Advances in the treatment of idiopathic macular epiretinal membrane / 中华实验眼科杂志

Idiopathic epiretinal membrane (iERM) is one of common fibroblast proliferative diseases in vitreoretinal interface and is significantly associated with aging.The treatment and management methods of iERM are limited, primarily including clinical following-up and vitrectomy.The time point of irreversible functional and structural damage of retina in macula is difficult to identify.Therefore, we can not predict whether surgery is safe when the symptoms of early iERM are mild, or whether surgical treatment should be postponed until metamorphopsia and vision loss occur.The formation of iERM is a process of retinal surface fibrosis, and fibrosis is a very common process in human body.Many studies on fibrosis have got a growing concern, which is helpful for us to find new treatment approch and also provides more clues of the causes of iERM.The research progress in the treatment of iERM was reviewed.

Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane

PURPOSE: To compare the visual acuity and retinal thickness in patients with an idiopathic epiretinal membrane (ERM) after vitrectomy and membranectomy using two different methods.METHODS: This retrospective observational study included 77 eyes (32 eyes in the diamond-dusted membrane scraper [DDMS] group, and 45 eyes in the intraocular forceps [IOF] group) of 77 patients with idiopathic ERM who underwent pars plana vitrectomy and membranectomy. The main outcome measures were best-corrected visual acuity (BCVA, logMAR) and mean retinal thickness.RESULTS: In the IOF group, the BCVA at postoperative 1 week was significantly lower than at baseline and had improved at 12 weeks after surgery. In the DDMS group, the BCVA at postoperative 1 week showed no significant difference at baseline and had improved at 4 weeks after surgery. The central macular thickness at postoperative 6 months was significantly lower than at baseline (all, p < 0.001); there was no significant difference between the two groups (p = 0.400). The postoperative macular thickness of the DDMS group was significantly lower than that of the IOF group in the inner inferior and outer inferior areas at postoperative 12 weeks and 4 weeks (p = 0.046 and p = 0.039, respectively). Five eyes of the DDMS group and 15 eyes of the IOF group developed cystoid macular edema, 14 eyes of that improved without treatment.CONCLUSIONS: In patients with ERM, the use of DDMS or IOF for vitrectomy and membranectomy both resulted in improved visual acuity and decreased mean retinal thicknesses.

Visual and Structural Differences in Idiopathic Epiretinal Membrane According to the Presence of Retinoschisis

PURPOSE: To present differences in visual acuity and macular structure before and after surgery in patients with idiopathic epiretinal membrane (ERM) according to the presence of retinoschisis. METHODS: This retrospective observational study included 324 eyes with idiopathic ERM, that underwent pars plana vitrectomy with ERM and internal limiting membrane peeling, and were followed for more than 6 months. Subjects were classified into two groups according to the presence of retinoschisis using preoperative optical coherence tomography (OCT; group 1, ERM with retinoschisis; group 2, ERM without retinoschisis). Preoperative and postoperative macular structure changes and surgical outcomes were compared. RESULTS: Group 1 included 61 eyes, and group 2 included 263 eyes. Group 1 had a significantly higher preoperative and final postoperative best-corrected visual acuity compared with group 2 (p = 0.01, p = 0.02). Preoperative disorganization of retinal inner layers (DRIL) was significantly less in group 1 than group 2 (p = 0.01). Preoperative central macular thickness was not significantly different between the two groups. However, postoperative central macular thickness was significantly lower in group 1 than group 2 (p = 0.02, p = 0.01, p < 0.01). The ratio of the inner or outer layer in the total retinal thickness before surgery was significantly smaller in group 1 than in group 2 (p = 0.02, p = 0.04). CONCLUSIONS: Preoperative visual acuity was better and the occurrence of DRIL was less in idiopathic ERM with retinoschisis than without retinoschisis. Postoperative visual and structural outcome was better in idiopathic ERM with retinoschisis than without retinoschisis. Retinoschisis may have played a role in reducing the tractional force given to the inner and outer retina.

