First Author: P.Carnota Méndez SPAIN
Co Author(s): C. Mendez Vazquez C. Torres Borrego
Back to previous
To describe the outcomes, complications and spectral domain optical coherence tomography (SD-OCT) characteristics in patients with epiretinal membrane (ERM) and visual acuity better than 20/30 treated with vitrectomy and peeling of ERM.
Centro de Ojos de La Coruña (Spain)
We retrospectively reviewed the clinical charts of patients with ERM treated with vitrectomy and peeling of ERM in our clinic from January 2008 to December 2016. For this study we included patients with idiopathic ERM and preoperative best-corrected visual acuity (BCVA) better than 20/30. We excluded patients with secondary ERM (post-vitrectomy, diabetic retinopathy, retinal vein occlusion and others) and patients with BCVA of 20/30 or worse. We measured BCVA and performed a quantitative (central macular thickness (CMT) and macular volume) and qualitative SD-OCT analysis before and 3, 6, 12 months after surgery and at the end of follow-up (Final). Other data collected were: sex, age, prior procedures/surgeries, reason for vitrectomy, lens status before and after surgery, type of surgery (vitrectomy alone, phacovitrectomy, sequential surgery vitrectomy-phacoemulsification), peeling (or not) of internal limiting membrane (ILM), intraoperative and postoperative complications and months of follow-up.
17 (13%) out of 127 patients met the inclusion criteria. Mean follow-up time was 29.7 months. Surgery was advised to patients because poor vision or disturbing symptoms at the moment of diagnosis (41%) or because a decrease in visual acuity or worsening of metamorphopsia during follow-up after diagnosis of ERM (59%). 41% underwent vitrectomy alone, 35% phacovitrectomy and 24% sequential surgery. Mean BCVA preoperatively, at 3, 6, 12 months and Final was 20/27, 20/27, 20/25, 20/29 and 20/23 respectively. 65% of patients improved and 35% mantained their vision at the end of follow-up (0% lost vision). CMT preoperatively, at 3, 6, and 12 months was 424, 384, 372 and 362 microns respectively. Two patterns of ERM were recognised: a thin line causing uniform thickening of the retina (65%) and a thicker line causing retinal wrinkling (35%). Preoperative characteristics by SD-OCT included foveal pseudocysts (18%), retinoschisis (18%) and foveal pseudovitelliform material (18%). ILM was performed in 12% of cases but postoperative defect of optic nerve fibre layer (DONFL) was observed in 29%. Regrowth of ERM without foveal involvement ocurred in 2 cases. No intraoperative complications were observed. 1 patient had vitreous haemorrhage 24 hours after surgery that resolved in 2 weeks.
Vitrectomy with peeling of ERM is an effective and safe procedure in patients with good visual acuity. However, we should carefully select those patients whose symptoms are clearly caused by the ERM.