Impact of Epiretinal Membrane on Anatomical and Visual Outcomes in Patients with Full-Thickness Macular Holes

Abstract

Purpose: This study aimed to evaluate the impact of an epiretinal membrane (ERM) on the postoperative outcomes of full-thickness macular hole (MH) repair, focusing on anatomical closure rates, postoperative visual acuity (VA), and recovery of the outer retinal layers.

Design: A retrospective cohort study.

Participants: A total of 605 eyes from 594 patients who underwent MH surgery from 2015 to 2023.

Methods: Patients were divided into 2 groups (MH with ERM [254 eyes] and MH without ERM [351 eyes]). Multiple regression analysis was employed to evaluate surgical outcomes, adjusting for minimum hole size and high myopia in relation to the initial MH closure rate and for preoperative VA and concurrent cataract surgery in relation to postoperative VA at 3 months. In all cases, ERM and internal-limiting membrane (ILM) peeling were performed, and the inverted ILM flap cover technique was added at the discretion of the surgeon. Patients with MH-associated retinal detachment, myopic foveoschisis and recurrent or traumatic MH were excluded.

Main outcome measures: The initial MH closure rate and postoperative VA at 3 months were evaluated using multiple regression analysis.

Results: Our results indicated that ERM did not significantly impact MH closure rates (97.2% vs. 98.3%, P = 0.554), which was consistent with the findings of the multiple regression analysis (r = -0.310, P = 0.666). The inverted ILM flap technique effectively promoted MH closure even in the presence of an ERM (P = 0.021). The MH with ERM group had significantly worse postoperative VA at 3 months (P = 0.004) and significantly lower restoration rates of the outer nuclear layer (64.4% vs. 75.1%, P = 0.006) and external limiting membrane (82.2% vs. 90.1%, P = 0.007).

Conclusions: An ERM does not significantly affect anatomical MH closure. The inverted ILM flap technique is effective for MH closure, even in the presence of an ERM. An ERM negatively impacted postoperative VA and outer retinal layer restoration.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Epiretinal membrane; Epiretinal proliferation; Internal-limiting membrane peeling; Inverted internal-limiting membrane flap cover technique; Macular hole.