes, only PRVD in the DCP significantly changed before versus after the operation (p < 0.05). For grade 2 iERM eyes, the FAZ area and perimeter became larger after the operation (p < 0.05). The MVR of grade 2 iERM eyes decreased postoperatively both in the SCP (p < 0.05) and in the DCP (p < 0.001). For grade 1 and grade 2 iERM eyes, preoperative LogMAR BCVA was negatively correlated with the FAZ area (p < 0.01) and perimeter (p < 0.01), and was positively correlated with the MVR in the SCP (p < 0.05). Postoperative LogMAR BCVA was positively correlated with the FVD in the DCP (p < 0.05). CONCLUSIONS: Idiopathic macular epiretinal membrane (iERM) eyes of different grades have significant differences in microvasculature features. According to OCTA, eyes with higher grades have more serious microvascular changes. Grading plays a part in predicting postoperative microvascular characteristics, and grade 1 iERM eyes have a better visual outcome compared with grade 2 iERM eyes.

Comparison of macular microcirculation in eyes with idiopathic and diabetic macular epiretinal membrane before and after surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the changes of macular microcirculation in eyes with idiopathic and diabetic macular epiretinal membrane(ERM)before and after pars plana vitrectomy(PPV), and to evaluate the prognosis of the two types of ERM.<p>METHODS:We conducted a retrospective study on 24 patients(24 eyes), 12 patients(12 eyes)with idiopathic macular epiretinal membrane(iERM)and 12 patients(12 eyes)with diabetic macular epiretinal membrane(dERM)who underwent PPV combined with ERM and internal limiting membrane(ILM)peeling from April 2020 to July 2020. In addition, 16 contralateral healthy eyes of iERM patients who underwent PPV combined with ERM and ILM removal from September 2019 to July 2020 were selected as the normal control group. All patients were followed up for more than 3mo. The area of foveal avascular zone(FAZ)and the macular vascular density(MVD), including superficial macular vascular density(SVD)and deep macular vascular density(DVD)were compared before and after surgery. And the prognosis was also analysed.<p>RESULTS: The area of FAZ in the iERM group and dERM group before surgery were significantly smaller than that in the control group(<i>P</i><0.05); The total SVD in the iERM and dERM groups were lower than that in the control group, and the dERM group was lower than that in the iERM group, but no statistically significant difference was found. The total DVD in the iERM and dERM groups was significantly lower than that in the control group(<i>P</i><0.05). The foveal SVD in the iERM was significantly higher than that in the dERM and control groups, and the foveal DVD in the iERM was significantly higher than that in the control group(<i>P</i><0.05). The parafoveal SVD in the iERM and dERM groups were lower than that in the control group, but only the difference was obvious between the dERM and the control group(<i>P</i><0.05). The parafoveal DVD in the iERM and dERM groups were significantly lower than that in the control group(<i>P</i><0.05). Postoperative visual acuity was significantly improved in the iERM group and dERM group(<i>P</i><0.05), but the SVD was barely changed. The total and parafoveal DVD in the iERM group were statistically higher than those before surgery(<i>P</i><0.05). DVD in the dERM group was higher than it was before surgery, but with no statistically difference. There were no differences in the visual acuity, SVD and DVD between the iERM and dERM groups after operation.<p>CONCLUSION: The changes of macular microcirculation in dERM were more obvious than those in iERM. DVD in the iERM patients was improved at the early stage after operation, while the improvement was not obvious in the dERM patients.