Two structural predictors of visual outcome of idiopathic epiretinal membrane surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate two structural predictors of visual outcome of epiretinal membrane surgery.METHODS:Retrospective study for 30 eyes of epiretinal membrane surgery between January 2014 and October 2016.We assessed the related parameters of the optical coherence tomography and recorded the best-corrected visual acuity(BCVA) at baseline and 1,3 and 6mo after surgery.Correlations between the final best-corrected visual acuity and photoreceptor integrity status or photoreceptor outer segment length were investigated.RESULTS:Average best-corrected visual acuity decreased at 1mo postoperatively compared with baseline,but improved at 3 and 6mo.Central macular were more sweller at 1mo postoperatively than baseline,but a significant thickeness reduction was found at 6mo (P＜ 0.05).Photoreceptor outer segment length were shortened at 1 mo compared with preoperation (P＜0.05),gradually approached the baseline level at 3 and 6mo.Multivariate regression the final best-corrected visual acuity associated with photoreceptor integrity and photoreceptor outer segment length (P=0.023,0.004).CONCLUSION:Photoreceptor integrity and photoreceptor outer segment length detected by OCT were significant predictors of the final best-corrected visual acuity(BCVA) after idiopathic epiretinal membrane surgery.

Intraoperative Foveal Traction in Patients with Epiretinal Membrane

PURPOSE: To determine influences of intraoperative foveal traction during membrane peeling in idiopathic epiretinal membrane (ERM) surgery. METHODS: This retrospective observational study included 46 eyes of 46 patients with idiopathic ERM who underwent pars plana vitrectomy with ERM and internal limiting membrane peeling from February 2015 to September 2015. The presence of intraoperative foveal traction during membrane peeling was reviewed using video records. The main outcome measures were best-corrected visual acuity (BCVA), central foveal thickness (CFT), foveal contour, and photoreceptor inner segment/outer segment junction disruption using optical coherence tomography at baseline and at 1, 3, 6, and 12 months after surgery. RESULTS: Group 1 (ERM with intraoperative foveal traction) included 22 eyes, and group 2 (ERM without intraoperative foveal traction) included 24 eyes. Preoperatively, convex pattern ERM was observed more often in group 1. Group 1 had a significantly thicker CFT and a lower BCVA compared to group 2 at baseline and during the first 6 months, but the final postoperative BCVA and CFT were not significantly different between the groups at 12 months. Among 22 eyes, 12 eyes (54.5%) were restored to flat or concave ERM patterns at an average of 5.4 months after surgery in group 1, and 18 out of 24 eyes (75%) recovered at 2.4 months (p < 0.01) in group 2. CONCLUSIONS: Preoperative thick CFT and convex pattern ERM indicated a high possibility of intraoperative foveal traction in idiopathic ERM surgery. There were no differences in long-term BCVA and restoration of foveal configuration according to foveal traction during membrane peeling.

Choroidal Thickness Changes Following Vitrectomy in Epiretinal Membrane Based on the Optical Coherence Tomography Pattern

PURPOSE: To analyze the influence of morphological classification in epiretinal membrane (ERM) based on surgical outcomes and optical coherence tomography (OCT) of the postoperative choroidal thickness. METHODS: This observational study included 122 eyes with ERM who underwent vitrectomy. Using OCT, the preoperative ERM was classified into six types: cystoid macular edema (CME), convex, flat, normal foveal contour (Normal), pseudolamellar hole (PLH), and vitreomacular traction (VMT). The preoperative multifocal electroretinogram (mfERG), postoperative change in subfoveal choroidal thickness (SCT), central macular thickness (CMT), and best-corrected visual acuity (BCVA) were compared. RESULTS: Preoperative subfoveal choroidal thickness increased in the VMT type compared to the fellow eye (207 µm vs. 234 µm, p = 0.028). Choroidal thickness decreased in all types at 12 months after vitrectomy (all, P < 0.05). There was a positive linear correlation between the mfERG and the preoperative BCVA (p = 0.001). The initial visual acuity was best in the Normal type followed by the flat, PLH, convex, CME, and VMT types (p = 0.001). The final visual acuity was the best in the Normal type, followed by the PLH, Flat, VMT, Convex, and CME types (p = 0.030). Gas tamponade during the surgery did not affect the surgical outcomes of the CMT (p = 0.458), BCVA (p = 0.550), and SCT (p = 0.127). CONCLUSIONS: Preoperative SCT increased only in the VMT type, but choroidal thickness decreased in all types after vitrectomy, regardless of the preoperative morphology.

