The Correlation between Preoperative En Face Optical Coherence Tomography and Postoperative Visual Prognoses in Idiopathic Epiretinal Membranes

Sung Hyun Ahn; Tae Eun Lee; In Cheon You; Min Ahn; Nam Chun Cho; Jin Gu Jeong

doi:10.3341/jkos.2018.59.4.347

Journal List > J Korean Ophthalmol Soc > v.59(4) > 1010885

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Ahn, Lee, You, Ahn, Cho, and Jeong: The Correlation between Preoperative En Face Optical Coherence Tomography and Postoperative Visual Prognoses in Idiopathic Epiretinal Membranes

Original Article

J Korean Ophthalmol Soc 2018;59(4):347-354.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.347

The Correlation between Preoperative En Face Optical Coherence Tomography and Postoperative Visual Prognoses in Idiopathic Epiretinal Membranes

Sung Hyun Ahn, MD¹, Tae Eun Lee, MD, PhD^1,^2,³, In Cheon You, MD, PhD^1,^2,³, Min Ahn, MD, PhD^1,^2,³, Nam Chun Cho, MD, PhD^1,^2,³, Jin Gu Jeong, MD^1,^2,^3,

^¹Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

^²Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea

^³Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea

Address reprint requests to Jin Gu Jeong, MD Department of Ophthalmology, Chonbuk National University Hospital, #20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea Tel: 82-63-259-3473, Fax: 82-63-250-1960, E-mail: terathan@naver.com

Received 21 September 2017 Revised 17 January 2018 Accepted 29 March 2018

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 investigate the correlation between en face optical coherence tomography and improvements in the postoperative prognoses of idiopathic epiretinal membranes.

Methods

The medical records of 59 epiretinal membrane patients who had epiretinal membrane peeling between January 2005 and January 2016, and were followed up for > 12 months, were retrospectively reviewed. The preoperative en face images were divided into four sections involving three circular areas (6,000 μm diameter circle, 3,000 μm diameter circle, and 1,000 μm diameter circle) and one square (6,000 × 6,000 μm). The surface area where no epiretinal adhesion was present was quantified by measuring the number of black pixels using image-editing software (Adobe Photoshop CS6, Adobe Systems, San Jose, CA, USA). Then the correlations among the value of black pixels, preoperative and postoperative visual acuities, and central retinal thickness were analyzed.

Results

The best-corrected visual acuity (BCVA) was significantly increased after epiretinal membrane peeling (p < 0.001), and the central retinal thickness was significantly decreased (p < 0.001). As the number of black pixels in the circles and the square in the en-face images increased, the postoperative BCVA significantly increased (r = 0.645, p < 0.001; r = 0.590, p < 0.001, respectively).

Conclusions

As the nonadhesive surfaces of the epiretinal membrane and the retina in preoperative en face images became wider, the increments of the BCVA after surgery were greater. Therefore, en face optical coherence tomography can be used to predict prognosis after epiretinal membrane peeling.

Keywords: En face image, Epiretinal membrane, Optical coherence tomography

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Figure 1.

Four types of En Face optical coherence tomography (OCT) images. 6,000 × 6,000 qm square (A), 6,000 qm diameter circle (B), 3,000 qm diameter circle (C), and 1,000 qm diameter circle (D). The original En Face OCT image (A) was edited in three circles according to the early treatment diabetic retinopathy study subfields. Then we obtained the black pixel values of each of the images.

Figure 2.

Large area of elevated epiretinal membrane (ERM) peeling. Line scanning ophthalmoscope image (A) and En Face image (B). Black pixelated areas calculated automatically reveal elevated ERM in (B). It shows that the retina and the ERM have a wide area of contact in (A). And the larger the area of contact, the lower the black pixel value may be considered as shown as the narrow area of black color in (B).

Figure 3.

Small area of elevated epiretinal membrane (ERM) peeling. Line scanning ophthalmoscope image (A), and En Face image (B). It shows that the retina and the ERM have a narrow are of contact in (A). And the narrower the area of contact, the greater the black pixel value may be considered as shown as the greater area of black color in (B).

