Short-term-outcomes of idiopathic epiretinal membranes treated with pars-plana-vitrectomy - examination of visual function and OCT-morphology

Abstract

Background: Epiretinal membranes (ERM) represent one of the most common findings in retinal examination. Structural changes of the retinal layers in patients with ERM can be visualized and classified using OCT. The purpose of this study is to evaluate structural and functional changes related to surgical treatment of ERM.

Methods: Monocentric retrospective analysis of 92 patients who underwent 23-gauge-pars plana vitrectomy (ppV) combined with cataract surgery for idiopathic ERM from 2015 to 2020. Visual acuity was determined directly preoperatively, at four weeks and three months postoperatively. Disease stage and tomographic biomarkers related to ERM were assessed in OCT imaging.

Results: 92 eyes of 92 patients were included. At the time of surgery, the mean patient age was 71 years. Visual acuity improved significantly by 2 lines postoperatively, on average from LogMar 0.4 to 0.2 (p < 0.001). Disease stage regressed from stage 3 to stage 2 postoperatively (p < 0.001). No patient had stage 4 postoperatively (n = 0). In the presence of preoperative intraretinal fluid, mean retinal thickness was 488 μm and decreased to 392 μm postoperatively (n = 32; p < 0.001). Preoperative presence of a Cotton Ball Sign (n = 30) was associated with better visual acuity (p = 0.009). This was also visible in patients with preoperative vitreomacular traction syndrome (p < 0.001). The presence of preoperative intraretinal fluid showed a tendency towards better disease staging after surgery (p = 0.080).

Conclusion: Surgery was able to achieve visual improvement and morphological regression of the preoperative OCT findings related to ERM. ppV led to a reduction in retinal thickness and disease stage. The presence of the Cotton Ball Sign and vitreomacular traction was associated with better visual acuity in the follow-up period. In our cohort the preoperative presence of intraretinal fluid showed a tendency for better postoperative disease staging.

Keywords: Biomarkers; Classification; Gliosis; Oct; Optical coherence tomography; Retina; Staging.

Fig. 1

Staging of epiretinal membranes (ERM) according to Govetto et al. A: Stage 1: presence of foveal pit, retinal layers are defined. B: Stage 2: Absence of clear foveal pit, retinal layers are defined. C: Stage 3: Absence of foveal pit, retinal leyers are defined, ectopic inner foveal layers (EIFL). D: Stage 4: Absence of foveal pit, retinal layers are disrupted, presence of EIFL

Fig. 2

Exemplary imaging of pre- and postoperative results. A1: preoperative finding in a patient with vitreomacular traction (VMT) and Cotton Ball sign (*). A2: postoperative result in the same patient at three months postoperatively. B1: preoperative finding in a patient with ERM, Cotton Ball sign (*), and intraretinal cavities due to ERM. B2: postoperative result in the same patient at three months postoperatively. C1: preoperative finding in a patient with ERM Stage 4. C2: postoperative result in the same patient at three months postoperatively