Vitrectomy combine with double membranes peeling for idiopathic epiretinal membrane / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the efficacy and safety of vitrectomy combine with internal limiting membrane peeling and epiretinal membranes peeling in the treatment of idiopathic epiretinal membrane(IERM). <p>METHODS: In this retrospective study, 53 patients(53 eyes)who underwent vitrectomy for IERM from January 2015 to December 2015 were evaluated, with 24-month follow-up. Only removal of the epiretinal membrane(ERM group)was performed in 21 patients, while 32 had removal of the epiretinal membrane associated with internal limiting membrane peeling(ERM+ILM group). The best corrected visual acuity(BCVA), central macular thickness(CMT)and the complications were observed and analyzed before operation, 1, 3, 12, 24mo after operation. <p>RESULTS: Both groups showed significant improvement of BCVA when compared to preoperative BCVA(<i>P</i><0.05). In ERM group the BCVA before and 1, 3, 12 and 24mo after operation were 0.676±0.137,0.576±0.099, 0.551±0.085, 0.514±0.077, 0.506±0.032, and in ERM+ILM group were 0.659±0.132, 0.582±0.111, 0.578±0.101, 0.523±0.062, 0.511±0.081. The comparison between the two groups at 1, 3,12 and 24mo after surgery were no significant differences(<i>P</i>>0.05). After operation, statistically significant CMT reduction occurred in both groups(<i>P</i><0.05). In ERM group the preoperative and postoperative CMT were 461.14±13.477μm, 402.36±11.346μm, 368.52±13.216μm, 325.24±8.246μm, 273.29±8.973μm, and in ERM+ILM group were 462.47±14.287μm, 414.72±9.237μm, 373.44±8.328μm, 328.94±6.923μm, 274.28±8.340μm. There were no significant difference between the two groups at 1, 3, 12 and 24 after operation(<i>P</i>>0.05). There were 3 cases(3 eyes)had retinal punctate hemorrhage after operation, of which 1(5%)was from the ERM group and 2(6%)were from the ERM+ILM group. No significant difference was observed between the groups(<i>P</i>=1.000). At the end of follow-up, 4 cases(19%)presented with recurrence of the epiretinal membrane all from the ERM group, and there no recurrence was found in ERM+ILM group, and the difference was statistically significant(<i>P</i>=0.020).<p>CONCLUSION: Vitrectomy with ILM peeling and epiretinal membranes peeling for the treatment of epiretinal membrane is the efficacy and safety, and it may reduce the recurrence.

Clinical classification and collagen measurement for idiopathic epiretinal membrane / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To decide the type of the idiopathic epiretinal membrane by measuring collagens.<p>METHODS: Totally 25 cases(25 eyes)were divided into cellophane macular reflex membrane(CMRM)and preretinal macular fibrosis membrane(PMFM)by fundus manifestation. Then the specimens of peeled idiopathic epiretinal membranes were made immunohistochemistry and measured for the collagen of Ⅵ and Ⅰ and Ⅱ. The coincidence rate were tested between the fundus examination and pathological examination. <p>RESULTS: The idiopathic epiretinal membranes were classified into 10 CMRM and 15 PMFM by fundus manifestation. The immunohistochemical specimens were classified into 16 Ⅵ collagens and 9Ⅰ or Ⅱ collagens.<p>CONCLUSION: The pathological examination is the means of the type of the idiopathic epiretinal membranes.

The Thickness of Each Retinal Layer and Visual Acuity after Vitrectomy in Idiopathic Epiretinal Membrane

PURPOSE: In this study, we evaluated the thickness of each retinal layer using spectral-domain optical coherence tomography (OCT) and investigated the correlation between the thickness of each retinal layer and postoperative visual acuity in eyes with idiopathic epiretinal membrane (ERM). METHODS: This retrospective study included 46 eyes from 46 patients with idiopathic ERM who underwent pars plana vitrectomy. Each retinal layer thickness was measured by spectral-domain OCT before operation and at 1, 3, and 6 months after operation. The thickness of each retinal layer was evaluated in the control group before the operation. We performed an analysis of the changes in thickness of each retinal layer at 6 months after operation and then investigated the correlation between the retinal layer thickness and visual improvement. RESULTS: Preoperatively, the thickness of the retinal nerve fiber layer (RNFL) in the ERM group showed more increased compared with that in the control group, and the thickness of photoreceptors and retinal pigment epithelium were decreased compared to those in the control group. At 6 months after the operation, thickness changes were reduced at the RNFL, ganglion cell layer (GCL), inner plexiform layer (IPL), GCL-IPL complex, and outer plexiform layer, while the photoreceptor layer increased compared with the values preoperatively. Differences in the preoperative thickness of GCL between the two groups had a significant correlation with postoperative visual acuity (r = 0.477, p = 0.008). CONCLUSIONS: Differences in preoperative thickness of the GCL between the two groups had a significant correlation with postoperative visual acuity. The greater was the thickness of the GCL, the worse was the visual outcome.