Influencing factors of visual function in patients with idiopathic macular epiretinal membrane after internal limiting membrane peeling / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the risk factors that affect visual function recovery in patients with idiopathic macular epiretinal membrane(IMEM)undergoing internal limiting membrane peeling(ILMP).<p>METHODS: This study retrospectively reviewed 118 patients(118 eyes)with IMEM who underwent ILMP in the hospital between January 2016 and April 2020. The patients were followed up for 6mo after surgery to evaluate curative effect. Changes in visual acuity before surgery and at 1, 3 and 6mo after surgery, metamorphopsia degree, mean central foveal thickness and volume of macular area were observed. The correlation of mean central foveal thickness and volume of macular area before and after surgery with postoperative visual acuity and metamorphopsia scores was analyzed. The risk factors for poor visual function recovery after surgery were evaluated.<p>RESULTS: In this study, 96 eyes obtained good visual function recovery, and the improvement rate was 81.4%. At 1, 3 and 6mo after surgery, visual acuity was significantly improved(<i>P</i><0.05), metamorphopsia score in horizontal direction, mean central foveal thickness and volume of macular area were significantly reduced(<i>P</i><0.05). The mean central foveal thickness and volume of macular area before surgery and at 6mo after surgery were negatively correlated with visual acuity at 6mo after surgery(<i>P</i><0.05), but positively correlated with metamorphopsia score in horizontal direction(<i>P</i><0.05). The course of IMEM, preoperative corrected visual acuity, preoperative horizontal or vertical metamorphopsia, and preoperative macular edema were influencing factors of visual function recovery after surgery(all <i>P</i><0.05). Poor preoperative corrected visual acuity(<i>OR</i>=3.062), horizontal metamorphopsia(<i>OR</i>=2.438)and preoperative macular edema(<i>OR</i>=2.000)were risk factors for poor visual function recovery.<p>CONCLUSION: The curative of ILMP is effect on IMEM, which can effectively improve visual acuity of operative eyes and reduce metamorphopsia. The longer the course of disease, the worse the preoperative corrected visual acuity, and the more severe the preoperative metamorphopsia, the worse the visual function recovery in patients with preoperative macular edema after ILMP.

Evaluate the effect of idiopathic macular epiretinal membrane on visual functional prognosis of cataract patients based on the new classification method for macular epiretinal membrane by SD-OCT / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the disruption degree of macular fovea structure by pre-operation SD-OCT examination and establish a new method of IMEM. Thus, to analysis the value of this method for predicting the visual functional prognosis of cataract patients complicated with idiopathic macular epiretinal membrane(IMEM)after cataract surgery alone.<p>METHODS: Totally 64 patients(80 eyes)diagnosed as cataract with IMEM, who simply underwent phaco cataract extraction combined with intraocular lens implantation were included in this study. These patients were admitted in Shenzhen Eye Hospital from October 2017 to November 2018. IMEM was divided into 4 stages based on the damage degree of macular fovea structure by pre-operative SD-OCT examination. The best corrected visual acuity(BCVA), mean retinal sensitivities(MS), central macular thickness(CMT)and the progression rate of IMEM in all the patients were compared and analyzed before and 3mo after the cataract operation.<p>RESULTS: With the IMEM grade rised, the epiretinal membranes became more obvious, the disruption of retinal layers and loss of the foveal depression became more serious on the SD-OCT image. The LogMAR BCVA of pre-operation and 3mo after cataract surgery progressively rised with the increasing of IMEM grade, and the differences were statistically significant(<i>F</i>=37.72, 26.43, <i>P</i><0.001). Otherwise, The MS of pre-operation and 3mo after cataract surgery progressively declined with the increasing of IMEM grade, and the differences were statistically significant(<i>F</i>=43.77, 28.96, <i>P</i><0.001). The change of CMT was not consistent with the progression rate of IMEM in 3mo after operation. There was no significant difference in CMT(<i>P</i>>0.05), but the progression rate of IMEM was increased significantly with the IMEM grading(χ²_Trend=12.59, <i>P</i><0.001).<p>CONCLUSION: The new classification method was created for IMEM by SD-OCT will help to predict the visual functional prognosis for cataract patients complicated with IMEM after cataract surgery.

Prediction of postoperative visual acuity in cataract patients with idiopathic macular epiretinal membrane by hand-held retinal optometer and optical coherence tomography / 南方医科大学学报

OBJECTIVE@#To investigate the value of hand-held retinal optometer and optical coherence tomography (OCT) in predicting postoperative visual acuity in patients with age-related cataract and idiopathic macular epiretinal membrane.@*METHODS@#We retrospectively analyzed the data of patients undergoing phacoemulsification combined with intraocular lens implantation for age-related cataract in our hospital from January, 2019 to April, 2020.Preoperative examination detected idiopathic macular epiretinal membrane in 45 of the patients (52 eyes) with lens opacity grade C2N2P1 according to LOCSⅡ lens opacity classification criteria.Based on the thickness of the macular fovea, the eyes were divided into group A (9 eyes) with macular thickness 400 μm.The best corrected visual acuity and retinal visual acuity before operation and the best corrected visual acuity on the first day and at 3 months after the surgery were compared among the 3 groups.The consistency between the preoperative retinal vision and the best corrected vision at 3 months after the surgery was analyzed.@*RESULTS@#The best corrected visual acuity at one day and 3 months after the surgery differed significantly from that before the surgery in all the 3 groups (@*CONCLUSIONS@#For patients with cataract and idiopathic macular epiretinal membrane, phacoemulsification combined with intraocular lens implantation can improve postoperative vision.Hand-held retinal optometer can accurately assess postoperative vision in patients with stage C2N2P1 cataract.Patients with a macular thickness >400 μm caused by idiopathic macular epiretinal membrane are likely to have poor postoperative visual outcomes.

