Surgical Outcome According to Morphology in Epiretinal Membrane Based on Optical Coherence Tomography (OCT)

Jin Seo Sang; Jung Lee Soo; Min Park Jung

doi:10.3341/jkos.2013.54.5.736

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Sang, Soo, and Jung: Surgical Outcome According to Morphology in Epiretinal Membrane Based on Optical Coherence Tomography (OCT)

Original Article

J Korean Ophthalmol Soc 2013;54(5):736-744.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.5.736

Surgical Outcome According to Morphology in Epiretinal Membrane Based on Optical Coherence Tomography (OCT)

Jin Seo Sang, MD¹, Jung Lee Soo, MD, PhD², Min Park Jung, MD, PhD¹

¹Department of Ophthalmology, Maryknoll Medical Center¹, Busan, Korea

²Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine², Busan, Korea

Address reprint requests to Jung Min Park, MD, PhD Department of Ophthalmology, Maryknoll Medical Center #121 Junggu-ro, Jung-gu, Busan 600-730, Korea Tel: 82-51-461-2549, Fax: 82-51-462-3534, E-mail: Pjm1438@hanmail.net

Received 21 July 201220 October 2012 Accepted 25 February 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 determine the influence of morphologic classification based on optical coherence tomography (OCT) on epi-retinal membrane (ERM) surgery outcomes.

Methods

We retrospectively reviewed the medical records of 77 eyes with ERM treated by vitrectomy with ERM peeling. By using OCT, the preoperative ERM was classified into four types: diffuse (DIF), cystoids macular edema (CME), pseudo-lamellar hole (PLH), and vitreomacular traction (VMT). The postoperative changes of central macular thickness (CMT) and best-corrected visual acuity (BCVA) were compared.

Results

Approximately six months postoperatively, the DIF type had the best BCVA for both idiopathic and secondary ERM, followed by the PLH, CME, and VMT types. On the other hand, regarding the mean BCVA improvement, the VMT type was the best, followed by the DIF, PLH, and CME types. When comparing the difference in BCVA improvement by each type, idiopathic ERM showed a clearer distinction when the inner segment/outer segment (IS/OS) junction was not disrupted.

Conclusions

BCVA improvement was significantly different depending on the morphologic classification of ERM by using OCT. Especially in cases of ERM with an intact IS/OS junction, the morphologic classification can help predict surgical outcomes.

Keywords: Epiretinal membrane, Inner segment/Outer segment junction, Optical coherent tomography

References

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Figure 1.

The type of macular epiretinal membrane (ERM) in OCT images. (A) The DIF type: The DIF type shows globally adherent membrane widely covering macular area in the sur-face of retina, diffuse edema and increasing retinal thickness, (B) The CME type: The CME type shows globally adherent membrane and the formation of intraretinal cystoids space, (C) The PLH type: The PLH type shows steepened foveal pit, (D) The VMT type: The VMT type shows a focal and adherent membrane bridging between vitreous and retina.

Figure 2.

Mean BCVA change in each type. (A) Idiopathic ERM, VMT > DIF > CME > PLH, (B) Secondary ERM, VMT > DIF > CME > PLH. BCVA = best corrected visual acuity; ERM = epiretinal membrane; DIF = diffuse; CME = cystoid macular edema; PLH = pseudolamellar hole; VMT = vitreomaculartraction.

Figure 3.

CMT change in each type. (A) Idiopathic ERM, VMT > CME > DIF > PLH, (B) Secondary ERM, CME > VMT > DIF > PLH. CMT = central macualr thickness; ERM = epiretinal membrane; DIF = diffuse; CME = cystoid macular edema; PLH = pseudolamellar hole; VMT = vitreo- maculartraction.

Table 1.

