Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

Sung II Kim; Sung Who Park; Ik Soo Byon; Ji Eun Lee

doi:10.3341/jkos.2014.55.5.686

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Kim, Park, Byon, and Lee: Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

Original Article

J Korean Ophthalmol Soc 201;55(5):686-692.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.686

Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

Sung II Kim, MD¹, Sung Who Park, MD¹, Ik Soo Byon, MD^2,^3,, Ji Eun Lee, MD, PhD^1,⁴

¹Department of Ophthalmology, Pusan National University Hospital, Busan, Korea

²Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea

³Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea

⁴Department of Ophthalmology, Pusan National University Graduate School of Medicine, Busan, Korea

Address reprint requests to Ik Soo Byon, MD, Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea, Tel: 82-55-360-2131, Fax: 82-55-360-2161 E-mail: isbyon@pusan.ac.kr

Received 27 June 2013 Revised 12 September 2013 Accepted 15 March 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 surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity.

Methods

We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images.

Results

Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 ± 0.06 and 0.25 ± 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 ± 86 pm at baseline to 343 ± 45 pm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months.

Conclusions

Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.

Keywords: Good visual acuity, Idiopathic epiretinal membrane, Inner limiting membrane, Removal of membrane, Vitrectomy

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Figure 1.

Classification of the inner segment/outer segment (IS/OS) junction of the photoreceptor layer according to optical coherence tomography scan. (A) Intact type; continuous hyper-reflectivity line of the IS/OS junction. (B) Attenuated type; decreased reflectivity line of the IS/OS junction. (C) Disrupted type; absent or discontinuity of the IS/OS junction.

Figure 2.

Changes in central subfield macular thickness (CSMT) and the best corrected visual acuity (BCVA). Values are presented as mean ? SD. CSMT improved significantly 1 month after surgery (*p < 0.01), but BCVA did not.

Figure 3.

Optical coherence tomography images of the fovea. (A) Of 17 eyes without foveal depression at baseline, (B) 11 eyes had a foveal depression after 6.6 months in average.

Table 1.

Baseline characteristics

Parameters	Values
Laterality (right:left)	11:13
Sex (M:F)	4:20
Age (years)	57.8 ± 9.4
BCVA (log MAR)	0.26 ± 0.06
CSMT (pm)	417.8 ± 86.4
Lens state (Phakia:Pseudophakia)	24:0
Combined cataract surgery (%)	16 (66.7)
ILM peeling (%)	21 (87.5)
ICG assisted (%)	12 (50.0)
TA assisted (%)	7 (29.2)
No adjuvant (%)	2 (8.3)

Values are presented as mean ± SD.

BCVA = best corrected visual acuity; CSMT = central subfield macular thickness; ILM = internal limiting membrane; ICG = indocyanine green; TA = triamcinolone acetonide.

Table 2.

Comparison of the three groups according to the change of 2 lines or more in BCVA

	Baseline			12 months
	Increased	No changes	Decreased	Increased	No changes	Decreased
BCVA (log MAR)	0.30 ± 0.00	0.25 ± 0.05	0.23 ± 0.08	0.07 ± 0.05	0.20 ± 0.09	0.48 ± 0.04
p-value	0.102			<0.001
CSMT	394.8 ± 70.7	422.3 ± 99.9	431.5 ± 80.1	328.5 ± 33.4	356.0 ± 48.6	330.3 ± 46.1
p-value	0.682			0.384
IS/OS junction
Normal	6	9	4	6	9	5
Attenuation	0	2	1	0	2	0
Disruption	0	1	1	0	1	1
p-value	0.649			0.273
ILM peeling				6	11	4
ICG assisted				3	8	1
TA assisted				2	3	2
No Adjuvant				1	0	1
p-value				0.396

Values are presented as mean ± SD.

BCVA = best corrected visual acuity; CSMT = central subfield macular thickness; IS/OS = inner segment/outer segment; ILM = internal limiting membrane; ICG = indocyanine green; TA = triamcinolone acetonide.

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