Effects of vitrectomy and macular epiretinal membrane dissection combined with or without internal limiting membrane peeling on choroid thickness, vision and metamorphopsia in patients with idiopathic macular epiretinal membrane / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the effects of vitrectomy and macular epiretinal membrane dissection combined with or without internal limiting membrane(ILM)peeling on choroid thickness, vision and metamorphopsia in patients with idiopathic macular epiretinal membrane(IMEM).<p>METHODS: Totally 88 patients(88 eyes)with IMEM admitted to the hospital were selected between January 2016 and January 2020. They were divided into group A and group B by random number table method with 44 eyes in each group. Patients in group A were treated with vitrectomy and macular epiretinal membrane dissection combined with ILM peeling, while patients in group B were treated with vitrectomy and macular epiretinal membrane dissection. The choroid thickness, vision, metamorphopsia, central macular thickness(CMT), ellipsoid zone(EZ)continuity were compared between the two groups.<p>RESULTS: Compared with preoperative, the sub-foveal choroidal thickness(SFCT), choroidal thickness 1 000μm from nasal side central of fovea(NFCT)and choroidal thickness 1 000μm from temporal side central of fovea(TFCT)were significantly reduced in the two groups at 3mo and 6mo after operation(<i>P</i><0.05), but there was no statistically significant difference between the groups(<i>P</i>>0.5). Compared with preoperative, the best corrected visual acuity(BCVA)LogMAR was reduced, while mean sensitivity(MS)was increased in the two groups. The number of scotoma points(SP)increased in group A and decreased in group B. Group A had significantly lower MS and higher SP than group B at 1mo, 3mo, and 6mo after operation(<i>P</i><0.05). Compared with preoperative, the M scores(Angle of view when horizontal and vertical variability begins to disappear)and average M scores of the two groups were significantly reduced at 3mo and 6mo after operation, without statistically significant differences between the groups(<i>P</i>>0.05). Compared with preoperative, CMT was significantly reduced in the two groups at 1, 3 and 6mo after operation. The ratio of EZ continuity in group A at 1mo after operation was significantly lower than that before operation. The CMT of group A was larger than that of group B at 3mo and 6mo after operation(<i>P</i><0.05). No statistically significant differences were found in the ratio of EZ continuity and the incidence of complications between the groups(<i>P</i>>0.05).<p>CONCLUSION: Vitrectomy and macular epiretinal membrane dissection combined with or without ILM peeling both can improve vision and metamorphopsia in patients with IMEM, with similar effects on choroid thickness and safety. However, combined use of ILM peeling will lower MS and increase SP as well as CMT. Therefore, it has no significant advantages in the treatment of patients with IMEM.

A study analyzing macular microvasculature features after vitrectomy using OCT angiography in patients with idiopathic macular epiretinal membrane.

