目的：对比特发性黄斑前膜(iERM)和糖尿病性黄斑前膜(dERM)玻璃体切除手术(PPV)前后黄斑区微循环的变化，评估PPV对两种不同类型黄斑前膜(ERM)的影响。方法：对2020-04/07于我院就诊并行PPV联合ERM、内界膜(ILM)剥除手术的24例ERM患者的临床资料进行回顾性分析。其中iERM患者12例12眼，dERM患者12例12眼。同时选取2019-09/2020-07行PPV联合ERM、ILM剥除术的iERM患者的对侧健眼16例16眼作为正常对照组。所有患者随访均超过3mo。对比分析两组患者手术前后黄斑区微循环状态，包括黄斑中心凹无血管区(FAZ)面积、黄斑区血流密度(MVD)，包括浅层血流密度(SVD)和深层血流密度(DVD)，并对两组手术的预后进行比较。结果：术前iERM组和dERM组FAZ面积显著小于正常对照组(P<0.05)； iERM组和dERM组总SVD均低于正常对照组，且dERM组低于iERM组，但均无差异； iERM组和dERM组总体DVD均低于正常对照组(P<0.05)； iERM组中心凹SVD高于dERM组和正常对照组，iERM组中心凹DVD高于正常对照组(P<0.05)。iERM组和dERM组旁中心凹SVD均低于正常对照组，但仅dERM组和正常对照组相比有差异(P<0.05)。iERM组和dERM组旁中心凹DVD均低于正常对照组(P<0.05)。iERM组和dERM组术后BCVA较术前均显著改善(P<0.05)，两组SVD较术前相比均无明显差异； iERM组术后总体DVD和旁中心凹DVD较术前明显增高(P<0.05)； dERM组术后DVD较术前稍有提高，但均无差异。iERM组和dERM组术后BCVA、SVD及DVD均无明显差异。结论：dERM患者黄斑区微循环的改变比iERM患者明显； PPV联合ERM、ILM剥除术后早期，iERM患者DVD有所改善，而dERM患者改善不明显。

AIM:To compare the changes of macular microcirculation in eyes with idiopathic and diabetic macular epiretinal membrane(ERM)before and after pars plana vitrectomy(PPV), and to evaluate the prognosis of the two types of ERM.METHODS:We conducted a retrospective study on 24 patients(24 eyes), 12 patients(12 eyes)with idiopathic macular epiretinal membrane(iERM)and 12 patients(12 eyes)with diabetic macular epiretinal membrane(dERM)who underwent PPV combined with ERM and internal limiting membrane(ILM)peeling from April 2020 to July 2020. In addition, 16 contralateral healthy eyes of iERM patients who underwent PPV combined with ERM and ILM removal from September 2019 to July 2020 were selected as the normal control group. All patients were followed up for more than 3mo. The area of foveal avascular zone(FAZ)and the macular vascular density(MVD), including superficial macular vascular density(SVD)and deep macular vascular density(DVD)were compared before and after surgery. And the prognosis was also analysed.RESULTS: The area of FAZ in the iERM group and dERM group before surgery were significantly smaller than that in the control group(P<0.05); The total SVD in the iERM and dERM groups were lower than that in the control group, and the dERM group was lower than that in the iERM group, but no statistically significant difference was found. The total DVD in the iERM and dERM groups was significantly lower than that in the control group(P<0.05). The foveal SVD in the iERM was significantly higher than that in the dERM and control groups, and the foveal DVD in the iERM was significantly higher than that in the control group(P<0.05). The parafoveal SVD in the iERM and dERM groups were lower than that in the control group, but only the difference was obvious between the dERM and the control group(P<0.05). The parafoveal DVD in the iERM and dERM groups were significantly lower than that in the control group(P<0.05). Postoperative visual acuity was significantly improved in the iERM group and dERM group(P<0.05), but the SVD was barely changed. The total and parafoveal DVD in the iERM group were statistically higher than those before surgery(P<0.05). DVD in the dERM group was higher than it was before surgery, but with no statistically difference. There were no differences in the visual acuity, SVD and DVD between the iERM and dERM groups after operation.CONCLUSION: The changes of macular microcirculation in dERM were more obvious than those in iERM. DVD in the iERM patients was improved at the early stage after operation, while the improvement was not obvious in the dERM patients.