Preoperative demographic and clinical characteristics of the patients

		Total	DIF	CME	PLH	VMT	p-value
Total	Number of eyes	77	33	23	13	8
	Gender (F:M)	53:24	21:12	17:6	10:3	5:3	0.767^*
	Age (years)	64.7 ± 9.6	64.9 ± 9.8	63.3 ± 9.5	65.5 ± 8.6	66.3 ± 11.3	0.760^†
	Number of combination with Phaco with PCL (%)	51 (66.2)	21 (66.7)	14 (60.9)	10 (76.9)	6 (75)	0.792^*
Idiopathic	Number of eyes	50	22	11	11	5
	Gender (F:M)	38:12	16:6	8:3	9:2	4:1	0.961^*
	Age (years)	66.7 ± 8.9	67.2 ± 9.4	66 ± 7.7	64.7 ± 9.1	69.6 ± 11.6	0.788^†
	Number of combination with Phaco with PCL (%)	35 (71.4)	13 (59.1)	9 (81.8)	9 (81.8)	4 (80)	0.501^*
Secondary	Number of eyes	28	11	12	2	3
	Gender (F:M)	16:12	5:6	9:3	1:1	1:2	0.377^*
	Age (years)	60.9 ± 9.6	60.3 ± 9.3	60.8 ± 10.7	70 ± 1.41	60.7 ± 10.0	0.738^†
	Number of combination with Phaco with PCL (%)	16 (57.1)	8 (72.7)	5 (41.7)	1 (50)	2 (66.7)	0.697^*

Values are presented as number or mean ± SD unless otherwise indicated. DIF = diffuse; CME = cystoid macular edema; PLH = pseudolamellar hole; VMT = vitreomacular traction.

^* Fischer’s Exact test

^† Kruskal-Wallis test.

Table 2.

Preoperative & postoperative log MAR visual acuity & mean BCVA change according to ERM type

		DIF	CME	PLH	VMT	p-value^*
Total	Preoperative BCVA	0.66 ± 0.34	0.74 ± 0.29	0.55 ± 0.81	1.50 ± 1.01	0.002^†
	Postoperative BCVA (6 months)	0.27 ± 0.21	0.59 ± 0.37	0.37 ± 0.23	0.76 ± 0.43	<0.001^†
	Postoperative BCVA (12 months)	0.38 ± 0.60	0.52 ± 0.37	0.42 ± 0.50	0.71 ± 0.48	0.030^†
	Mean BCVA change (6 months)	0.39 ± 0.30	0.16 ± 0.30	0.18 ± 0.75	0.75 ± 0.80	0.001^†
	Mean BCVA change (12 months)	0.27 ± 0.58	0.23 ± 0.24	-0.12 ± 0.30	0.92 ± 0.75	<0.001^†
Idiopathic	Preoperative BCVA	0.66 ± 0.31	0.62 ± 0.27	0.58 ± 0.88	1.27 ± 0.97	0.029^†
	Postoperative BCVA (6 months)	0.27 ± 0.22	0.38 ± 0.23	0.37 ± 0.21	0.57 ± 0.20	0.045^†
	Postoperative BCVA (12 months)	0.45 ± 0.82	0.43 ± 0.32	0.39 ± 0.32	0.43 ± 0.19	0.419^†
	Mean BCVA change (6 months)	0.38 ± 0.29	0.24 ± 0.23	0.21 ± 0.88	0.70 ± 0.93	0.034^†
	Mean BCVA change (12 months)	0.16 ± 0.76	0.17 ± 0.18	-0.12 ± 0.33	0.84 ± 0.83	0.004^†
Secondary	Preoperative BCVA	0.69 ± 0.39	0.86 ± 0.26	0.40 ± 0.43	1.90 ± 1.15	0.058^†
	Postoperative BCVA (6 months)	0.28 ± 0.22	0.78 ± 0.37	0.37 ± 0.46	1.06 ± 0.58	0.006^†
	Postoperative BCVA (12 months)	0.30 ± 0.24	0.58 ± 0.27	0.52 ± 0.67	1.40 ± 0.39	0.025^†
	Mean BCVA change (6 months)	0.40 ± 0.30	0.07 ± 0.34	0.03 ± 0.04	0.84 ± 0.68	0.019^†
	Mean BCVA change (12 months)	0.39 ± 0.27	0.27 ± 0.27	-0.13 ± 0.25	1.10 ± 0.70	0.042^†