BACKGROUND: To evaluate postoperative changes in retinal capillary plexus and to assess contributing factors in postoperative visual improvement using optical coherence tomography angiography (OCT-A) in patients with idiopathic epiretinal membrane (iERM) post membrane removal. METHODS: Patients scheduled for vitrectomy and membrane peel for iERM were enrolled. 35 subjects were included for this study. OCT-A was used to measure the FAZ related parameters and the superficial and deep capillary plexus layers using 3 mm × 3 mm scans. Measurements were taken before surgery and at every post-surgical follow-up. The unaffected fellow eyes were used as controls. Evaluated factors included: BCVA, vessel density (VD) and retinal thickness (RT) in five regions, FAZ area, FAZ perimeter (PERIM), acircularity index (AI) and foveal vessel density (FD). RESULTS: Compared with the control group, the foveal vessel density (FVD) in superficial capillary plexus (SCP) was greater in the epi-retinal membrane group (P < 0.0001), whereas both groups had comparable parafoveal vessel density (PRVD) in SCP (p > 0.05). After surgery there was a reduction in the PRVD in SCP. The FVD in DCP increased and the PRVD in DCP decreased at baseline (p < 0.001). After surgery there was an increase in PRVD in DCP. By 6 months post-op, the PRVD had no statistically significant difference compared with the control group (p > 0.05). D-value of LogMAR BCVA was positively correlated with pre-op LogMAR BCVA (p < 0.0001), FVD in SCP (p < 0.001). It was negatively correlated with FAZ area (P < 0.001) and PERIM (P < 0.05). CONCLUSIONS: Vitrectomy and membrane removal led to the decrease of VD in SCP and the increase of PRVD in DCP. Patients with a more severe iERM may receive greater visual improvement with surgery. TRIAL REGISTRATION: Trial registration number (TRN) and date of registration. ChiCTR2000031289, retrospectively registered, 2020.03.26.

Effect of vitrectomy combined with macular epiretinal membrane peeling on visual acuity and metamorphopsia in IMEM patients / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the effect of vitrectomy combined with macular epiretinal membrane peeling on visual acuity, central macular thickness(CMT)and metamorphopsia degree in patients with idiopathic macular epiretinal membrane(IMEM).<p>METHODS: Totally 31 cases(31 eyes)of patients with IMEM were treated with vitrectomy combined with macular epiretinal membrane peeling, and the best corrected visual acuity(BCVA), CMT, ellipsoid zone(IS/OS)connectivity and macular morphology were examined before and after operation. The treatment effect was assessed, and the relationship between BCVA, macular structure and morphology before and after operation was studied. All the factors that might affect the surgical outcomes were analyzed.<p>RESULTS: The mean BCVA and CMT were 0.59±0.14 and 429.35±86.17μm respectively before operation, and were decreased to 0.38±0.09 and 304.87±62.54μm at 6mo after operation(<i>P</i><0.05). The metamorphopsia degree after operation was gradually decreased, and the metamorphopsia degree at 1, 3 and 6mo after operation was lower than before operation(<i>P</i><0.008). At 1mo after operation, the IS/OS connectivity ratios were 65%, and there was no significant difference compared with that before operation with 52%(<i>P</i>>0.008). The ratio of IS/OS connectivity was 81% and 90% at 3mo and 6mo after operation, and the difference was statistically significant compared with that before operation(<i>P</i><0.008). There was significant difference in the macular morphology at different time after operation(<i>P</i><0.008). The proportions of patients with normal macular morphology at 1, 3 and 6mo after operation were 26%, 52% and 77% respectively, and the differences were statistically significant compared with before operation(<i>P</i><0.008). Pearson or Spearman correlation analysis showed postoperative BCVA in IMEM patients was positively correlated with preoperative BCVA and postoperative CMT(<i>P</i><0.05), but that was negatively correlated with preoperative macular morphology, preoperative and postoperative IS/OS connectivity and postoperative macular morphology(<i>P</i><0.05).<p>CONCLUSION: Vitrectomy combined with macular epiretinal membrane peeling can significantly reduce the CMT of patients with IMEM, and improve the IS/OS connectivity and macular morphology, so as to improve the visual acuity and reduce the metamorphopsia degree.

Recent progress of formation mechanisms and factors related to postoperative visual function in patients with IMEM / 国际眼科杂志(Guoji Yanke Zazhi)

@#Idiopathic macular epiretinal membrane(IMEM)is a common macular area disease associated with age and characterized by symptoms of decreased visual acuity and metamorphopsia. With the acceleration of aging population, the incidence of IMEM is also increasing year by year. At present, its exact pathogenesis is not clear, and there is no effective drug therapy. Vitrectomy is an effective treatment, but the improvement of postoperative visual function is very different. This article reviews the pathogenesis and factors related to prognosis in patients with IMEM, in order to adopt more accurate and effective preventive and therapeutic measures.

