目的：利用光学相干断层扫描血管成像(OCTA)观察特发性黄斑前膜(IMEM)患者术眼与对侧正常眼、术前与术后黄斑区形态结构及血流灌注的差异，分析其与手术预后的相关性，并以此协助评估患者预后。

方法：前瞻性研究。连续收集2023年1月至2024年12月就诊于浙江省人民医院的单眼IMEM患者，并选取患者对侧健康眼作为对照组。所有研究对象行OCT、OCTA和眼底照相检查，重点观察IMEM患眼组术前，术后1、3 mo最佳矫正视力(BCVA)、中央黄斑区厚度(CMT)、中心凹无血管区(FAZ)面积、视网膜内层、浅层、深层毛细血管丛(ICP、SCP、DCP)密度以及脉络膜毛细血管层灌注面积(CCPA)的变化。并对上述检查参数与术后BCVA、CMT进行相关性分析。

结果：本研究纳入IMEM患者30例60眼，其中男14例，女16例，年龄65.4±10.8岁。与对侧眼比较，IMEM患眼术前BCVA较差，DCP、FAZ显著偏小，CMT、CCPA增加。与术前比较，术后1、3 mo患眼CMT显著降低(均P<0.05)，DCP、BCVA明显改善(均P<0.05)，FAZ无明显变化(均P>0.05)。术后3 mo，患眼BCVA与CMT呈负相关(r=-0.549，P=0.022)； 术后1 mo CMT与术前DCP、FAZ呈负相关，与术前CMT呈正相关，与术后1 mo ICP、SCP呈正相关，与术后1 mo FAZ呈负相关(均P<0.05)。此外，术后3 mo CMT与术前DCP呈负相关(r=-0.498，P=0.042)。

结论：IMEM患者患眼的DCP及FAZ面积减小，CMT及CCPA增大。患者术后CMT降低，DCP有所恢复，视力也逐渐改善。术前更小的CMT、更大的DCP及FAZ面积，术后更小的ICP、SCP及更大的FAZ面积提示更好的手术预后。

METHODS:A prospective study was conducted at Zhejiang Provincial People's Hospital between January 2023 and December 2024. Consecutive patients diagnosed with unilateral IMEM were enrolled; the fellow eye served as an internal control. All participants underwent standardized ophthalmic evaluations, including optical coherence tomography(OCT), OCTA, and color fundus photography. Key quantitative parameters assessed included best-corrected visual acuity(BCVA), central macular thickness(CMT), foveal avascular zone(FAZ)area, vessel density in the inner capillary plexus(ICP), superficial capillary plexus(SCP), deep capillary plexus(DCP), and choroidal capillary perfusion area(CCPA). Measurements were obtained preoperatively and at 1 and 3 mo postoperatively. Correlation analyses were performed between the above parameters and postoperative BCVA and CMT.

RESULTS: This study enrolled 30 patients(60 eyes)diagnosed with IMEM, comprising 14 males and 16 females, with a mean age of 65.4±10.8 y.At baseline, IMEM-affected eyes demonstrated significantly reduced BCVA, DCP density, and FAZ area, alongside significantly increased CMT and CCPA, compared with contralateral controls. Following vitrectomy with membrane peeling, CMT decreased significantly at both 1 and 3 mo(both P<0.05)postoperatively; DCP density and BCVA showed significant improvement(both P<0.05). No significant change in FAZ area was observed postoperatively(P>0.05). At 3 mo postoperatively, BCVA of the affected eye was negatively correlated with CMT(r=-0.549, P=0.022). At 1 mo postoperatively, CMT was negatively correlated with preoperative DCP and FAZ, positively correlated with preoperative CMT, and positively correlated with ICP and SCP at 1 mo postoperatively, and negatively correlated with FAZ at 1 mo postoperatively(all P<0.05). Furthermore, CMT at 3 mo postoperatively was negatively correlated with preoperative DCP(r=-0.498,P=0.042).

CONCLUSION:In patients with IMEM, the affected eyes exhibit significantly reduced DCP density and FAZ area, alongside increased CMT and CCPA. Following vitrectomy with membrane peeling, CMT decreased progressively, DCP density demonstrated partial restoration, and vision improved gradually. Preoperatively, smaller CMT larger DCP, and FAZ were associated with more favorable surgical outcomes; postoperatively, smaller ICP and SCP densities—combined with a larger FAZ—also correlated with better functional recovery.