Clinical Outcomes of Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane in Epiretinal Membrane Surgery

PURPOSE: In this study we compared the clinical outcomes of idiopathic epiretinal membrane (ERM) surgery according to the use of indocyanine green (ICG) and ICG exposure time. METHODS: The medical records of 76 patients with an idiopathic ERM that underwent vitrectomy and ERM and internal limiting membrane (ILM) removal were reviewed. We compared the results (best corrected visual acuity [BCVA, log MAR] and central macular thickness [CMT, µm]) of idiopathic ERM surgeries using ILM peeling with (group I, 39 eyes) and without ICG (group II, 37 eyes). Additionally, the correlation of ICG exposure time and clinical outcomes in group I was analyzed. RESULTS: Gender, age, lens state, preoperative BCVA, and preoperative CMT were not significantly different between the two groups. The postoperative BCVA was significantly improved in both groups but the difference was not statistically significant. The postoperative CMT was significantly improved in both groups and the change amount of group I was more larger than group II. Additionally, ICG exposure time was not significantly correlated with changes of BCVA and CMT. CONCLUSIONS: Intravitreal ICG-assisted ILM peeling did not significantly affect the recovery of BCVA, however that impaired the recovery of CMT. ICG exposure time did not affect the postoperative visual outcome.

Reproliferation of Idiopathic Epiretinal Membrane after Spontaneous Separation

PURPOSE: To report the reproliferation of membrane after a spontaneous separation in a patient with idiopathic epiretinal membrane (ERM). CASE SUMMARY: A 62-year-old woman complained of metamorphopsia in the left eye. Her vision without correction was 0.8. On fundus examination, the epiretinal membrane was covering the fovea with posterior vitreous detachment. Optical coherence tomography (OCT) showed the ERM and thickened macula. Retinal break, intraocular inflammatory disease, and retinal vascular disease were not noted. We diagnosed her with idiopathic ERM and followed up regularly. At month 7, a partial separation of the membrane from the retinal surface was noted. At month 12, complete spontaneous separation of the ERM from the macula except that in the temporal area was accompanied by improvement of vision to 1.0. OCT, showing recovery of the fovea contour. However, her corrected vision decreased to 0.7 at month 17, and the ERM was again observed to cover the macula. Thickening of the ERM progressed further, and her corrected vision decreased to 0.5 at month 21. CONCLUSIONS: Spontaneous separation of membrane is a rare phenomenon in idiopathic ERM. Reproliferation of membrane can develop and induce visual impairment. Therefore, regular examination is recommended in patients with spontaneous separation of membrane.

Effect of Posterior Subtenon Triamcinolone Injection during Vitrectomy for Idiopathic Epiretinal Membrane

PURPOSE: To evaluate the effect of posterior sub-Tenon triamcinolone acetonide injection combined with vitrectomy for idiopathic epiretinal membrane (ERM). METHODS: This study included 40 eyes of 40 patients who underwent vitrectomy and membrane peeling for idiopathic ERM. Triamcinolone acetonide (40 mg) was injected into the posterior sub-Tenon space following vitrectomy in 20 eyes of the injected group. The other 20 eyes that did not receive the injection were selected as the control group to match preoperative visual acuity and central macular thickness with the injected group. Pre- and postoperative best-corrected visual acuity, central macular thickness, intraocular pressure, and complications were compared between the 2 groups. RESULTS: The average visual acuity in the injected group improved from 0.56 +/- 0.23 (log MAR) at baseline to 0.52 +/- 0.36 at 1 month, 0.44 +/- 0.39 at 3 months, and 0.38 +/- 0.41 at 6 months postoperatively. Central macular thickness decreased from 456.2 +/- 86.2 to 399.0 +/- 60.1 at 1 month, 377.1 +/- 71.5 at 3 months, and 353.1 +/- 57.4 at 6 months postoperatively. In the control group, average visual acuity improved from 0.56 +/- 0.23 at baseline to 0.53 +/- 0.25 at 1 month, 0.41 +/- 0.20 at 3 months, and 0.37 +/- 0.24 at 6 months postoperatively. Central macular thickness decreased from 456.4 +/- 74.8 to 394.9 +/- 63.5 at 1 month, 377.2 +/- 56.8 at 3 months, and 358.0 +/- 57.2 at 6 months postoperatively. Significant differences in visual acuity and central macular thickness were not observed between the 2 groups before surgery and during the follow-up period. Intraocular pressure and complications were similar. CONCLUSIONS: Posterior sub-Tenon injection of triamcinolone acetonide combined with vitrectomy for idiopathic epiretinal membrane did not affect postoperative anatomical and functional outcomes.

