J Korean Ophthalmol Soc.  2020 Jan;61(1):59-68. 10.3341/jkos.2020.61.1.59.

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

Affiliations
  • 1Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Korea. ckseek@naver.com

Abstract

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.

Keyword

Diamond-dusted membrane scraper; Idiopathic epiretinal membrane; Membranectomy

MeSH Terms

Epiretinal Membrane*
Humans
Macular Edema
Membranes
Observational Study
Outcome Assessment (Health Care)
Retinaldehyde*
Retrospective Studies
Surgical Instruments
Visual Acuity*
Vitrectomy
Retinaldehyde

Figure

  • Figure 1 Early treatment of diabetic retinopathy study subfield. Sector 1: C0, Sector 2: IS, Sector 3: IN, Sector 4: II, Sector 5: IT, Sector 6: OS, Sector 7: ON, Sector 8: OI, Sector 9: OT. C0 = central fovea; IS = inner superior; IN = inner nasal; II = inner inferior; IT = inner temporal; OS = outer superior; ON = outer nasal; OI = outer inferior; OT = outer temporal.

  • Figure 2 Preoperative and postoperative best corrected cisual acuity (BCVA, logMAR). BCVA in the DDMS groups were improved at postoperative 4 weeks, but BCVA in the IOF groups were deteriotating until postoperative 4 weeks and then improved at 12 weeks after surgery. LogMAR = logarithm of minimal angle of resolution; DDMS = diamond dusted membrane scraper; IOF = intraocular forcep. *,†p-value were analyzed by Wilcoxon singed rank test. Each postoperative BCVA were compared with preoperative BCVA.

  • Figure 3 Preoperative and postoperative best corrected cisual acuity (logMAR) by combined cataract surgery. (A) Patients of phakic eyes, vitrectomy combined cataract surgery. (B) Patients of pseudophakic eyes, only vitrectomy. p-value were analyzed by Mann-Whitney U test. DDMS = diamond dusted membrane scraper; IOF = intraocular forcep.

  • Figure 4 Average retinal thickness of early treatment of diabetic retinopathy study subfield (ETDRS) 9 sectors at preoperative and postoperative time. Preoperative mean retinal thickness was not significantly different between the two groups in all sectors of ETDRS. The averge retinal thickness in the sector 4 (inferior) was significantly lower in the diamond dusted membrane scraper (DDMS) group than in the intraocular forcep (IOF) group after 12 and 24 weeks postoperatively. The average retinal thickness at 4, 12, and 24 weeks after surgery was significantly lower in the DDMS group than in the IOF group. IOP = intraocular pressure. *p-value were analyzed by Mann Whitney U test. Each mean retinal thickness were compared DDMS group with IOF group.

  • Figure 5 Difference of average retinal thckness of early treatment of diabetic retinopathy study subfield (ETDRS) 9 sectors compared preoperative time with each postoperative time. (A) The diamond dusted membrane scraper group showed more decrease than the intraocular forcep group in sector 1, 2, 3, 4, 5 and 6 postoperatively, but not significant statistically. (B) At 4, 12 weeks postoperatively, changes in retinal thickness were presented as a percentage of the ETDRS area. DDMS = diamond dusted membrane scraper; IOP = intraocular pressure; IOF = intraocular forcep.

  • Figure 6 Postoperative optical coherence tomography finding of cystoid macular edema. (A) After 6 weeks, cystoid macular edema was developed in the diamond dusted membrane scraper groups. (B) After 6 weeks, cystoid macular edema was developed in the intraocular forcep groups.


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