Original article
Inner Segment/Outer Segment Junction Assessed by Spectral-Domain Optical Coherence Tomography in Patients with Idiopathic Epiretinal Membrane

https://doi.org/10.1016/j.ajo.2010.06.006Get rights and content

Purpose

To evaluate the anatomic features of the photoreceptor inner/outer segment (IS/OS) junction before and after surgery by spectral-domain optical coherence tomography in patients undergoing idiopathic epiretinal membrane (ERM) surgery and to correlate these features with the functional outcomes.

Design

Prospective, cohort study.

Methods

We prospectively studied 45 eyes of 45 patients with idiopathic epiretinal membrane who had a preoperative visual acuity of 20/32 or less and were scheduled to undergo transconjunctival 25-gauge vitrectomy. The patients were divided into 2 groups based on the preoperative structural integrity of the IS/OS junction: the intact IS/OS junction group and the disrupted IS/OS junction group. Changes in the IS/OS junction and best-corrected visual acuity were compared between 2 groups before and at 3, 6, and 12 months after surgery.

Results

A total of 45 patients were recruited for this study. There were 34 eyes with an intact IS/OS junction (group 1) and 11 eyes with a disrupted or irregular IS/OS junction (group 2), as determined before surgery. Significantly better postoperative best-corrected visual acuity was seen in group 1 as compared with that in group 2 at 3, 6, and 12 months after the surgery (P < .001). Significant improvement of visual acuity was also seen in group 1 when compared to group 2 (P < .05). Of the 34 eyes in group 1, 17 (50%) showed disruption of the IS/OS junction at 3 months after surgery, although this disruption was only transient and resolved completely by 12 months after the surgery. However, none of the eyes from group 2 showed a normal appearance of the IS/OS junction at any time point during the study period of 1 year.

Conclusions

The IS/OS junction can recover in eyes with preoperative intact IS/OS junction as assessed over a follow-up period of 1 year after surgery. Preoperative integrity of the IS/OS junction may be an important prognostic factor for better visual recovery and better improvement of the postoperative best-corrected visual acuity after epiretinal membrane surgery.

Section snippets

Methods

A total of 45 consecutive eyes of 45 patients with idiopathic ERM who had a preoperative visual acuity of 20/32 or less and were followed up for 12 months or longer after surgical treatment at the Yokohama City University Medical Center between September 2007 and October 2009 participated to our study. Patients with eye diseases influencing the visual acuity, such as glaucoma, macular degeneration, diabetic retinopathy, or rhegmatogenous retinal detachment, were excluded.

Preoperative visual

Results

The baseline characteristics and clinical data of the patients are shown in Table 1. All the 45 patients were included in this study. There were 34 patients in group 1 and 11 patients with disrupted or irregular IS/OS junctions in group 2. Of the 45 patients, 15 were men and 30 were women, with the patients ranging in age from 42 to 77 years (mean age ± standard deviation, 66.8 ± 8.2 years) in group 1 and from 52 to 74 years (mean age, 63.9 ± 6.2 years) in group 2. Both groups were comparable

Discussion

Our study demonstrated that IS/OS junction morphologic features after ERM surgery, as assessed at 12 months after surgery, continue to show disruption or irregularity if the IS/OS junction shows disruption or irregularity before surgery. This is the first report to describe the use of SD OCT, which has higher resolution than standard time-domain OCT, to evaluate the IS/OS junction before and at various time points during the first 12 months after the surgery. Furthermore, the improvement of the

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