摘要目的:观察特发性黄斑前膜（IMEM）患者手术前后黄斑微囊样水肿（MME）的发病情况及其相关影响因素。方法:回顾性病例系列研究。2017年1月至2021年5月于温州医科大学附属眼视光医院杭州院区的IMEM患者72例72只眼纳入研究。其中，男性18例，女性54例；年龄（64.8±7.8）岁；均为单眼。采用标准对数视力表行最佳矫正视力（BCVA）检查，统计时换算为最小分辨角对数（logMAR）视力。采用光相干断层扫描仪测量黄斑中心凹厚度（CMT）。MME定义为位于中心凹旁视网膜内核层小的、边界清晰且垂直的囊样空腔。根据手术前有无MME将患眼分为无MME组、有MME组，分别为35、37只眼。两组患眼logMAR BCVA、CMT比较，差异有统计学意义（ t=3.117、2.589， P=0.003、0.012）。所有患眼均行标准经睫状体平坦部三通道23G玻璃体切割手术（PPV）联合黄斑前膜及内界膜（ILM）剥除。根据手术后随访期内是否存在MME，将无MME组再分为手术前后均无MME组（A1组）、手术前无手术后有MME组（A2组）；有MME组再分为手术前有手术后无MME组（B1组）、手术前后均有MME组（B2组）。手术后随访时间（8.8±7.7）个月。随访期间采用与手术前相同的设备和方法行相关检查。手术前后MME、BCVA及CMT变化行配对 t检验。手术前后各组间CMT、BCVA比较行独立样本 t检验及单因素方差分析。手术前后MME形成的影响因素行logistic回归分析；手术后视力的影响因素行多元线性回归分析。 结果:无MME组35只眼中，A1组、A2组分别为18 （51.43%，18/35）、17 （48.57%，17/35）只眼；有MME组37只眼中，B1组、B2组分别为6 （16.22%、6/37）、31 （83.78%，31/37）只眼。末次随访时，A1组、A2组、B1组、B2组患眼logMAR BCVA分别为0.10±0.12、0.25±0.17、0.09±0.11、0.30±0.26；与手术前logMAR BCVA比较，差异均有统计学意义（ t=3.779、4.253、7.869、6.668， P<0.01）。4组患眼间logMAR BCVA比较，差异有统计学意义（ F=4.460， P<0.01）。组间logMAR BCVA比较，A1组与A2组，差异有统计学意义（ t=-2.930， P=0.006）；B1组与B2组，差异无统计学意义（ t=-1.921， P=0.063）。A1组、A2组、B1组、B2组患眼CMT分别为（371.83±73.24）、（431.24±83.13）、（407.00±28.07）、（425.19±70.97 ） μm；均较手术前降低，差异有统计学意义（ t=5.197、2.465、3.055、6.078， P<0.05）。4组患眼间CMT比较，差异无统计学意义（ F=2.597， P=0.059）。Logistic回归分析结果显示，手术前MME与手术前IMEM分期相关（ β=1.494， P=0.004）；手术后新出现MME与年龄相关（ β=0.153 ， P=0.013）。多元线性回归分析结果显示，手术后视力与手术前CMT、手术后有无MME显著相关（ β= 0.001、0.134， P=0.015、0.019）。 结论:PPV联合黄斑前膜及ILM剥除治疗IMEM可有效改善患眼视力，降低CMT；手术后MME消退或再生；年龄是手术后新出现MME的独立风险预测因素。

abstractsObjective:To observe the incidence and risk factors of microcystic macular edema (MME) in patients with idiopathic macular epiretinal membrane (IMEM) preoperatively and postoperatively.Methods:A retrospective case series study. From January 2017 to May 2021, 72 eyes of 72 patients with IMEM in Eye Hospital of Wenzhou Medical University at Hangzhou were included. There were 18 male and 54 female. Average age was 64.8±7.8 years. Eyes were all monocular. All patients received the examination of best corrected visual acuity (BCVA) by standard logarithmic visual acuity chart, which was represented logarithmic of minimum angle of resolution (logMAR). Optical coherence tomography was used to measure central macular thickness (CMT). MME was defined as small, vertically bounded cystic space located outside the fovea in the inner layer of the retina. According to the presence or absence of MME before surgery, the affected eyes were divided into two groups: non-MME group (35 eyes) and MME group (37 eyes). The difference of logMAR BCVA and CMT was statistically significant between Group A and B ( t=3.117, 2.589; P=0.003, 0.012). All patients with IMEM were treated with 23G three-channels pars plana vitrectomy (PPV) with epiretinal membrane and inner limiting membrane (ILM) peeling. The two groups were further divided into four groups according to whether there was MME in the postoperative follow-up time. The group A1 was without MME before and after surgery, group A2 was without MME before surgery and with MME after surgery. The MME group was subdivided into the group with MME before surgery and without MME after surgery (group B1) and the group with MME before and after surgery (group B2). The mean follow-up time was 8.8±7.7 months. The same equipment and methods were used to exam the patients during the follow-up. Paired t test was used to compare the changes of MME, BCVA and CMT before and after surgery. The differences of CMT and BCVA among groups before and after surgery were compared by independent sample t test and one-way ANOVA. Logistic regression was used to analyze the influencing factors of MME before and after surgery, and multiple linear regression was used to analyze the influencing factors of postoperative BCVA. Results:There were 35 eyes in the non-MME group, 18 eyes (51.43%, 18/35) in the A1 group and 17 eyes (48.57%, 17/35) in the A2 group, respectively. There were 37 eyes in MME group, 6 eyes (16.22%, 6/37) in group B1 and 31 eyes (83.78%, 31/37) in group B2, respectively. At last follow-up, the logMAR BCVA was 0.10±0.12, 0.25±0.17, 0.09±0.11, 0.30±0.26 in group A1, A2, B1, and B2, respectively. Compared with the logMAR BCVA before surgery, the differences were statistically significant ( t=3.779, 4.253, 7.869, 6.668; P<0.01). There was significant difference in logMAR BCVA among the four groups ( F=4.460, P<0.01). There was a significant difference in logMAR BCVA between group A1 and group A2 ( t=-2.930, P=0.006). There was no significant difference between group B1 and group B2 ( t=-1.921, P=0.063). The CMT of group A1, A2, B1 and B2 were 371.83±73.24, 431.24±83.13, 407.00±28.07 and 425.19±70.97 μm, respectively. Compared with those before operation, the differences were statistically significant ( t=5.197, 2.465, 3.055, 6.078; P<0.05). There was no significant difference in CMT among the four groups ( F=2.597, P=0.059). Logistic regression analysis showed that pre-operation MME was correlated with pre-operation IMEM stage ( β=1.494, P=0.004). New MME after surgery was correlated with age ( β=0.153, P=0.013). Multiple linear regression analysis showed that postoperative visual acuity was significantly correlated with CMT before surgery and MME after surgery ( β=0.001, 0.134; P=0.015, 0.019). Conclusions:PPV combined with epiretinal membrane and ILM peeling surgery for IMEM can improve visual acuity and decrease CMT. MME regress or regenerate after surgery. Age is an independent predictor of the risk of newly formed MME after surgery.