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Epiretinal Membrane Surgery after Retinal Detachment Repair: Visual Acuity Outcomes and OCT Analysis

Published:March 28, 2021DOI:https://doi.org/10.1016/j.oret.2021.03.013

      Purpose

      To assess visual acuity (VA) outcomes of epiretinal membrane (ERM) surgery following primary rhegmatogenous retinal detachment (RD) repair and to identify OCT features predictive of visual outcomes.

      Design

      Retrospective, consecutive case series.

      Subjects

      Eyes undergoing pars plana vitrectomy (PPV) with membrane peel (MP) surgery for ERM following primary RD repair (PPV with or without scleral buckle (SB) and gas tamponade).

      Methods

      Retrospective chart review from 2015 to 2018. A previously described ERM grading scale was utilized for OCT structural analysis.

      Main Outcome Measures

      Visual acuity (VA) and change in VA from pre- MP to 6 months and final follow-up. Secondary outcomes included RD and OCT features predictive of VA, as well as RD factors associated with need for subsequent MP surgery.

      Results

      53 eyes of 53 patients underwent MP following RD repair. VA improved significantly from logMAR 1.00 ± 0.51 (Snellen 20/200) pre-MP to 0.45 ± 0.41 (20/56) at 6 months and 0.42 ± 0.41 (20/53) at final follow-up, (p<0.001) for each respectively. Macula on eyes had better 6 month [0.29 ± 0.18 (20/39) vs. 0.51 ± 0.46 (20/65), p=0.02] and final VA [0.29 ± 0.14 (20/39) vs. 0.46 ± 0.47 (20/58), p=0.04] after MP surgery. VA improved significantly from pre-MP to 6 months and final follow-up regardless of macula status. MP occurring ≤180 days from RD repair and IS/OS loss were associated with worse pre-MP VA [1.13 ± 0.09 (20/270) vs. 0.82 ± 0.07(20/132), p=0.01 and 1.21 ± 0.07 (20/324) vs. 0.74 ± 0.09 (20/110) p=0.0003, respectively]. IS/OS loss [adjusted means 0.54 ± 0.07 (20/69) vs. 0.25 ± 0.08 (20/36) at final visit, p=0.006] and RD repair with PPV/SB [0.53 ± 0.08 (20/68) vs. 0.31 ±0.07 (20/41) at final visit, p=0.03] were significantly associated with worse VA at both 6 months and final follow-up.

      Conclusions

      Eyes undergoing MP after RD repair have significant visual acuity gains independent of macula-status at time of RD repair. Pre-operative IS/OS disruption was the OCT feature best predictive of visual acuity.

      Keywords

      Abbreviations and Acronyms:

      CFT (central foveal thickness), EIFL (ectopic inner foveal layer), ERM (epiretinal membrane), ILM (inner limiting membrane), IS/OS (inner segment/outer segment zone), logMAR (logarithm of the minimum angle of resolution), MP (membrane peeling), ONL (outer nuclear layer), PFCL (perfluorocarbon), PPV (pars plana vitrectomy), RD (rhegmatogenous retinal detachment), RPE (retinal pigment epithelium), SB (scleral buckle), VA (visual acuity)
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