Research on accuracy of different IOL power calculation following the combination of phacoemulsification and vitrectomy in eyes with idiopathic macular epiretinal membrane / 中华实验眼科杂志

Objective To evaluate the accuracy of intraocular lens (IOL) power calculation using IOL-Master in patients underwent phacoemulsification and vitrectomy for idiopathic macular epiretinal membrane (IMEM) concurrent with age-related cataract (ARC).Methods A prospective study was designed.A total of 32 patients (32 eyes) with ARC (ARC group) and 30 patients (30 eyes) with ARC and IMEM (ARC+IMEM group) were enrolled from March 2013 to July 2015 in the Hangzhou District of Eye Hospital of Wenzhou Medical University.All the surgeries were performed by the same experienced surgeon and the same IOL (Adapt-AO) was implanted.IOL power was calculated by both SRK-T and Haigis formulas.The central macular thickness was measured by OCT preoperatively and postoperatively.The mean postoperative refractive prediction error (ME),mean absolute postoperative prediction error (MAE) and percentage of eyes achieved target refraction within ± 0.25,± 0.50 and ± 1.00 D were compared between the 2 groups.The correlation between the refractive error and macular thickness change was evaluated.Results The ME and MAE calculated by Haigis were (-0.47±0.66)D and (0.63±0.44)D in ARC+IMEM group,and (-0.18±0.74)D and (0.68±0.65)D in ARC group.The ME and MAE calculated by SRK-T were (-0.60 ±0.59) D and (0.73 ±0.41) D in ARC +IMEM group,and (-0.23 ±0.85)D and (0.75 ±0.69)D in ARC group.No significant differences were found between the two groups in each formula (all at P＞0.05).There was no significant difference of MAE distribution between the two groups in Haigis formula.In SRK-T formula,the percentage of MAE≤0.25 D in the ARC+IMEM group was significantly higher than that in the ARC group (x2 =7.114,P=0.007).In the A RC+IMEM group,the change of the macular thickness was (-97.4± 115.3)μm,which was statistically correlated with the ME of H aigis and SRK-T formulas (r=0.369,P =0.045;r =0.421,P =0.021).Conclusions There is a tendency toward myopia shift in patients underwent phacoemulsification and vitrectomy compared with conventional phacoemulsification.The myopia shift shows a significant correlation with macular thickness changes.Haigis formula performs better than SRK-T formula with the condition of un-optimized parameters.

Assessment of outcomes of idiopathic macular epiretinal membrane based on preoperative classification of the epiretinal membrane with OCT / 眼科新进展

Objective To classify idiopathic macular epiretinal membrane (IMEM) on the basis of OCT and its application value in predicting visual acuity of patients after operation.Methods Totally 29 patients (30 eyes) with IMEM admitted in Shenzhen Eye Hospital from February 2013 to May 2016 were included in this study and divided into 4 levels based on the morphologic change of macular fovea by preoperative OCT examination.All the patients were given minimally invasive vitrectomy for stripping macular epiretinal membrane (MEM),and examined for best corrected visual acuity (BCVA) and central foveal thickness (CFT) 6 months after surgery.Results As the grading increased,the patient's macular foveal became disorganized,the appearance of the macular membrane was presented and the loss of macular foveal was more obvious.There was significant difference between preoperative and postoperative LogMAR BCVA (all P ＜ 0.01).Preoperative and postoperative LogMAR BCVA was increased with the grading,and the difference was statistically significant (all P ＜ 0.05),suggesting that patients with high-level epiretinal membranes suffered from poor visual acuity.The difference between preoperative and postoperative LogMAR BCVA was the largest in patients with grade Ⅱ idiopathic macular degeneration,and the difference was statistically significant compared with other levels (all P ＜ 0.001).It is suggested that BCVA of grade Ⅱ patients has the greatest improvement after operation.Apart from grade Ⅲ patients,there was no significant difference in CFT among the patients with other levels before and after operation (all P ＞ 0.05).The preoperative and postoperative CFTs between patients were increased with the grading,and the differences were statistically significant (all P ＜ 0.001),suggesting that the higher the level was,the larger the macular thickness.Conclusion The classification of IMEM based on OCT examination images not only helps to predict the postoperative visual acuity and CFT recovery but also the timing of operation in patients with idiopathic macular degeneration.

