Surgical Outcomes in Epiretinal Membrane According to the Presence of Vitreomacular Traction Syndrome

Jong Won Moon; Ji Hye Jang; Young Wook Cho

doi:10.3341/jkos.2014.55.12.1834

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Moon, Jang, and Cho: Surgical Outcomes in Epiretinal Membrane According to the Presence of Vitreomacular Traction Syndrome

Original Article

J Korean Ophthalmol Soc 2014;55(12):1834-1842.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1834

Surgical Outcomes in Epiretinal Membrane According to the Presence of Vitreomacular Traction Syndrome

Jong Won Moon, MD, Ji Hye Jang, MD, Young Wook Cho, MD

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea

Address reprint requests to Ji Hye Jang, MD, Department of Ophthalmology, Daegu Fatima Hospital, #99 Ayang-ro, Dong-gu, Daegu 701-724, Korea, Tel: 82-53-940-7545, Fax: 82-53-954-7417, E-mail: Mjmom99@naver.com

Received 28 March 2014 Revised 20 June 2014 Accepted 17 November 2014

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 present preoperative macular structure deformities and surgical outcomes in idiopathic epiretinal membrane (ERM) patient according to the presence of vitreomacular traction syndrome (VMTS).

Methods

This retrospective observational study included 54 eyes of 51 patients with idiopathic ERM, who underwent pars plana vitrectomy with ERM and internal limiting membrane (ILM) peeling, and were followed for more than 6 months. Subjects were classified into 2 groups according to the presence of VMTS using preoperative optical coherence tomography (group 1: ERM without VMTS, 29 eyes; group 2: ERM with VMTS, 22 eyes). Preoperative macular structure deformity and surgical outcomes were compared and prognostic factors were analyzed.

Results

Group 1 (ERM without VMTS) included 29 eyes, and group 2 (ERM with VMTS) included 22 eyes. Group 2 had a significantly higher occurrence of lamellar macular hole and a significantly lower preoperative best-corrected visual acuity (BCVA) compared to group 1. However, final postoperative BCVAs were not significantly different between the groups because BCVA changed more in group 2. Preoperative macular structure deformities (irregular retinal surface, retinal thickening, lamellar macular hole, and cystoid macular edema) did not affect visual outcomes. The presence of photoreceptor inner segment/outer segment (IS/OS) junction disruption and preoperative BCVA were highly related with visual outcomes.

Conclusions

BCVA significantly improved in idiopathic ERM patients who underwent pars plana vitrectomy with ERM and ILM peeling regardless of the presence of VMTS. There may be a stronger association of IS/OS junction disruption with visual acuity compared to VMTS in idiopathic ERM surgery.

Keywords: Idiopathic epiretinal membrane, Internal limiting membrane peeling, Macular structure deformity, Vitreomacular traction syndrome

References

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Figure 1.

Spectral domain optical coherence tomography (SD-OCT) images of 2 groups. (A, B) Epiretinal membrane (ERM) without vitreomacular traction syndrome (VMTS); hyper-reflective ERM above retinal surface and retinal thickening are seen, but posterior hyaloid is not seen. (C, D) ERM with VMTS; posterior hyaloid attached with ERM causing retinal traction and inner retinal plication are seen.

Figure 2.

Spectral domain optical coherence tomography (SD-OCT) images of preoperative macular structure deformities. (A) Inner segment/outer segment (IS/OS) junction disruption; white arrow presents hypo-reflective discontinuity in the hyper-reflective IS/OS junction. (B) Irregular retinal surface beneath hyper-reflective epiretinal membrane (ERM) is seen. (C) Diffuse retinal thickening. (D) Cystoid macular edema. (E) Lamellar macular hole at fovea. Photoreceptor layers are intact.

Figure 3.

Spectral domain optical coherence tomography (SD-OCT) image changes after surgery of the same eye as in Fig. 1; Epiretinal membrane (ERM) without vitreomacular traction syndrome (VMTS). (A) Preoperative SD-OCT images with visual acuity log MAR 0.52. (B) SD-OCT image at 12 months after operation with visual acuity log MAR 0.30. Foveal contour is not completely recovered but fovea is depressed. White arrow presents damages of nerve fiber layer and ganglion cell layer during internal limiting membrane (ILM) peeling.

Figure 4.

Spectral domain optical coherence tomography (SD-OCT) image changes after surgery of the same eye as in Fig. 1; Epiretinal membrane (ERM) with vitreomacular traction syndrome (VMTS). (A) Preoperative SD-OCT images with visual acuity log MAR 0.70. (B) SD-OCT image at 12 months after operation with visual acuity log MAR 0.05. Inner retinal surface is still irregular, but overall retina is remarkably flattened and photoreceptor layers are intact.

Table 1.

