Abstract
Objective
To evaluate short- and long-term changes in best-corrected visual acuity (BCVA) and
retinal layer thicknesses after combined epiretinal membrane (ERM) and internal limiting
membrane (ILM) peeling for macular holes and symptomatic ERMs.
Design
Retrospective observational case series.
Participants
Patients with ERMs or with macular holes and ERMs treated with combined ERM and ILM
peeling.
Methods
Study eyes (n = 36) and healthy fellow eyes (n = 17) were evaluated using the automated
segmentation of retinal layers performed by SPECTRALIS software that automatically
calculated the average central retinal thickness and the average thickness in each
of the individual retinal layers. The analysis was performed at 6–18 months after
surgery and after 60 months.
Main Outcome Measures
Changes in BCVA and retinal layer thicknesses determined by automated segmentation
at the first and last follow-up visits.
Results
BCVA improved from a baseline 0.48 ± 0.25 logMAR (20/60 Snellen) to 0.18 ± 0.18 logMAR
(20/30 Snellen) at the short-term postoperative examination (p < 0.0001). Between first and last follow-up visit, 5 eyes (14%) were classified as
better, 28 (78%) as stable, and 3 (8%) as worse. BCVA of the control fellow eyes remained
stable during the follow-up. The thicknesses of retinal layers decreased significantly
(p < 0.009). At the last follow-up, the ganglion cell layer was thinner and the inner
nuclear layer was thicker in the operated eyes compared with the healthy fellow eyes.
Conclusion
Combined ERM and ILM peeling may improve BCVA in some patients. However, over a long
follow-up period, it can be associated with progressive ganglion cell layer thinning
that could affect BCVA stability.
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References
- Epiretinal macular membranes: pathogenesis and treatment.Dev Ophthalmol. 1997; 29: 61-63
- The role of Müller cells in fibrocontractive retinal disorders.Prog Retin Eye Res. 2005; 24: 75-76
- Vitrectomy for epiretinal membranes: visual outcome and prognostic criteria.Bull Soc Belg Ophtalmol. 2004; 293: 7-15
- Epiretinal membrane surgery with or without internal limiting membrane peeling.Clin Exp Ophthalmol. 2005; 33: 379-385
- Uffer Achache F. Surgery for epimacular membrane: impact of retinal internal limiting membrane removal on functional outcome.Retina. 2004; 24: 728-735
- Long-term prognosis of internal limiting membrane peeling for idiopathic epiretinal membrane.Nippon Ganka Gakkai zasshi. 2004; 108: 150-156
- Macular pucker removal with and without internal limiting membrane peeling: pilot study.Ophthalmology. 2003; 110: 62-64
- Progressive thinning of regional macular thickness after epiretinal membrane surgery.Invest Ophthalmol Vis Sci. 2015; 56: 7236-7242
- Clinicopathologic correlation of recurrent epiretinal membranes after previous surgical removal.Retina. 1990; 10: 213-222
- Does the presence of an epiretinal membrane alter the cleavage plane during internal limiting membrane peeling?.Ophthalmology. 2010; 117: 320-323
- Reduction of thickness of ganglion cell complex after internal limiting membrane peeling during vitrectomy for idiopathic macular hole.Eye (Lond). 2012; 26: 1173-1180
- Real-time automatic segmentation of optical coherence tomography volume data of the macular region.PLoS One. 2015; 10e0133908
- Spectral-domain optical coherence tomography for monitoring epiretinal membrane surgery.Ophthalmology. 2010; 117: 798-805
- Photoreceptor outer segment length: a prognostic factor for idiopathic epiretinal membrane surgery.Ophthalmology. 2013; 120: 788-794
- Analysis of the ganglion cell layer and photoreceptor layer using optical coherence tomography after idiopathic epiretinal membrane surgery.Graefes Arch Clin Exp Ophthalmol. 2015; 253: 207-214
- Natural history of idiopathic epiretinal membrane in eyes with good vision assessed by spectral-domain optical coherence tomography.Ophthalmologica. 2015; 234: 91-100
- Long-term natural history of idiopathic epiretinal membranes with good visual acuity.Eye (Lond). 2019; 33: 714-723
- Vitreous surgery for macular holes.Ophthalmology. 1993; 100: 1671-1676
- Vitrectomy for epiretinal membranes: ganglion cell features correlate with visual function outcomes.Ophthalmol Retina. 2018; 2: 1152-1162
- Long-term follow-up after macular hole surgery with internal limiting membrane peeling.Am J Ophthalmol. 2002; 134: 661-666
- Long-term outcomes of macular hole surgery with triamcinolone acetonide-assisted internal limiting membrane peeling.Retina. 2007; 27: 1249-1254
- Inner nuclear layer thickening is inversely proportional to retinal ganglion cell loss in optic neuritis.PLoS One. 2013; 8: e78341
- Five-year functional outcomes after epiretinal membrane surgery: a prospective, controlled study.Retina. 2019; 39: 2326-2331
- Reproducibility of retinal thickness measurements on normal and pathologic eyes by different optical coherence tomography instruments.Am J Ophthalmol. 2010; 150: 815-824
- Glaucoma after macular hole surgery.Ophthalmology. 1998; 105: 94-99
- Elevated intraocular pressure following vitreoretinal surgery.Ophthalmol Clin North Am. 2004; 17: 507-512
- Mechanisms of intraocular pressure elevation after pars plana vitrectomy.Ophthalmology. 1989; 96: 1357-1362
Article Info
Publication History
Published online: August 02, 2021
Publication stage
In Press Corrected ProofFootnotes
Originally received Feb. 9, 2021. Final revision Mar. 31, 2021. Accepted Jun. 27, 2021.
Identification
Copyright
© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