Resultados visuales y anatómicos post-operatorios obtenidos mediante el empleo de vitrectomía pars plana en el pelaje de membranas epirretinianas idiopáticas / Anatomical and visual post-operative results using pars plana vitrectomy in idiopathic epiretinal membranes peeling procedure

Objetivo: examinar resultados anatómicos y visuales de los pacientes con membranas epirretinianas idiopáticas (MER) tratados mediante pelaje de membranas y su correlación funcional post-operatoria. Métodos: Estudio de serie de casos donde se revisaron las historias clínicas de 27 pacientes elegidos de manera aleatoria y a quienes se realizó pelaje de membranas epirretinianas idiopáticas con seguimiento clínico por 6 meses del post-operatorio. Al 90% (n=24) de los pacientes se les realizó cirugía combinada de facovitrectomía. Se tomaron como variables a analizar la agudeza visual pre y post-operatoria a la semana, al mes y a los 6 meses, tomografía de coherencia óptica pre y post-operatoria al mes y a los 6 meses de la cirugía. Se comparó la agudeza visual y el grosor retiniano en el milímetro central entre la medida pre y postoperatoria utilizando la prueba de t de student. Resultados: la media de agudeza visual pre-operatoria fué de 20/60 y post-operatoria (6 meses) de 20/30. La media del grosor retiniano en el milímetro central pre-operatoria resultó 409.7 micras con un valor post-operatoria (6 meses) de 341 micras. En el 82% de los pacientes se observó una mejoría en la agudeza visual post-operatoria a los 6 meses. Los pacientes con mejores agudezas visuales fueron aquellos cuya agudeza visual pre-operatoria estuvo alrededor del 20/50. Conclusiones: la agudeza visual y el grosor retiniano pre-operatorio son los mejores factores pronósticos para estimar la agudeza visual post-operatoria en pacientes operados con diagnóstico de MER. La agudeza visual post-operatoria definitiva se alcanza posterior a los 6 meses de la cirugía. Se recomienda establecer como punto de corte para la decisión quirúrgica aquellos pacientes con agudezas visuales de 20/50 o peor.

Objective: to examine anatomic and visual outcomes in patients undergoing epiretinal membrane surgery. Methods: a case series study. Twentyseven eyes from 27 patients who underwent epiretinal membrane surgery were reviewed. Correlations between preoperative and first week, one and six months post-operative bestcorrected visual acuity and Optical Coherence Tomography (OCT) findings were obtained and analyzed using t student test. Results: mean pre-operative best corrected visual acuity (BCVA) was 20/60 and six months post-op was 20/30. Mean pre-op retinal central thickness was 409.7 microns and six months post-op was 341 microns. BCVA significantly improved in 82% of the patients after six months of surgery. Patients whom achieved higher BCVA levels post-op were those with pre-op BCVA around 20/50. Conclusions: pre-operative BCVA and central retinal thickness are the most importante factors to estimate post-operative BCVA. Highest BCVA levels were achieved after six months of surgery. It is recommended to use pre-op BCVA of 20/50 as cut-off level to consider surgical treatment.