Values are presented as mean ± SD. DIF = diffuse; CME = cystoid macular edema; PLH = pseudolamellar hole; DIF = diffuse; CME = cystoid macular edema; PLH = pseudolamellar hole; VMT = vitreomacular traction; BCVA = best corrected visual acuity.

^* Kruskal-Wallis test

^† Statistically significant.

Table 3.

Proportion of inner segment/outer segment (IS/OS) Junction Disruption according to ERM type

		DIF	CME	PLH	VMT	p-value^*
Preoperative BCVA		0.67±0.32	0.61±0.32	0.63±0.99	0.82±0	0.246^†
IS/OS Junction disruption	Total	18.2%	60.9%	30.8%	87.5%	0.001^§
	Idiopathic	13.6%	45.5%	36.4%	80.0%	0.022^§
	Secondary	27.3%	75.0%	0%	100%	0.012^§

Values are presented as mean ± SD or %. DIF = diffuse; CME = cystoid macular edema; PLH = pseudolamellar hole; VMT = vitreomacular traction.

^* Fischer’s Exact test

^† Kruskal-Wallis test

^§ Statistically significant.

Table 4.

Preoperative & postoperative log MAR visual acuity & mean BCVA change in Idiopathic ERM with Intact inner seg-ment/outer segment (IS/OS) junction

	DIF	CME	PLH	VMT	p-value^*
Preoperative BCVA	0.67 ± 0.32	0.61 ± 0.32	0.63 ± 0.99	0.82 ± 0	0.246
Postoperative BCVA (6 months)	0.22 ± 0.15	0.24 ± 0.16	0.35 ± 0.20	0.30 ± 0	0.406
Postoperative BCVA (12 months)	0.21 ± 0.16	0.30 ± 0.32	0.38 ± 0.35	0.22 ± 0	0.710
Mean BCVA change (6 months)	0.46 ± 0.22	0.38 ± 0.19	0.28 ± 0.90	0.52 ± 0	0.015^†
Mean BCVA change (12 months)	0.40 ± 0.20	0.20 ± 0.08	‐0.01 ± 0.21	0.62 ± 0	0.011^†

Values are presented as mean ± SD. DIF = diffuse; CME = cystoid macular edema; PLH = pseudolamellar hole; VMT = vitreomacular traction; BCVA = best corrected visual acuity.

^* Kruskal-Wallis test

^† Statistically significant.

Table 5.

Comparison of group of combination with Cataract surgery between Pseudophakia for each type ( p-value^*)

		DIF	CME	PLH	VMT
Idiopathic	Preoperative BCVA	0.613	0.905	0.287	0.468
	Postoperative BCVA (6 months)	0.866	0.458	0.042	0.717
	Postoperative BCVA (12 months)	1.000	0.313	0.132	1.000
	Mean BCVA change (6 months)	0.421	0.287	0.812	1.000
	Mean BCVA change (12 months)	0.688	1.000	0.143	0.717
Secondary	Preoperative BCVA	0.158	0.075	0.317	0.221
	Postoperative BCVA (6 months)	0.338	0.934	0.317	0.480
	Postoperative BCVA (12 months)	0.393	0.244	0.317	0.480
	Mean BCVA change (6 months)	0.390	0.115	0.317	0.221
	Mean BCVA change (12 months)	0.349	0.415	0.317	0.221

DIF = diffuse; CME = cystoid macular edema; PLH = pseudolamellar hole; VMT = vitreomacular traction; BCVA = best corrected visua acuity.

^* Mann-Whitney test.

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