Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane

Charm Kim; Hae Jung Sun; Sung Jin Lee; Kyung Seek Choi

doi:10.3341/jkos.2020.61.1.59

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Kim, Sun, Lee, and Choi: Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane

Original Article

Journal of the Korean Ophthalmological Society 2020; 61(1): 59-68.

Published online: 15 January 2020

DOI: https://doi.org/10.3341/jkos.2020.61.1.59

Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane

Charm Kim, MD, Hae Jung Sun, MD, Sung Jin Lee, MD, Kyung Seek Choi, MD

Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Korea.

Address reprint requests to Kyung Seek Choi, MD. Department of Ophthalmology, Soonchunhyang University Seoul Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. Tel: 82-2-709-9354, Fax: 82-2-710-3196, ckseek@naver.com

Received 13 June 2019 Revised 19 August 2019 Accepted 30 December 2019

The Korean Ophthalmological Society

(open-access):

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 compare the visual acuity and retinal thickness in patients with an idiopathic epiretinal membrane (ERM) after vitrectomy and membranectomy using two different methods.

Methods

This retrospective observational study included 77 eyes (32 eyes in the diamond-dusted membrane scraper [DDMS] group, and 45 eyes in the intraocular forceps [IOF] group) of 77 patients with idiopathic ERM who underwent pars plana vitrectomy and membranectomy. The main outcome measures were best-corrected visual acuity (BCVA, logMAR) and mean retinal thickness.

Results

In the IOF group, the BCVA at postoperative 1 week was significantly lower than at baseline and had improved at 12 weeks after surgery. In the DDMS group, the BCVA at postoperative 1 week showed no significant difference at baseline and had improved at 4 weeks after surgery. The central macular thickness at postoperative 6 months was significantly lower than at baseline (all, p < 0.001); there was no significant difference between the two groups (p = 0.400). The postoperative macular thickness of the DDMS group was significantly lower than that of the IOF group in the inner inferior and outer inferior areas at postoperative 12 weeks and 4 weeks (p = 0.046 and p = 0.039, respectively). Five eyes of the DDMS group and 15 eyes of the IOF group developed cystoid macular edema, 14 eyes of that improved without treatment.

Conclusions

In patients with ERM, the use of DDMS or IOF for vitrectomy and membranectomy both resulted in improved visual acuity and decreased mean retinal thicknesses.

Keywords: Diamond-dusted membrane scraper, Idiopathic epiretinal membrane, Membranectomy

Figures and Tables

Figure 1

Early treatment of diabetic retinopathy study subfield. Sector 1: C0, Sector 2: IS, Sector 3: IN, Sector 4: II, Sector 5: IT, Sector 6: OS, Sector 7: ON, Sector 8: OI, Sector 9: OT. C0 = central fovea; IS = inner superior; IN = inner nasal; II = inner inferior; IT = inner temporal; OS = outer superior; ON = outer nasal; OI = outer inferior; OT = outer temporal.

Figure 2

Preoperative and postoperative best corrected cisual acuity (BCVA, logMAR). BCVA in the DDMS groups were improved at postoperative 4 weeks, but BCVA in the IOF groups were deteriotating until postoperative 4 weeks and then improved at 12 weeks after surgery. LogMAR = logarithm of minimal angle of resolution; DDMS = diamond dusted membrane scraper; IOF = intraocular forcep. ^*,^†p-value were analyzed by Wilcoxon singed rank test. Each postoperative BCVA were compared with preoperative BCVA.

Figure 3

Preoperative and postoperative best corrected cisual acuity (logMAR) by combined cataract surgery. (A) Patients of phakic eyes, vitrectomy combined cataract surgery. (B) Patients of pseudophakic eyes, only vitrectomy. p-value were analyzed by Mann-Whitney U test. DDMS = diamond dusted membrane scraper; IOF = intraocular forcep.

Figure 4

Average retinal thickness of early treatment of diabetic retinopathy study subfield (ETDRS) 9 sectors at preoperative and postoperative time. Preoperative mean retinal thickness was not significantly different between the two groups in all sectors of ETDRS. The averge retinal thickness in the sector 4 (inferior) was significantly lower in the diamond dusted membrane scraper (DDMS) group than in the intraocular forcep (IOF) group after 12 and 24 weeks postoperatively. The average retinal thickness at 4, 12, and 24 weeks after surgery was significantly lower in the DDMS group than in the IOF group. IOP = intraocular pressure. ^*p-value were analyzed by Mann Whitney U test. Each mean retinal thickness were compared DDMS group with IOF group.

Figure 5

Difference of average retinal thckness of early treatment of diabetic retinopathy study subfield (ETDRS) 9 sectors compared preoperative time with each postoperative time. (A) The diamond dusted membrane scraper group showed more decrease than the intraocular forcep group in sector 1, 2, 3, 4, 5 and 6 postoperatively, but not significant statistically. (B) At 4, 12 weeks postoperatively, changes in retinal thickness were presented as a percentage of the ETDRS area. DDMS = diamond dusted membrane scraper; IOP = intraocular pressure; IOF = intraocular forcep.

Figure 6

Postoperative optical coherence tomography finding of cystoid macular edema. (A) After 6 weeks, cystoid macular edema was developed in the diamond dusted membrane scraper groups. (B) After 6 weeks, cystoid macular edema was developed in the intraocular forcep groups.

Table 1

Demographics and other baseline characteristics of each group with ERM

Values are presented as mean ± standard deviation or number (%) in student t-test and median (inter quartile range; Q1–Q3) in Mann-Whitney U test unless otherwise indicated.

ERM = epiretinal membrane; DDMS = diamond dusted membrane scraper; IOF = intraocular forcep; BCVA = best corrected visual acuity; logMAR = logarithm of minimal angle of resolution; CMT = central macular thickness.

^*Student t-test; ^†χ² test; ^‡Mann-Whitney U test.

Table 2

Comparison of best corrected visual acuity (logMAR) according to surgery

Values are presented as median (inter quartile range; Q1–Q3) unless otherwise indicated.

logMAR = logarithm of minimal angle of resolution; Op. = operation; DDMS = diamond dusted membrane scraper; IOF = intraocular forcep; Postop. = postoperative; wk(s) = week(s).

*p-value were calculated using Mann-Whitney U test.

Table 3

Comparison of postoperative complications between each groups

Values are presented as number (%).

DDMS = diamond dusted membrane scraper; IOF = intraocular forcep; Postop. = postoperative; ERM = epiretinal membrane.

^*χ² test.

Notes

The study was presented as an e-poster at the 120th Annual Meeting of the Korean Ophthalmological Society 2018.

This study was supported by an Industry-academic cooperation of Soonchunhyang University.

^{Conflicts of Interest} The authors have no conflicts to disclose.

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