Patient's demographic findings in 2 groups

	Group 1^*	Group 2^†	Total	p-value
No. of eyes	32	22	54
Sex (M:F)	8:21	8:14	16:35	0.773^‡
Age (years)	69.6 ± 6.3	61.4 ± 11.8	66.2 ± 9.7	0.003^§
Duration of symptom (months)	12.3 ± 11.5	7.4 ± 6.4	10.5 ± 10.0	0.248^§
Phakic:Pseudophakic	28:4	21:1	49:5	0.638^‡
Surgery (%)
Combined cataract surgery	28 (87.5)	21 (95.5)	49 (90.7)	0.638^‡
PPV + ERM removal + ILM peeling	32 (100)	22 (100)	54 (100)	−
SF6 gas tamponade	10 (31.3)	17 (77.3)	27 (50.5)	0.002^‡
Follow-up (months)	20.4 ± 14.6	20.9 ± 13.8	20.6 ± 14.2	0.832^§

Values are presented as mean ± SD unless otherwise indicated.

PPV = pars plana vitrectomy; ERM = epiretinal membrane; ILM = inner limiting membrane.

^* Idiopathic ERM without VMTS;

^† Idiopathic ERM with vitreomacular traction syndrome (VMTS);

^‡ Fisher's exact test;

^§ Mann-Whitney test.

Table 2.

Comparisons of preoperative macular structure deformities by OCT in 2 groups

OCT findings	Group 1^*	Group 2^†	p-value
IS/OS junction disruption (%)	4/32 (12.5)	7/22 (31.8)	0.100^§
Presence of irregular retinal surface (%)	12/32 (37.5)	10/22 (45.5)	0.559^‡
Increased retinal thickness (%)	28/32 (87.5)	20/22 (90.9)	0.695^§
Presence of cystoid macular edema (%)	5/32 (15.6)	4/22 (18.2)	0.702^§
Presence of lamellar macular hole (%)	2/32 (6.3)	10/22 (45.5)	0.002^§

OCT = optical coherence tomography; IS/OS = inner segment/outer segment.

^* Idiopathic epiretinal membrane (ERM) without vitreomacular traction syndrome (VMTS);

^† Idiopathic ERM with VMTS;

^‡ Chi-Square test;

^§ Fisher's exact test.

Table 3.

Comparisons of best corrected visual acuity in 2 groups

	Group 1^*	Group 2^†	p-value
Preoperative BCVA (log MAR)	0.34 ± 0.24	0.50 ± 0.24	0.010^‡
Final BCVA (log MAR)	0.19 ± 0.21	0.23 ± 0.19	0.258^‡
BCVA change (log MAR)	0.14 ± 0.13	0.26 ± 0.23	0.003^‡
p-value	0.001^§	0.001^§

Values are presented as mean ± SD.

BCVA = best corrected visual acuity.

^* Idiopathic epiretinal membrane (ERM) without vitreomacular traction syndrome (VMTS);

^† Idiopathic ERM with VMTS;

^‡ Mann-Whitney test;

^§ Wilcoxon signed rank test.

Table 4.

Comparisons of central macular thickness in 2 groups

	Group 1^*	Group 2^†	p-value
Preoperative CMT (μm)	418.8 ± 107	510.6 ± 144.5	0.014^‡
Final CMT (μm)	338.0 ± 83.0	328.5 ± 85.2	0.805^‡
CMT change (μm)	80.8 ± 75.8	182.1 ± 147.6	0.003^‡
p-value	0.001^§	0.001^§

Values are presented as mean ± SD.

CMT = central macular thickness.

^* Idiopathic epiretinal membrane (ERM) without vitreomacular traction syndrome (VMTS);

^† Idiopathic ERM with VMTS;

^‡ Mann-Whitney test;

^§ Wilcoxon signed rank test.

Table 5.

Prognostic factors according to preoperative macular structure deformities by OCT in 2 groups

OCT findings	Postoperative BCVA (log MAR)		p-value
OCT findings	≥0.3 (n = 19)	<0.3 (n = 35)	p-value
IS/OS junction disruption (%)	9/19 (47.4)	2/35 (5.7)	0.000^*
Presence of irregular retinal surface (%)	7/19 (36.8)	15/35 (42.9)	0.667^†
Increased retinal thickness (%)	17/19 (89.5)	29/35 (82.9)	0.698^*
Presence of cystoid macular edema (%)	4/19 (21.1)	4/35 (11.4)	0.431^*
Presence of lamellar macular hole (%)	5/19 (26.3)	7/35 (20.0)	0.734^*

OCT = optical coherence tomography; BCVA = best corrected visual acuity; IS/OS = inner segment/outer segment.

^* Fisher's exact test;

^† Chi-Square test.

Table 6.

Prognostic factors for final BCVA

Factors	p-value^*
Age	0.220
Sex	0.564
Duration of symptom	0.422
Preoperative BCVA	0.000
Presence of VMTS	0.303
IS/OS junction disruption	0.000
Presence of irregular retinal surface	0.989
Increased retinal thickness	0.379
Presence of lamellar macular hole	0.361
Presence of cystoid macular edema	0.790
SF6 gas tamponade	0.340

BCVA = best corrected visual acuity; VMTS = vitreomacular traction syndrome; IS/OS = inner segment/outer segment.

^* Multiple linear regression analysis.

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