Original article
Associations Between Macular Findings by Optical Coherence Tomography and Visual Outcomes After Epiretinal Membrane Removal

https://doi.org/10.1016/j.ajo.2008.09.020Get rights and content

Purpose

To identify characteristics measured by optical coherence tomography (OCT) that are correlated with visual outcome after epiretinal membrane (ERM) removal by pars plana vitrectomy (PPV).

Design

Interventional, prospective, randomized case series.

Methods

One hundred and one eyes of 101 patients with idiopathic ERM underwent PPV for ERM removal. Ophthalmic evaluations included best-corrected visual acuity (BCVA) and Stratus OCT preoperatively at 3 and 6 months postoperatively. Relations between three OCT features including integrity of junction between inner and outer segments of photoreceptors (IS/OS junction), macular thickness, foveal contour and the three visual acuity parameters such as preoperative BCVAs, postoperative BCVAs, and the differences between preoperative and postoperative BCVAs (BCVA differences) were evaluated with respect to time.

Results

Eyes with disruption of IS/OS junction had significantly lower postoperative BCVA and BCVA differences than those without disruption (P < .0001, respectively). “Same” (increment or decrement of BCVA up to 1 Snellen line) and “Better” (visual increment of at least 2 Snellen lines) BCVA outcome groups were significantly different with respect to the status of IS/OS junction (P < .005). An increase in the proportion of eyes with photoreceptor disruption was observed at 3 months postoperatively, and this proportion was maintained afterward. Preoperative macular thicknesses showed a positive correlation with BCVA differences, and postoperative macular thicknesses negatively correlated with postoperative BCVA (r > 0.25; P < .05, respectively). Thickness difference and foveal contour were not correlated with the three parameters of visual outcome (P > .05, respectively).

Conclusion

Photoreceptor disruption detected by OCT was found to be a predictor of poor visual outcome in eyes with idiopathic ERM, and it was found that this disruption may be irreversible. Thus, early membrane removals may beneficially prevent further progression of photoreceptor damage in ERM patients with photoreceptor disruption.

Section snippets

Patients and Sample Collection

A total of 120 eyes of 120 patients operated on for idiopathic ERM removal between January 2004 and November 2006 were enrolled in this study. Patients were followed up for at least 3 months after surgery at Seoul National University Hospital (SNUH) and Seoul National University Bundang Hospital (SNUBH). Exclusion criteria included: 1) eyes with secondary ERM, such as diabetic retinopathy, venous occlusion, retinal detachment (RD), uveitis, or trauma; 2) myopia of more than 6 diopters; and 3)

Baseline Characteristics

Of the 120 patients who were enrolled in the study, 19 were excluded for various reasons, eg, loss before 3-month follow-up, incompletely removed ERM, or definite cystoid macular edema or leakage by postoperative fundus photography and FA. None of the 101 patients (101 eyes) included in this analysis experienced postoperative complications of glaucoma or RD during follow-up.

Our patients had a mean age of 63.1 ± 9.0 years and were composed of 78 men and 23 women. Preoperatively, 91 eyes (90.01%)

Discussion

The main objective of this study was to identify the factors that influence visual outcome after successful ERM surgery by utilizing OCT. According to our tomographic evaluation, postoperative photoreceptor integrity was strongly correlated with visual outcome by univariate linear regression analysis and was a potent predictor of visual prognosis by multivariate analysis. Moreover, all eyes except 1 eye in the “same” BCVA group demonstrated disruption of the IS/OS junction at 3 months after

Min Hee Suh, MD, is a Chief Resident of Ophthalmology at Seoul National University Hospital. Dr Suh received her MD from Seoul National University College of Medicine in 2004. Dr Suh completed an internship and continues her residency in Seoul National University Hospital. Her current research of interests includes ocular imaging with epiretinal membrane and optic disc hemorrhage in glaucoma patients.

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Min Hee Suh, MD, is a Chief Resident of Ophthalmology at Seoul National University Hospital. Dr Suh received her MD from Seoul National University College of Medicine in 2004. Dr Suh completed an internship and continues her residency in Seoul National University Hospital. Her current research of interests includes ocular imaging with epiretinal membrane and optic disc hemorrhage in glaucoma patients.

Supplemental Material available at AJO.com.

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