Remained Macular Edema After Surgical Treatment in Patients With Epiretinal Membrane

Sun Young Jang; Kyung Seek Choi; Sung Jin Lee

doi:10.3341/jkos.2009.50.11.1657

Journal List > J Korean Ophthalmol Soc > v.50(11) > 1008415

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Jang, Choi, and Lee: Remained Macular Edema After Surgical Treatment in Patients With Epiretinal Membrane

Original Article

J Korean Ophthalmol Soc 2009;50(11):1657-1660.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.11.1657

Remained Macular Edema After Surgical Treatment in Patients With Epiretinal Membrane

Sun Young Jang, MD, Kyung Seek Choi, MD, Sung Jin Lee, MD

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

Address reprint requests to Sung Jin Lee, MD, Department of Ophthalmology, College of Medicine, Soonchunhyang University #657 Hannam-dong, Yongsan-gu, Seoul 140-743, Korea Tel: 82-2-709-9354, Fax: 82-2-798-7797, E-mail: wismile@unitel.co.kr

Received 19 May 2009 Accepted 4 August 2009

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 clinical features of patients with macular edema persisting for three months after a successful vitrectomy and removal of the epiretinal membrane.

Methods

The authors retrospectively reviewed the records of 32 patients (32 eyes) with epiretinal membranes who underwent pars plana vitrectomies and membranectomies from January 2005 to September 2008. The patients selected for the study underwent optical coherence tomography (OCT) which revealed macular edema. Macular edema is defined as central macular thickness measuring over 300 m. Several factors including age, presence of systemic disorders, preoperative visual acuity, surgical technique, preoperative state of the macula, and the response to treatment for macular edema were reviewed.

Results

Eight out of 32 eyes (25%) had no improvement of visual acuity after surgery of the epiretinal membrane. Six out of 32 eyes (18.75%) persisted in their macular edema. No common features were detected. All patients showed no improvement of visual acuity after their vitrectomies. Two of the eyes were treated with intravitreal or subtenon triamcinolone injection or non-steroidal anti-inflammatory eye drops. Only one eye (16.7%) achieved visual improvement as of the last follow-up.

Conclusions

Despite a successful vitrectomy and membranectomy, macular edema can remain without any specific cause. Per-sistantmacular edema appears to be a main cause of poor visual outcome and tends to resist conventional treatment.

Keywords: Epiretinal membrane, Membranectomy, Remained macular edema, Triamcinolone injection

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Figure 1.

OCT images of No.6 patient shows that the macular edema aggravated after surgical treatment. (A) Preoperative OCT image, central macular thickness was about 565 µm. (B) Postoperative OCT image at 3 months after surgery revealed that the macular thickness was measured about 655 µm.

Table 1.

Characteristics of the patients who had idiopathic epiretinal membrane and remained macular edema after surgical treatment

No	Sex	Age	ILM^§	ICG^‡	Gas^†	Preop. VA	Postop. VA	Preop. CMT^*	Postop. CMT	Cystoid	Tx.
1	M	74	No	No	SF6	20/40	20/40	506	387	−	NSAID^#
2	F	77	No	No	−	20/80	20/32	406	549	−	STTA^**
3	M	72	No	No	SF6	20/20	20/40	431	439	−	NSAID
4	F	60	Yes	Yes	−	20/200	20/200	723	556	+	IVTA^П
5	F	61	No	No	SF6	20/125	20/100	564	375	−	IVTA
6	F	65	Yes	Yes	−	20/50	20/63	565	655	+	STTA

^*CMT (µm)=central macular thickness

^†Gas=intravitreal gas injection

^‡ICG=indocyanine green dye

^§ILM=internal limiting membrane peeling

^ПIVTA=intravitreal triamcinolone injection

^#NSAID=non-steroidal anti-inflammatory drug (Dicrofenac) instillation

^**STTA=subtenon triamcinolone injection.

Table 2.

Responses to the treatment in patients with remained macular edema after surgery

Treatment	Improvement	No change	Worsening
STTA^* 40.0 mg/1.0cc (2 eyes)	1		1
IVTA^† 4.0 mg/0.1cc (2 eyes)		2
Diclofenac instillation (2 eyes)		1	1

^*STTA=subtenon triaminolone injection

^†IVTA=intravitreal triamcinolone injection.

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