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Risk of newly developing visual field defect and neurodegeneration after pars plana vitrectomy for idiopathic epiretinal membrane
  1. Kunihiko Akino1,
  2. Norihiro Nagai1,2,
  3. Kazuhiro Watanabe1,
  4. Norimitsu Ban1,
  5. Toshihide Kurihara1,
  6. Atsuro Uchida1,
  7. Hajime Shinoda1,
  8. Kazuo Tsubota1,
  9. Yoko Ozawa1,2,3,4
  1. 1Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  2. 2Laboratory of Retinal Cell Biology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  3. 3Department of Ophthalmology, St. Luke’s International Hospital, Chuo-ku, Tokyo, Japan
  4. 4St. Luke’s International University, Chuo-ku, Tokyo, Japan
  1. Correspondence to Yoko Ozawa, Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan; ozawa{at}; ozaway{at}


Background/Aims Pars plana vitrectomy (PPV) is widely performed in patients with idiopathic epiretinal membrane (iERM) to improve vision. Postoperative visual field defects (VFDs) have been previously reported. However, whether they occur when using the most recent PPV system, and the frequency of VFDs as measured by standard automated perimetry, remain poorly documented and were examined in this study.

Methods Data of 30 eyes (30 patients; mean age, 66.1 years; 15 men) who underwent PPV for iERM during February 2016–June 2019 and had preoperative and postoperative visual field measurements using standard automated perimetry (Humphrey visual field analyser 30-2 program) were retrospectively analysed. Eyes with diseases other than iERM, including moderate-to-severe cataract or preoperative VFDs were excluded.

Results VFD, defined by the Anderson and Patella’s criteria, was found in 73.3% of the eyes 1 month after PPV. After age adjustment, internal limiting membrane (ILM) peeling was identified as a risk factor for postoperative VFD (p=0.035; 95% CI 1.173 to 92.8). Postoperative VFD was frequently observed nasally (86.4%, p=0.002), and on optical coherence tomography measurements, ganglion cell layer (GCL) thinning was found temporal to the fovea (p=0.008). Thinning of the superior and inferior retinal nerve fibre layers and of the GCL temporal to the fovea were significant in eyes after ILM peeling (all p<0.05).

Conclusion ILM peeling may cause inner retinal degeneration and lead to the development of VFDs after PPV, which should be further examined.

  • Macula
  • Retina
  • Treatment Surgery
  • Field of vision

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  • KA and NN contributed equally

  • Contributors Conception and designs: NN, YO. Data collection: KA, NN, YO. Analysis and interpretation: KA, NN. Obtain funding: NN, KW, AU, TK, NB, HS. Review the manuscript: HS, KT. Overall responsibility: YO.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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