Morphologic and Functional Evaluation before and after Vitrectomy in Idiopathic Epiretinal Membrane Patients Using Microperimetry

Sam Seo; Han Woong Lim; Yong Un Shin; Min Ho Kang; Min Cheol Seong; Hee Yoon Cho

doi:10.3341/jkos.2013.54.6.893

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Seo, Lim, Shin, Kang, Seong, and Cho: Morphologic and Functional Evaluation before and after Vitrectomy in Idiopathic Epiretinal Membrane Patients Using Microperimetry

Original Article

J Korean Ophthalmol Soc 2013;54(6):893-901.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.6.893

Morphologic and Functional Evaluation before and after Vitrectomy in Idiopathic Epiretinal Membrane Patients Using Microperimetry

Sam Seo, MD, Han Woong Lim, MD, Yong Un Shin, MD, Min Ho Kang, MD, Min Cheol Seong, MD, Hee Yoon Cho, MD

Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea

Address reprint requests to Hee Yoon Cho, MD Department of Ophthalmology, Hanyang University Guri Hospital #153 Gyeongchun-ro, Guri 471-701, Korea Tel: 82-31-560-2350, Fax: 82-31-564-9479, E-mail: hycho@hanyang.ac.kr

Received 20 October 201213 December 2012 Accepted 8 April 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the relationship between photoreceptor inner/outer segment (IS/OS) integrity and macular sensi-tivity after epiretinal membrane (ERM) surgery using spectral-domain optical coherence tomography combined with microperimetry.

Methods

20 eyes of 20 patients with idiopathic ERM who underwent pars plana vitrectomy for ERM removal were pro-spectively reviewed. The IS/OS defect diameter, BCVA, macular sensitivity, and fixation stability were measured using spectral-domain optical coherence tomography combined with microperimetry. The correlation of these factors was analyzed.

Results

The macular sensitivity improved after successful ERM surgery (p < 0.001), but the IS/OS defect diameter has not improved. The preoperative and postoperative macular sensitivity were negatively correlated with preoperative IS/OS de-fect diameter (p = 0.035, p = 0.006). The fixation stability was not correlated with preoperative IS/OS defect diameter.

Conclusions

Macular sensitivity showed significant correlation with IS/OS defect diameter. Macular sensitivity is vital functional parameter allows subjective quantification of the retinal function and reflects morphologic changes.

Keywords: Idiopathic epiretinal membrane, Macular sensitivity, Microperimetry, Spectral domain optical coherence tomography

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Figure 1.

Representative figures of groups according to the integrity of junction between photoreceptor inner and outer segment (IS/OS) within 500 μ m from the center of fovea. (A) Group 1 (Preserved IS/OS). IS/OS is well preserved within the 500 μ m from the center of fovea. (B) Group 2 (Disrupted IS/OS). There is partially disrupted area of IS/OS (arrow). The disrupted IS/OS length was measured manually with caliper built in the spectral domain optical coherence tomography.

Figure 2.

A microperimetry combined with Spectral domain optical coherence tomographic image of a 76 year old male patient with idiopathic ERM. Preoperative fundus image of the right eye shows an epiretinal membrane (upper left). Optical coherence tomog-raphy (OCT) result shows epiretinal membrane delineated as highly reflective band and globally adherent to the retina. IS/OS dis-ruption (arrowheads) also presented. Microperimetry results show mean sensitivity in colors (upper right), and fixation stability (bottom right).

Figure 3.

(A) Preoperative macular sensitivity (dB) of the group 1 and 2. Preoperative macular sensitivity in the group 1 is significantly better than that in the group 2. (B) Preoperative best-corrected visual acuity (BCVA) (log MAR) of the group 1 and 2. However, there is no significant difference between the group 1 and the group 2. (C) Postoperative BCVA (log MAR) of the group 1 and 2. Postoperative BCVA in the group 1 is significantly better than that in the group 2. (p val-ue related to Kruskall-Wallis test). (^* p < 0.05, ^** p > 0.05) The box and whisker plots: horizontal lines within the box represent medians, the ends of the boxes represent the first and third quartiles, and the whiskers represent the smallest and largest non-outlier values.

Figure 4.

Correlation between macular sensitivity (dB) and diame-ter of disrupted photoreceptor inner and outer segment junction (IS/OS defect diameter) (μ m) in the group 1 and 2 (marked with black triangle and white circle respectively) at the preoperative (A) and postoperative (B) visits. (A) shows that there is significant negative correlation between the preoperative IS/OS defect diame-ter (μ m) and macular sensitivity (dB) (r = -0.474, p = 0.035). (B) shows that there is significant negative correlation between the preoperative IS/OS defect diameter (μ m) and postoperative mac-ular sensitivity (dB) (r = -0.589, p = 0.006). In accordance with an increase in the IS/OS defect diameter at the preoperative visit, the postoperative macular sensitivity worsened. (C) shows there is significant negative correlation between the postoperative IS/OS defect diameter (μ m) and macular sensitivity (dB) (r = -0.647, p = 0.002). p-value related to linear logistic regression analysis.

Table 1.

Summary of demographic data of all eyes with Idiopathic epiretinal membrane

Characteristics	Value
Number of eyes (subjects)	20 (20)
Sex (M:F) [n(%)]	7 (35%) : 13 (65%)
Age (years)	64.55 ± 2.41
Refraction (S.E)	0.63 ± 1.22
Lens status^*
Mild cataract	4
Moderate cataract	16
Severe cataract	0

Values are presented as mean ± SD unless otherwise indicated.

S.E = spherical equivalent

^* Cataract classified by lens opacification classification system III, Mild cataract: NO 1-NO 2, Moderate cataract: NO 3-NO 4, Severe cataract: NO 5-NO 6.

Table 2.

Preoperative data and outcomes during follow up

Characteristics	Base line	After surgery	p-value^*
BCVA (log MAR)	0.58 ± 0.05	0.39 ± 0.057	0.003
IS/OS defect diameter (μ m)	1247.8 ± 988.9	1023.4 ± 896.2	0.062
Macular sensitivity (dB)	16.95 ± 6.60	22.35 ± 4.29	<0.001
Fixation stability (%)	61.0 ± 18.2	67.4 ± 23.5	0.059

Values are presented as mean ± SD unless otherwise indicated.

^* Statistical significance was calculated by Wilcoxon signed rank test.

Table 3.

Comparison of preoperative characteristics of patients with IS/OS preserved and disrupted epiretinal membrane

Characteristics	Group 1 (IS/OS preserved)	Group 2 (IS/OS disrupted)	p
Number of eyes (%)	8 (40%)	12 (60%)
Sex (M:F)	5:3	8:4	0.85
Age (years)	64.25 ± 9.59	64.75 ± 10.79	0.79
BCVA (log MAR)	0.46 ± 0.27	0.63 ± 0.23	0.11
IS/OS defect diameter (μ m)	288.69 ± 365.81	1887.33 ± 699.27	<0.01
Macular sensitivity (dB)	20.64 ± 2.70	14.49 ± 7.37	0.02

Values are presented as mean ± SD unless otherwise indicated.

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