Surgical Outcomes in Epiretinal Membrane According to the Presence of Vitreomacular Traction Syndrome

PURPOSE: To present preoperative macular structure deformities and surgical outcomes in idiopathic epiretinal membrane (ERM) patient according to the presence of vitreomacular traction syndrome (VMTS). METHODS: This retrospective observational study included 54 eyes of 51 patients with idiopathic ERM, who underwent pars plana vitrectomy with ERM and internal limiting membrane (ILM) peeling, and were followed for more than 6 months. Subjects were classified into 2 groups according to the presence of VMTS using preoperative optical coherence tomography (group 1: ERM without VMTS, 29 eyes; group 2: ERM with VMTS, 22 eyes). Preoperative macular structure deformity and surgical outcomes were compared and prognostic factors were analyzed. RESULTS: Group 1 (ERM without VMTS) included 29 eyes, and group 2 (ERM with VMTS) included 22 eyes. Group 2 had a significantly higher occurrence of lamellar macular hole and a significantly lower preoperative best-corrected visual acuity (BCVA) compared to group 1. However, final postoperative BCVAs were not significantly different between the groups because BCVA changed more in group 2. Preoperative macular structure deformities (irregular retinal surface, retinal thickening, lamellar macular hole, and cystoid macular edema) did not affect visual outcomes. The presence of photoreceptor inner segment/outer segment (IS/OS) junction disruption and preoperative BCVA were highly related with visual outcomes. CONCLUSIONS: BCVA significantly improved in idiopathic ERM patients who underwent pars plana vitrectomy with ERM and ILM peeling regardless of the presence of VMTS. There may be a stronger association of IS/OS junction disruption with visual acuity compared to VMTS in idiopathic ERM surgery.

Surgical Outcomes in Epiretinal Membrane According to the Presence of Vitreomacular Traction Syndrome

PURPOSE: To present preoperative macular structure deformities and surgical outcomes in idiopathic epiretinal membrane (ERM) patient according to the presence of vitreomacular traction syndrome (VMTS). METHODS: This retrospective observational study included 54 eyes of 51 patients with idiopathic ERM, who underwent pars plana vitrectomy with ERM and internal limiting membrane (ILM) peeling, and were followed for more than 6 months. Subjects were classified into 2 groups according to the presence of VMTS using preoperative optical coherence tomography (group 1: ERM without VMTS, 29 eyes; group 2: ERM with VMTS, 22 eyes). Preoperative macular structure deformity and surgical outcomes were compared and prognostic factors were analyzed. RESULTS: Group 1 (ERM without VMTS) included 29 eyes, and group 2 (ERM with VMTS) included 22 eyes. Group 2 had a significantly higher occurrence of lamellar macular hole and a significantly lower preoperative best-corrected visual acuity (BCVA) compared to group 1. However, final postoperative BCVAs were not significantly different between the groups because BCVA changed more in group 2. Preoperative macular structure deformities (irregular retinal surface, retinal thickening, lamellar macular hole, and cystoid macular edema) did not affect visual outcomes. The presence of photoreceptor inner segment/outer segment (IS/OS) junction disruption and preoperative BCVA were highly related with visual outcomes. CONCLUSIONS: BCVA significantly improved in idiopathic ERM patients who underwent pars plana vitrectomy with ERM and ILM peeling regardless of the presence of VMTS. There may be a stronger association of IS/OS junction disruption with visual acuity compared to VMTS in idiopathic ERM surgery.

Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.

Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.

Relationship of the change of macular thickness and microstructure with visual acuity in eye with idiopathic epiretinal membrane / 中华实验眼科杂志