Figure 4.

Scattergram showing the significant positive correlation between the change in best corrected visual acuity (BCVA) and preoperative epiretinal membrane area (pixels) with no retinal contact. (A) BCVA and 6,000 × 6,000 μm square (r = 0.645,p < 0.001), and (B) BCVA and 6,000 μm diameter circle (r = 0.590, p < 0.001).

Table 1.

Demographic characteristics and clinical features of the patients

Characteristics	Value
Number of patients	59
Sex (male:female)	27:32
Age at surgery (years)	64.8 ± 8.9
Preoperative lens state (phakic:pseudophakic)	36:23
Types of operation (phacovitrectomy:vitrectomy)	15:44
BCVA (logMAR) (preoperative:postoperative)	0.51 ± 0.29:0.24 ± 0.23*
BCVA change (logMAR)	0.27 ± 0.24

Values are presented as mean ± SD unless otherwise indicated.

SD = standard deviation; BCVA = best corrected visual acuity

^* p-value < 0.001, Wilcoxon signed rank test.

Table 2.

Central retinal thickness after and before epiretinal membrane peeling (ERMP), and values of the black pixelated area on En Face images

Variables	Value
CRT (μm) (preoperative:postoperative)	468.97 ± 101.44:354.75 ± 63.20*
CRT chage (μm)	113.53 ± 86.11
6,000 × 6,000 μm square (pixels)	42,893.92 ± 6,826.66
6,000 μm diameter circle (pixles)	33,799.24 ± 5,652.37
3,000 μm diameter circle (pixles)	8,094.85 ± 1,958.61
1,000 μm diameter circle (pixles)	861.90 ± 391.41

Values are presented as mean ± SD unless otherwise indicated.

CRT = central retinal thickness; SD = standard deviation.

^* p-value < 0.001, Wilcoxon signed rank test.

Table 3.

Correlation between the visual prognosis and values of the black pixelated area on En Face images

Variables	Preoperative BCVA		Postoperative BCVA (12 months)		BCVA change (12 months)
Variables	r*	p-value	r*	p-value	r*	p-value
6,000 × 6,000 μm square pixels	0.300	0.021^†	−0.312	0.016^†	0.645	<0.001^†
6,000 μm diameter circle pixels	0.247	0.059	−0.321	0.013^†	0.590	<0.001^†
3,000 μm diameter circle pixels	0.199	0.131	−0.125	0.344	0.352	0.006^†
1,000 μm diameter circle pixels	0.162	0.220	0.035	0.792	0.163	0.218

BCVA = best corrected visual acuity.

^* Spearman correlation test;

^† Statistically significant.

Table 4.

Correlation between the values of the black pixelated area on En Face images and the values of central retinal thickness (CRT) change

Variables	CRT change (12 months)
Variables	r*	p-value
6,000 × 6,000 μm square pixels	0.055	0.680
6,000 μm diameter circle pixels	0.042	0.758
3,000 μm diameter circle pixels	0.081	0.540
1,000 μm diameter circle pixels	0.040	0.764

^* Spearman correlation test.

Table 5.

Correlation between the visual prognosis and the values of the central retinal thickness (CRT)

Variables	Postoperative BCVA (12 months)		BCVA change (12 months)
	r*	p-value	r*	p-value
	Preoperative CRT	0.360	0.005^†	−0.026	0.843
CRT change (12 months)	0.286	0.028^†	0.179	0.174
Preoperative BCVA	0.580	<0.001^†	0.663	<0.001^†

BCVA = best corrected visual acuity.

^* Spearman correlation test;

^† Statistically significant.

Table 6.

Correlation between the values of the central retinal thickness (CRT)

Variables	Postoperative CRT (12 months)		CRT change (12 months)
	r*	p-value	r*	p-value
	Preoperative CRT	0.536	<0.001^†	0.786	<0.001^†

^* Spearman correlation test;

^† Statistically significant.

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