Evaluation of Each Retinal Layer Thickness According to Preoperative OCT Patterns after Idiopathic ERM Removal

Sang Won Kim; Jae Hong Park; Dong Seob Ahn; Hee Seong Yoon

doi:10.3341/jkos.2014.55.12.1843

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Kim, Park, Ahn, and Yoon: Evaluation of Each Retinal Layer Thickness According to Preoperative OCT Patterns after Idiopathic ERM Removal

Original Article

J Korean Ophthalmol Soc 2014;55(12):1843-1852.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1843

Evaluation of Each Retinal Layer Thickness According to Preoperative OCT Patterns after Idiopathic ERM Removal

Sang Won Kim, MD, Jae Hong Park, MD, Dong Seob Ahn, MD, Hee Seong Yoon, MD

Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Hee Seong Yoon, MD Sungmo Eye Hospital, #409-1 Haeun-daero, Haeundae-gu, Busan 612-823, Korea, Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: heesyoon@dreamwiz.com

Received 31 May 2014 Revised 12 August 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 evaluate the changes in each retinal layer thickness according to preoperative optical coherence tomography (OCT) patterns after idiopathic epiretinal membrane (ERM) removal and to investigate the correlation between retinal layer thickness and visual improvement.

Methods

The medical records of 63 patients (63 eyes) who underwent vitrectomy with internal limiting membrane (ILM) peeling for idiopathic ERM and followed for more than 6 months were retrospectively reviewed. The OCT images of preoperative idiopathic ERM were classified into 3 patterns being flat, convex, and concave. Then, the changes of each retinal layer thickness were compared among OCT patterns and the correlations between retinal layer thickness and visual improvement were analyzed.

Results

Improvement in visual acuity was measured in the following order: concave, flat, and convex patterns. The patients with the convex pattern only showed significant improvement of visual acuity. Ganglion cell layer plus inner plexiform layer (GCL + IPL), inner nuclear layer (INL), and outer plexiform layer (OPL) thicknesses were significantly larger in preoperative ERM patients than in normal controls in the following order: convex, concave, and flat patterns. Retinal layer thickness decreased significantly in GCL + IPL and INL after surgery in convex, flat, and concave patterns, in that order. Generally, preoperative retinal layer thickness and postoperative visual acuity were not correlated. However, improvement of visual acuity was significantly related to GCL + IPL and INL thicknesses in the convex pattern and IPL thickness in the flat pattern.

Conclusions

In patients with idiopathic ERM, preoperative difference in each retinal layer thickness according to preoperative OCT patterns was observed. After ERM removal, reduction of each retinal layer thickness and specific retinal layer related to visual improvement was different according to preoperative OCT patterns.

Keywords: Epiretinal membrane, Optical coherence tomography, Retinal layer thickness

References

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Figure 1.

Three patterns of epiretinal membrane according to optical coherence tomography images. (A) The flat pattern (B) the convex pattern (C) the concave pattern.

Figure 2.

Segmentation of inner and outer retina with epiretinal membrane. GCL + IPL = ganglion cell layer and inner plexiform layer; INL = inner nuclear layer; OPL = outer plexiform layer; ONL = outer nuclear layer; PRL = photoreceptor inner segment and outer segment.

Figure 3.

Mean BCVA changes according to the pattern of epiretinal membrane. BCVA = best corrected visual acuity.

Figure 4.

A boxplot of each retinal layer thickness according to epiretinal membrane pattern before epiretinal membrane removal surgery. GCL + IPL = ganglion cell layer and inner plexiform layer; INL = inner nuclear layer; OPL = outer plexiform layer; ONL = outer nuclear layer; PRL = photoreceptor inner segment and outer segment; CMT = central macular thickness.

Figure 5.

A boxplot of reductions of each retinal layer thickness according to epiretinal membrane pattern after epiretinal membrane removal surgery. GCL + IPL = ganglion cell layer and inner plexiform layer; INL = inner nuclear layer; OPL = outer plexiform layer; ONL = outer nuclear layer; PRL = photoreceptor inner segment and outer segment; CMT = central macular thickness.

Table 1.

Preoperative demographics and clinical characteristics of the patients

	Flat pattern	Convex pattern	Concave pattern	Total
Number of eyes (%)	23 (36.5)	28 (44.5)	12 (19)	63
Sex (M:F)	8:15	6:22	5:7	20:43
Age (years)	64.6 ± 10.1	65.4 ± 9.7	65.5 ± 7.1	65.1 ± 9.3
Duration of follow-up (months)	13.7 ± 5.1	14.3 ± 7.6	12.5 ± 8.5	13.9 ± 7.1
Number of combination surgical procedure with phacoemusification (%)	20 (86.9)	23 (85.1)	10 (76.9)	53 (84.1)

Values are presented as mean ± SD unless otherwise indicated.

Table 2.

Preoperative and postoperative log MAR visual acuity according to the pattern of epiretinal membrane

	Flat	Convex	Concave	Total	p-value^*
Preoperative BCVA (log MAR)	0.37 ± 0.23	0.74 ± 0.41	0.36 ± 0.18	0.53 ± 0.36	<0.001^‡
Postoperative 2 months BCVA (log MAR)	0.33 ± 0.2	0.46 ± 0.15	0.32 ± 0.19	0.38 ± 0.19	0.046^‡
Postoperative 13.9 months BCVA (log MAR)	0.28 ± 0.24	0.4 ± 0.24	0.23 ± 0.13	0.32 ± 0.23	0.022^‡
Mean BCVA change (log MAR)	0.09 ± 0.29	0.34 ± 0.39	0.13 ± 0.23	0.21 ± 0.35	0.045^‡
p-value^†	0.184	<0.001^‡	0.062

Values are presented as mean ± SD.

