摘要目的:探讨特发性黄斑前膜（IMEM）手术前后黄斑中心凹无血管区（FAZ）面积及形态指数与视力的相关性。方法:回顾性病例系列研究。纳入2019年5月至2020年10月在贵州医科大学附属医院确诊IMEM并行玻璃体切除联合黄斑前膜及内界膜剥除术患者的病例资料。患者术前以及术后1周、1个月、3个月检测最佳矫正视力（BCVA），采用相干光层析血管成像术（OCTA）测量视网膜浅层毛细血管丛FAZ面积和形态指数。分析手术前后指标的变化及指标间的相关性。BCVA采用最小分辨角的对数（logMAR）表示，采用混合线性模型和Spearman相关分析进行统计分析。结果:共纳入患者30例（30只眼），均为单眼患病；其中18只右眼，12只左眼。患者年龄为（65.1±7.3）岁；男性17例（56.7%），女性13例（43.3%）。患者术前和术后1周、1个月、3个月的BCVA分别为0.82（0.70，0.85）、0.70（0.52，0.82）、0.70（0.52，0.70）、0.52（0.49，0.70），差异有统计学意义（ P<0.05）。患者术前和术后1周、1个月、3个月的FAZ面积分别为0.13（0.06，0.30）、0.17（0.08，0.26）、0.19（0.13，0.33）、0.27（0.18，0.40）mm 2，差异有统计学意义（ P<0.05）。患者术前和术后1周、1个月、3个月的FAZ形态指数分别为0.67（0.54，0.81）、0.71（0.66，0.77）、0.72（0.66，0.80）、0.75（0.55，0.84），差异有统计学意义（ P<0.05）。术后3个月BCVA与术前BCVA呈正相关，相关系数为0.579；术后3个月BCVA与术前FAZ面积、形态指数均呈负相关，相关系数分别为-0.461、-0.402，均有统计学意义（均 P<0.05）。 结论:IMEM患者行玻璃体切除联合黄斑前膜及内界膜剥除术后BCVA、FAZ面积、FAZ形态指数均有显著改善。术前BCVA和FAZ面积、形态指数与术后视力具有相关性，可以作为IMEM术后视力的预估指标。

abstractsObjective:To investigate microstructural changes of the macular area after surgery for idiopathic macular epiretinal membrane (IMEM) using optical coherence tomography angiography, so as to preoperatively predict the postoperative vision.Methods:This was a single-center, retrospective case series study. The clinical data of patients diagnosed with IMEM who underwent surgical treatment at the Affiliated Hospital of Guizhou Medical University from May 2019 to October 2020 were included. All affected eyes were treated with vitrectomy combined with epiretinal membrane and internal limiting membrane peeling. Data on best-corrected visual acuity (BCVA), foveal avascular zone (FAZ) area and acircularity index of the superficial capillary plexus were collected preoperatively and at 1 week, 1 month, and 3 months postoperatively. Changes in these indicators and their correlations were analyzed. BCVA was expressed in terms of the logarithm of the minimum angle of resolution (logMAR). Repeated measurement data were analyzed using a mixed linear model, and the Spearman correlation analysis was used for correlation assessment.Results:A total of 30 patients (30 eyes) were included. All patients had monocular involvement, including 18 cases in the right eye and 12 cases in the left eye. The mean age of the patients was (34.47±8.10) years. There were 17 male patients (56.7%) and 13 female patients (43.3%). The median BCVA was 0.82 (0.70, 0.85) before surgery, 0.70 (0.52, 0.82) at 1 week postoperatively, 0.70 (0.52, 0.70) at 1 month postoperatively, and 0.52 (0.49, 0.70) at 3 months postoperatively. There was a statistically significant difference in the BCVA between preoperative and postoperative time points ( F=34.67, P<0.001). The median FAZ area was 0.13 (0.06, 0.30) mm2 preoperatively, 0.17 (0.08, 0.26) mm2 at 1 week postoperatively, 0.19 (0.13, 0.33) mm2 at 1 month postoperatively, and 0.27 (0.18, 0.40) mm2 at 3 months postoperatively. A statistically significant difference in the FAZ area was observed between preoperative and postoperative time points ( F=43.69, P<0.001). The median preoperative acircularity index was 0.67 (0.54, 0.81), compared to 0.71 (0.66, 0.77) at 1 week postoperatively, 0.72 (0.66, 0.80) at 1 month postoperatively, and 0.75 (0.55, 0.84) at 3 months postoperatively. There was a statistically significant difference in the acircularity index between preoperative and postoperative time points ( F=58.15, P<0.001). The BCVA at 3 months postoperatively was positively correlated with the preoperative BCVA ( r=0.579, P=0.001). Additionally, the BCVA at 3 months postoperatively was negatively correlated with the preoperative FAZ area of the superficial capillary plexus ( r=-0.461, P=0.010) and preoperative acircularity index ( r=-0.402, P=0.028). Conclusion:Significant improvements in BCVA, FAZ area, and acircularity index were achieved in IMEM patients after pars plana vitrectomy combined with epiretinal membrane and internal limiting membrane peeling. The preoperative BCVA, FAZ area, and acircularity index can serve as predictive indicators for postoperative visual acuity in patients with IMEM.