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.
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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* |
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† |
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§ |
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† |
Table 5.
Comparison of group of combination with Cataract surgery between Pseudophakia for each type ( p-value*)