First Author: E.K.Lee SOUTH KOREA
Co Author(s): M.K. Lee H.C. Ku W. Rhim 0 0 0 0 0 0 0 0 0
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To report the spectral-domain optical coherence tomography (SD-OCT) findings in eyes with macular epiretinal membrane (ERM) with a firm foveal adherence during surgery.
Retrospective case series
A total of 123 eyes of 122 patients who underwent vitrectomy for idiopathic ERM were included in this study. We reviewed the operation videography of 123 eyes to identify cases with operation-based firm attachment (OFA). OFA is defined as definite retinal elevation near the fovea without membrane separation during the peeling procedure followed by retinal hemorrhage. And we observed hyperreflective invasive lesions (HILs) in the inner retina or between the ERM and the inner retina in SD-OCT of the OFA area. Based on the videography and SD-OCT, the 123 cases were divided into three groups: OFA(-) (group I), OFA(+) (group II), and OFA(+) plus HIL(+) (group III).
The operation videography indicated that 22 cases had OFA. HILs were present in 15 of 22 cases, with nodular, diffusely invasive, and sharply invasive shapes. The mean ages of group II (60.45±8.85 years) and III (59.62±8.13 years) were significantly younger than that of group I (67.62±8.55 years). The photoreceptor inner segment and outer segment (IS/OS) defect occurrence rate after surgery was 6.52% in group I, 36.84% in group II, and 46.15% in group III. Positive OFA and positive OFA plus HIL were associated with a significant increase in the odds ratio (OR) for the occurrence of an IS/OS defect (10.472, 14.548, respectively). In the cases with a recent IS/OS defect, the visual acuity improvement (0.07±0.22) was significantly lower than in the intact IS/OS cases (0.28±0.30) (P=.0006).
A firm foveal adherence was more frequently observed in younger adult patients. Hyperreflective lesions in SD-OCT are the characteristic findings of the firmly attached area and increase the risk of the photoreceptor layer damage. The presence of these findings in SD-OCT may be the crucial factor in surgical difficulties that hinder visual acuity improvement after surgery.