BCVA = best corrected visual acuity.

^* Kruskal-Wallis test;

^† Wilcoxon signed rank test;

^‡ Statistically significant.

Table 3.

Thickness of each retinal layers according to epiretinal membrane patterns before epiretinal membrane removal surgery

	Flat	Convex	Concave	p-value^*	Fellow eye	p-value^*
GCL + IPL	125.76 ± 36.59	189.2 ± 67.64	131.16 ± 40.55	0.001^†	63.33 ± 10.97	<0.001^†
INL	90.95 ± 29.31	131.9 ± 39.18	91.16 ± 36.54	0.001^†	36.75 ± 7.01	<0.001^†
OPL	30.95 ± 7.43	38.4 ± 5.18	31.2 ± 8.2	0.002^†	22.75 ± 5.38	<0.001^†
ONL	99.42 ± 22.1	109.8 ± 24.22	102.83 ± 23.59	0.266	91.25 ± 19.63	0.163
PRL	90.9 ± 7.61	89.15 ± 10.12	88.11 ± 7.93	0.604	88.96 ± 9.14	0.173
CMT	413.09 ± 66.31	560.7 ± 77.64	378.66 ± 102.6	<0.001^†	249.75 ± 15.77	<0.001^†

Values are presented as mean ± SD.

GCL + IPL = ganglion cell layer and inner plexiform layer; INL = inner nuclear layer; OPL = outer plexiform layer; ONL = outer nuclear layer; PRL = photoreceptor inner segment and outer segment; CMT = central macular thickness.

^* Kruskal-Wallis test;

^† Statistically significant.

Table 4.

Reductions of each retinal layer thickness according to epiretinal membrane patterns after epiretinal membrane removal surgery

	Flat		p-value^*	Convex		p-value^*	Concave		p-value^*	p-value^†
	Thickness (μm)	Reductions (%^‡)	p-value^*	Thickness (μm)	Reductions (%^‡)	p-value^*	Thickness (μm)	Reductions (%^‡)	p-value^*	p-value^†
GCL + IPL	88.09 ± 22.07	37.66 ± 28.35 (29.9)	<0.001	105.4 ± 22.05	83.8 ± 76.24 (44.2)	<0.001	102.91 ± 28.13	28.25 ± 40.81 (21.5)	0.05	0.05
INL	70.66 ± 16.04	20.29 ± 22.83 (22.3)	0.003	96.05 ± 19.43	35.85 ± 35.72 (27.1)	0.001	71.75 ± 9.56	18.41 ± 35.74 (20.4)	0.05	<0.001
OPL	27.85 ± 8.47	3.09 ± 10.55 (10.1)	0.213	32.05 ± 6.5	6.35 ± 7.95 (16.5)	0.003	31 ± 10.29	0.25 ± 8.99 (0.6)	0.755	0. 212
ONL	107.14 ± 19.39	−7.71 ± 28.8 (-7.7)	0.192	122.75 ± 19.41	−12.95 ± 28.26 (-11.7)	0.070	108.41 ± 27.04	−5.58 ± 18.36 (-5.4)	0.343	0. 022
PRL	84.61 ± 5.66	6.28 ± 8.94 (6.9)	0.004	82.15 ± 12.61	7.1 ± 16.65 (7.8)	0.059	82.91 ± 15.93	5.08 ± 14.41 (5.9)	0.326	0. 653
CMT	363 ± 42.88	50.09 ± 62.95 (12.1)	0.003	400.15 ± 35.75	160.55 ± 76.79 (28.6)	<0.001	366.16 ± 58.04	12.5 ± 102.11 (3.3)	0.969	0. 023

Values are presented as mean ± SD.

^* Wilcoxon signed rank test;

^† Kruskal-Wallis test;

^‡ (Preoperative thickness-postoperative thickness)/preoperative thickness × 100.

Table 5.

Correlation between visual acuity and each retinal layer thickness according to epiretinal membrane patterns before and after epiretinal membrane

Preop retinal layer	Flat			Convex			Concave			Total
Preop retinal layer	Preop VA	Postop VA	Change of VA	Preop VA	Postop VA	Change of VA	Preop VA	Postop VA	Change of VA	Preop VA	Postop VA	Change of VA
GCL + IPL	−0.121	−0.296	0.082	0.600^*	0.164	0.562^*	−0.132	0.109	−0.137	0.552^†	0.242	0.383^†
INL	−0.09	−0.272	0.165	0.605^*	0.074	0.633^*	−0.206	−0.044	−0.158	0.49^†	0.124	0.414^†
OPL	−0.044	−0.497^‡	0.585^*	−0.153	0.124	−0.295	−0.132	0.046	−0.053	0.197	−0.076	0.268
ONL	−0.065	0.12	−0.291	0.105	−0.145	0.066	0.406	−0.455	0.54	0.127	0.048	0.094
PRL	0.015	0.071	−0.103	0.296	0.513^*	−0.126	0.14	−0.197	0.137	0.006	0.114	−0.086
CMT	−0.121	−0.301	0.156	0.661^*	0.374	0.445^‡	0.089	−0.08	0.095	0.527^†	0.234	0.363^†

VA = visual acuity; GCL + IPL = ganglion cell layer and inner plexiform layer; INL = inner nuclear layer; OPL = outer plexiform layer; ONL = outer nuclear layer; PRL = photoreceptor inner segment and outer segment; CMT = central macular thickness.

^* p < 0.01, Spearman's rho correlation coefficient;

^† p < 0.01, Pearson's correlation coefficient;

^‡ p < 0.05, Spearman's rho correlation coefficient.

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