Relationship between choroidal thickness and idiopathic macular epiretinal membrane / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the relationship between the thickness of choroid and the development of idiopathic macular epiretinal membrane (IMEM). ·METHODS: A retrospective analysis on 48 cases (48 eyes) of idiopathic macular epiretinal membrane patients (the IMEM group) was taken in our hospital from January 2014 to December 2016, and 50 right eyes in 50 healthy persons with physical examination were selected the control group, comparison on subfoveal choroidal thickness (SFCT) levels of sicked eyes, normal eyes in IMEM group and the control group were made, postoperative SFCT level change of sicked eyes in IMEM patients and normal eyes were investigated via follow-up, and analysis on correlation between postoperative choroidal thickness and the best corrected visual acuity was taken. ·RESULTS: The SFCT of sicked eyes in IMEM group 362.22±40.75μm was significantly lower than that of the contralateral eyes (410.56 ± 38.45μ m) and the right eyes of the control group (420.73±39.63μ m), and data of the contralateral eyes was lower than right eyes of the control group, distinct difference was shown between groups(P<0.05). The IMEM group's SFCT of sicked eyes and normal eyes at postoperative 1wk had no significant difference with that before operation (P>0.05), and at postoperative 1mo,SFCT of sicked eyes and normal eyes evidently increased, showing sharp difference compared with that before operation (P<0. 05). After that, the SFCT value stabilized, but there was no obvious difference between the sicked eyes and healthy eyes at postoperatively 1mo (P>0.05). The numbers of patients whose postoperative BCVA ≥ 0. 5 with different preoperative SFCT values had statistically significant differences (P<0.05), and those with BCVA ≥0.5 of SFCT values> 380μ m were significantly higher than those with <320μ m and 320μ m-380μ m groups. Fisher exact probability analysis showed that the differences were significant. Pearson analysis showed that there was a positive correlation between the postoperative choroid thickness and the best corrected visual acuity of IMEM group (r=0.629,P<0.05). · CONCLUSION: Choroidal thinning may be an important cause of IMEM, and preoperative choroidal thickness also has an influential effect on postoperative visual recovery.

Comparative observation of vitrectomy with macular epiretinal membranes peeling with or without air tamponade for idiopathic macular epiretinal membranes / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To compare the treatment efficacy of vitrectomy with macular epiretinal membrane ( MEM ) peeling combined with or without air tamponade for idiopathic macular epiretinal membranes( IMEM) .·METHODS: Forty-two cases of IMEM patients ( 46 eyes ) associated with cataract were randomly divided into two groups. Twenty-five eyes of 23 cases in Group A were performed with vitrectomy with macular epiretinal membrane peeling combined with air tamponade. The other 21 eyes of 19 cases in Group B only underwent vitrectomy and macular epiretinal membrane peeling ( without air tamponade ) . The visual acuity and central macular thickness ( CMT ) were compared between the two groups before and after the surgery. The intraoperative and postoperative complications were also observed in both groups in the mean time.· RESULTS: There was no statistical significant difference between two groups in age, visual acuity and CMT before operation (P>0. 05). By 1wk, 3 and 6mo follow-up after operation, mean visual acuity improved significantly; mean CMT decreased obviously in both groups after the operation and the difference was statistically significant (P<0. 05). But for mean visual acuity and CMT, there were not statistically significant difference between two groups postoperatively at the same time(P>0. 05),there was no correlation between postoperative mean visual acuity and CMT in the two groups. No serious complications occurred during and after operation.· CONCLUSION: Vitrectomy with macular epiretinal membrane peeling can be a safe and effective treatment for IMEM, meanwhile air tamponade in vitreous cavity does not reveal more advantages in the treatment.