Background Traction of epiretinal membrane results in macular morphologic change and visual functional impairment in eye with idiopathic epiretinal membrane (IERM),therefore figuring out their relationship is helpful for evaluation of disease prognosis.Objective This study was to observe the morphological change of macula and microstructure,and analyze the relationship between retina thickness,integrity of cone outer segment tips (COST) line in fovea and visual acuity.Methods This was a retrospective case-observational study.Fifty-six consecutive cases diagnosed as IERM in Zhongshan Ophthalmic Center from March 2011 to December 2011 were enrolled in this study,and all the patients showed unilateral IERM with the normal fellow eyes.Sixteen patients were males and 40 were females,with a mean age of (61.05 ± 6.58) years old.Spectral-domain optical coherence tomography (SD-OCT) examination was performed on the eyes,and Macular Cube (512×128) and HD 5 Line program were selected.Mean retinal thickness of central area (＜1 mm diameter),inner ring area (1-3 mm diameter) and outer ring area (＞3-6 mm diameter) of macula and the status of COST line (intact or fractured) was recorded.Mean thickness of whole macular areas and the difference of foveal microstructure were compared,and the correlation between retinal thickness and visual acuity was analyzed using Pearson linear correlation analysis.Related parameters including age,visual acuity,retinal thickness were also compared between the continuous COST lines group and the fractured COST lines group by independent sample t test.Results The flatted or disappeared fovea was seen in IERM eyes on the SD-OCT image.Retinal thicknesses were (446±89)μm,(418±64)μm and (328±34)ttm in the central area,inner ring area and outer ring area of macula in the IERM eyes,exhibiting significant increasing in comparison with (250±22) μm,(319±17) μm and (279±17) μm in the normal fellow eyes (t=13.370,9.523,7.769,all P =0.000).Significantly negative correlations were found between the visual acuity and the central macular thickness,inner ring thickness or outer ring thickness (r=-0.686,-0.653,-0.417,P＜0.05).In the IERM eyes,COST band was intact in 20 eyes and lack in 36 eyes.Compared with COST band intact group,aging,worse vision and increased retinal thickness were seen in the COST band absent group (t =2.109,P =0.039 ; t =-4.093,P =0.000 ; t =6.669,P=0.000;t=5.376,P=0.000;t=4.247,P=0.000).COST band was clear in all the normal fellow eyes on the SD-OCT image.Conclusions Increase of macular thickness and disruption of COST band reflect the visual function damage in IERM eye.Deficiency of COST band on OCT image seems to be an early indication of photoreceptor damage.Incomplete fovea COST band is often seen in older patients.

Morphologic and Functional Evaluation before and after Vitrectomy in Idiopathic Epiretinal Membrane Patients Using Microperimetry

PURPOSE: To investigate the relationship between photoreceptor inner/outer segment (IS/OS) integrity and macular sensitivity after epiretinal membrane (ERM) surgery using spectral-domain optical coherence tomography combined with microperimetry. METHODS: 20 eyes of 20 patients with idiopathic ERM who underwent pars plana vitrectomy for ERM removal were prospectively reviewed. The IS/OS defect diameter, BCVA, macular sensitivity, and fixation stability were measured using spectral-domain optical coherence tomography combined with microperimetry. The correlation of these factors was analyzed. RESULTS: The macular sensitivity improved after successful ERM surgery (p < 0.001), but the IS/OS defect diameter has not improved. The preoperative and postoperative macular sensitivity were negatively correlated with preoperative IS/OS defect diameter (p = 0.035, p = 0.006). The fixation stability was not correlated with preoperative IS/OS defect diameter. CONCLUSIONS: Macular sensitivity showed significant correlation with IS/OS defect diameter. Macular sensitivity is vital functional parameter allows subjective quantification of the retinal function and reflects morphologic changes.

Combined Clear Corneal Phacoemulsification and Vitrectomy Versus Two-Step Surgery in Korean Patients With Idiopathic Epiretinal Membrane

PURPOSE: To evaluate the surgical outcomes on the combined procedures of phacoemulsification, intraocular lens (IOL) implantation, and vitrectomy, and to compare clinical results with sequential surgery results in Korean patients with idiopathic epiretinal membrane. METHODS: The present retrospective study included 20 eyes of 19 patients with idiopathic epiretinal membrane who underwent combined phacoemulsification, IOL implantation, and pars plana vitrectomy (combined surgery), and 18 eyes of 18 patients who underwent phacoemulsification and IOL implantation subsequent to vitrectomy (sequential surgery). Postoperative clinical results and intra- and postoperative complications were compared between the 2 groups. RESULTS: Postoperative best corrected visual acuity (BCVA) (logMAR) was 0.41 +/- 0.42 in the combined group, and 0.35 +/- 0.37 in the sequential group. There was no significant difference in BCVA between the 2 groups (p = 0.675). The mean refractive prediction error was -0.46 +/- 0.88 diopters (D) in the combined group, and -0.06 +/- 0.68 D in the sequential group, showing no statistically significant difference between the 2 groups (p = 0.147). The present study showed no major differences between the 2 groups in complications such as intraoperative mild corneal edema, postoperative ocular hypertension, and lens capsular opacity. CONCLUSIONS: Combined phacoemulsification, IOL implantation, and pars plana vitrectomy as well as the two-step procedure are safe and effective for treating patients with idiopathic epiretinal membrane.