摘要目的:观察并分析特发性黄斑前膜（iERM）患者房水细胞因子水平与视网膜内层结构紊乱（DRIL）及手术后视力的相关性。方法:前瞻性临床研究。2022年11月至2024年10月于浙江省人民医院（附属人民医院）眼科中心检查确诊并接受白内障或白内障联合玻璃体切割手术的iERM患者40例40只眼（iERM组）纳入研究。选取同期单纯行白内障手术的白内障患者19例19只眼作为对照组。患眼均行最佳矫正视力（BCVA）、扫频源光相干断层扫描（SS-OCT）检查。BCVA检查采用对数视力表进行，统计时转换为最小分辨角对数（logMAR）视力。采用SS-OCT仪测量患眼黄斑中心凹视网膜厚度（CMT）。根据是否存在DRIL将iERM组再分为DRIL阳性组、DRIL阴性组，分别为21、19只眼。iERM组、对照组患眼手术前抽取前房水，检测其中转化生长因子（TGF）-β1、TGF-β2、TGF-β3、血小板源性生长因子（PDGF）-AB、肝细胞生长因子、成纤维细胞生长因子、血管内皮生长因子（VEGF-A）、胎盘生长因子（PLGF）、胶质细胞源性神经营养因子（GDNF）、细胞粘附分子（ICAM）-1、血管紧张素（Ang）-1、Ang-2、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6的水平。手术后1个月采用手术前相同设备和方法行相关检查。对比观察iERM组、对照组、DRIL阳性组、DRIL阴性组患眼房水中细胞因子水平以及iERM组患眼房水中细胞因子水平与BCVA、CMT的相关性。组间比较采用Mann-Whitney U检验；变量间的相关性采用Spearman秩相关分析。 结果:与对照组比较，iERM组患眼房水中TGF-β1、TGF-β3、PDGF-AB、PLGF、GDNF、ICAM-1、Ang-1、TNF-α水平显著高于对照组，差异均有统计学意义（ P<0.05 ）。与DRIL阴性组比较，DRIL阳性组患眼房水中TGF-β3、PDGF-AB、PLGF、GDNF、ICAM-1、Ang-1、Ang-2、TNF-α、IL-6水平显著升高，差异均有统计学意义（ P<0.05 ）。手术前、手术后1个月，iERM组患眼logMAR BCVA （ P=0.028）、CMT （ P<0.001）比较，差异均有统计学意义；DRIL阳性组、DRIL阴性组logMAR BCVA比较，差异有统计学意义（ P=0.048 ）。相关性分析结果显示，DRIL阳性组患眼基线房水中VEGF-A、IL-6水平与手术后BCVA呈正相关（ r=0.324、0.452， P=0.042、0.003）；CMT与房水中细胞因子水平无显著相关性（ P>0.05）。 结论:iERM患眼房水细胞因子水平与DRIL密切相关，IL-6和VEGF-A或可作为手术后早期视力恢复的潜在预测标志物。

abstractsObjective:To observe and analyze the correlations between aqueous humor cytokine concentrations and disorganization of retinal inner layers (DRIL), as well as postoperative visual acuity, in patients with idiopathic epiretinal membrane (iERM).Methods:A prospective clinical study. From November 2022 to October 2024, 40 eyes of 40 patients diagnosed with iERM at Ophthalmology Center of Zhejiang Provincial People's Hospital (Affiliated People's Hospital) underwent cataract surgery alone or combined with pars plana vitrectomy (iERM group) were enrolled; 19 eyes of 19 patients undergoing cataract surgery alone during the same period served as the control group. All eyes underwent best-corrected visual acuity (BCVA) testing and swept-source optical coherence tomography (SS-OCT). BCVA was assessed using a logarithmic visual acuity chart and converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Central macular thickness (CMT) was measured using SS-OCT. The iERM group was further subdivided into DRIL-positive and DRIL-negative subgroups (21 eyes and 19 eyes, respectively), based on the presence or absence of DRIL. Aqueous humor samples were collected preoperatively from eyes in both the iERM and control groups. Concentrations of transforming growth factor (TGF)-β1, TGF-β2, TGF-β3, platelet-derived growth factor (PDGF)-AB, hepatocyte growth factor, fibroblast growth factor, vascular endothelial growth factor-A (VEGF-A), placental growth factor (PLGF), glial cell line-derived neurotrophic factor (GDNF), intercellular adhesion molecule-1 (ICAM-1), angiopoietin (Ang)-1, Ang-2, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured. Follow-up examinations using the same equipment and methods were performed at 1 month postoperatively. Aqueous cytokine levels were compared between the iERM group, control group, DRIL-positive subgroup, and DRIL-negative subgroup. Correlations between aqueous cytokine levels in the iERM group and BCVA or CMT were also analyzed. Intergroup comparisons utilized the Mann-Whitney U test; correlations between variables were assessed using Spearman's rank correlation analysis. Results:Compared to the control group, the iERM group exhibited significantly higher aqueous concentrations of TGF-β1, TGF-β3, PDGF-AB, PLGF, GDNF, ICAM-1, Ang-1, and TNF-α ( P<0.05). Compared to the DRIL-negative subgroup, the DRIL-positive subgroup showed significantly elevated aqueous concentrations of TGF-β3, PDGF-AB, PLGF, GDNF, ICAM-1, Ang-1, Ang-2, TNF-α, and IL-6 ( P<0.05). Significant differences were observed in logMAR BCVA ( P=0.028) and CMT ( P<0.001) within the iERM group between preoperative and 1-month postoperative measurements. LogMAR BCVA differed significantly between the DRIL-positive and DRIL-negative subgroups ( P=0.048). Correlation analysis revealed that baseline aqueous levels of VEGF-A and IL-6 in eyes with DRIL were positively correlated with postoperative BCVA ( r=0.324, 0.452; P=0.042, 0.003). No significant correlation was found between CMT and any cytokine ( P>0.05). Conclusions:Aqueous humor cytokines are closely associated with DRIL in iERM patients. IL-6 and VEGF-A may serve as potential predictive biomarkers for early postoperative visual recovery.