不同EIFL分级对特发性黄斑前膜患者术后黄斑结构及视功能的影响

Influence of EIFL Staging Scheme on Postoperative Macular Structure and Visual Function in Patients with Idiopathic Epiretinal Membrane

摘要: 目的：探讨不同中心凹内层视网膜异位(EIFL)分级的特发性黄斑前膜(IMEM)行玻璃体切除联合黄斑前膜内界膜剥除术后早期黄斑结构和视功能效果以及影响因素，并比较不用玻璃体腔填充物对手术疗效的影响。方法：收集2018年12月至2022年6月就诊于青岛大学附属医院眼科并确诊为IMEM的患者共51例(共51眼)，根据患者术前光学相干断层扫描(OCT)图像，将EIFL2级、3级、4级IMEM患者分别纳入A组、B组、C组。收集三组患者的性别、年龄、病程、手术方式、手术前后最佳矫正视力(BCVA)、黄斑中心凹厚度(CFT)、黄斑容积、黄斑平均容积厚度、神经节细胞层(GCL)厚度，术后随访3个月，比较各组患者术后视网膜结构及视功能的差异，分析不同分级患者接受手术治疗后视网膜结构及视功能的改善效果及影响因素，探究不同玻璃体腔填充物对存在EIFL患者的手术效果的影响。结果：不同分级患者术后视力均较术前改善，A组、C组患者术后CFT厚度较术前降低，差异具有统计学意义(P < 0.05)。B组、C组手术前后黄斑容积及黄斑平均容积厚度均降低，差异具有统计学意义(P < 0.05)，但各组术前–术后GCL厚度变化不明显。IMEM患者术前BCVA (log MAR)、EIFL分级与术后BCVA (log MAR)存在相关性。存在EIFL的患者术后玻璃体腔空气填充与否对术后黄斑结构及视功能的恢复差异并无统计学意义(P > 0.05)。结论：EIFL分级法对IMEM患者手术时机选择及预后判断具有一定指导作用，EIFL分级早、术前视力好的患者能够获得更好的视力预后。

Abstract: Objective: To investigate the early effects and influencing factors of macular structure and visual function of idiopathic macular epiretinal membrane (IMEM) with different ectopic inner foveal lay-ers (EIFL) staging scheme after vitrectomy combined with ectopic inner foveal layer. Methods: A to-tal of 51 eyes of 51 patients diagnosed with IMEM in the Department of Ophthalmology, Affiliated Hospital of Qingdao University from December 2018 to June 2022 were collected. According to pre-operative optical coherence tomography (OCT) images, patients with EIFL-2, 3 and 4 IMEM were di-vided into group A, group B and group C, respectively. The gender, age, course of disease, surgical method, best corrected visual acuity (BCVA), foveal thickness (CFT), macular volume, macular mean volume thickness, and ganglion cell layer (GCL) thickness were collected before and after surgery, and the patients were followed up for 3 months. The differences in retinal structure and visual function were compared among the three groups. To analyze the improvement effect and influenc-ing factors of retinal structure and visual function in patients with different grades after surgical treatment and the effect of different intravitreal fillers on the surgical outcome of patients with EIFL. Results: The visual acuity of patients with different grades was improved after operation, be-sides, the CFT thickness of patients in group A and C was reduced compared with pre-operation, and the differences were statistically significant (P < 0.05). The macular volume and macular mean volume thickness of group B and C were decreased before and after operation, and the differences were statistically significant (P < 0.05), but the GCL thickness of each group before and after opera-tion did not change significantly. Preoperative BCVA (Log MAR), and EIFL grade were correlated with postoperative BCVA (Log MAR) in IMEM patients. There was no significant difference in the re-covery of macular structure and visual function in patients with EIFL (P > 0.05). Conclusion: EIFL grading has a certain guiding role in the selection of surgical timing and prognosis of patients with IMEM. Patients with early EIFL grading and good preoperative vision can obtain better vision prog-nosis.