Efficacy of 20G or 25G three-channel vitrectomy for idiopathic macular epiretinal membrane / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the curative effect of 20G and 25G three-channel pars plana vitrectomy in the treatment of idiopathic macular epiretinal membrane,and to provide a theoretical basis for the minimally invasive treatment of idiopathic macular epiretinal membrane.METHODS:Medical records were retrospectively analyzed to explore curative effect.From January 2014 to December 2016,60 patients (60 eyes) with idiopathic macular pucker in our hospital for eye treatment were selected.They were grouped according to different operation way,in 28 patients (28 eyes) using three-channel 20G pars plana vitrectomy as the control group,32 patients (32 eyes) with 25G no-suture conjunctival vitrectomy as observation group.Two groups of patients were evaluated at 3mo after treatment for visual acuity,OCT examination,comfort,and we recorded the operation time,complications and recurrence.RESULTS:The operating time of observation group was 18-25min,average 20±2.15min,the control group was 22-35min,28 ± 2.07min on average,the difference was statistically significant (P＜0.05).At the time of the last follow-up,visual acuity of two groups improved compared with preoperative,without vision decrease.In observation group vision improved in 69％,significantly higher than that of control group (50％),difference was statistically significant (x2 =7.287,P＜ 0.05).Preoperative intraocular pressure of two groups was not significantly different.intraocular pressure of two group at postoperative 1d reduced compared with preoperative (Ftime =31.34,P＜0.01;Fgr.up =17.43,P＜0.01).There was no statistically significant difference at 7d and 1mo compared with preoperative (P＞0.05).Preoperative OCT on macular thickness of the two groups had no statistically significant difference.At 7d,1 and 3mo after treatment,epiretinal membranes disappeared in all patients,and the macular thickness reduced,the macular edema relieved (P＜ 0.05).At postoperative 3mo,two groups of patients were found no recurrence of epiretinal membranes.At 7d,1 and 3mo after treatment,differences between the two groups on macular thickness had no statistical significance.At postoperative 1d,in the control group there were foreign body sensation,swelling,and tears,pain and discomfort,20 patients with eye conjunctival congestion,edema,conjunctival suture to cause discomfort,the symptoms relieved after treatment.In observation group,12 patients with mild conjunctival congestion and edema,dotted hemorrhage at the wound in 4 eyes,5 eyes appeared lower intraocular pressure (6-8mmHg).without special treatment,Postoperative bleeding and edema stopped at 7d,intraocular pressure returned to normal.Patients of observation group did not have foreign body sensation,swelling and discomfort symptoms.At the time of the last follow-up,in the two groups,no iatrogenic retinal detachment,cataract,endophthalmitis and other serious complications occurred.CONCLUSION:The 20G of three-channel pars plana vitrectomy and 25G the no-suture conjunctival vitrectomy are equal for idiopathic macular epiretinal membrane,25G vitrectomy operation time is short with better patient comfort.

Correlation between morphological changes in the macula and visual acuity before and after idiopathic macular epiretinal surgery / 眼科新进展

Objeetive To evaluate the morphological change in macuia in patients with idiopathic macuiar membrane and its relationship with visual acuity.Methods A retrospective study was conducted in 32 eye of 32 patients with idiopathic macuiar epiretinal membrane,who underwent the pars plana vitrectomy combined with internal membrane peeling.Then data on visual acuity and optical coherence variables,including the morphology and thickness of the fovea were collected and analyzed.Results Improvement in the best corrected visual acuity (BCVA) was observed in 29 patients,and the difference in the mean preoperative BCVA was statistically significant before surgery (0.25 ± 0.12) and after surgery (0.49 ± 0.28) (P ＜ 0.05).Unfortunately,3 patients maintained the same visual acuity after surgery.The thickness of the fovea decreased in all patients,from (385 ± 115) μm to (241 ± 64) μm (P ＜ 0.05).And the BCVA had a negative correlation with the thickness of the fovea.Conclusion The visual acuity of patients is closely related to the morphological feature of the macuia,and optical coherence tomography can be a useful tool for preoperative assessment and postoperative follow-up.

Application of optic coherent tomography in assessing visual performance of idiopathic macular epiretinal membrane patients / 天津医药

Objective To investigate the correlation between retinal deformation degree and retina thickness (RT) detected by optic coherent tomography (OTC) in patients with idiopathic macular epiretinal membrane (IMEM). Methods The 66 eyes (56 patients) with IMEM diagnosed by OCT were retrospectively analyzed in this study. After best corrected visual acuity (BCVA), ocular fundus and OCT examination, patients were divided into three groups (mild, medium and severe) according to retinal deformation degrees. The RT value was measured manually. Results There were significant differences in RT values between mild, moderate and severe groups:(311.95 ±51.78) μm, (447.13±41.95) μm and (560.00± 58.23) μm (P<0.05). The values of BCVA were 0.78±0.16, 0.38±0.12 and 0.27±0.14 for mild, moderate and severe groups, there were significant differences between them (P<0.05). There was no significant correlation between RT and BCVA in mild group (r=-0.352,P=0.128). There was negative correlation between RT and BCVA in medium group and serious group (r=-0.768 and-0.482,P<0.05). Conclusion The retinal deformation degree and RT are two objective indicators to assess visual performance in patients of IMEM. When RT is more than 400 μm, it can be used as objective criteria for surgical intervention.