J Korean Ophthalmol Soc.  2014 Dec;55(12):1834-1842. 10.3341/jkos.2014.55.12.1834.

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

• Moon JW
• Jang JH
• Cho YW

• KMID: 2338971
• DOI: http://doi.org/10.3341/jkos.2014.55.12.1834

Abstract

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.

Keyword

Idiopathic epiretinal membrane; Internal limiting membrane peeling; Macular structure deformity; Vitreomacular traction syndrome

MeSH Terms

Congenital Abnormalities
Epiretinal Membrane*
Humans
Membranes
Observational Study
Retinal Perforations
Retinaldehyde
Retrospective Studies
Tomography, Optical Coherence
Traction*
Visual Acuity
Vitrectomy
Retinaldehyde

Figure

• 

  Figure 1. Spectral domain optical coherence tomography (SD-OCT) images of 2 groups. (A, B) Epiretinal membrane (ERM) without vitreomacular traction syndrome (VMTS); hyper-reflective ERM above retinal surface and retinal thickening are seen, but posterior hyaloid is not seen. (C, D) ERM with VMTS; posterior hyaloid attached with ERM causing retinal traction and inner retinal plication are seen.

• 

  Figure 2. Spectral domain optical coherence tomography (SD-OCT) images of preoperative macular structure deformities. (A) Inner segment/outer segment (IS/OS) junction disruption; white arrow presents hypo-reflective discontinuity in the hyper-reflective IS/OS junction. (B) Irregular retinal surface beneath hyper-reflective epiretinal membrane (ERM) is seen. (C) Diffuse retinal thickening. (D) Cystoid macular edema. (E) Lamellar macular hole at fovea. Photoreceptor layers are intact.

• 

  Figure 3. Spectral domain optical coherence tomography (SD-OCT) image changes after surgery of the same eye as in Fig. 1; Epiretinal membrane (ERM) without vitreomacular traction syndrome (VMTS). (A) Preoperative SD-OCT images with visual acuity log MAR 0.52. (B) SD-OCT image at 12 months after operation with visual acuity log MAR 0.30. Foveal contour is not completely recovered but fovea is depressed. White arrow presents damages of nerve fiber layer and ganglion cell layer during internal limiting membrane (ILM) peeling.

• 

  Figure 4. Spectral domain optical coherence tomography (SD-OCT) image changes after surgery of the same eye as in Fig. 1; Epiretinal membrane (ERM) with vitreomacular traction syndrome (VMTS). (A) Preoperative SD-OCT images with visual acuity log MAR 0.70. (B) SD-OCT image at 12 months after operation with visual acuity log MAR 0.05. Inner retinal surface is still irregular, but overall retina is remarkably flattened and photoreceptor layers are intact.

Reference

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