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Pars Plana Vitrectomy for Idiopathic Epiretinal Membrane: Optical Coherence Tomography Biomarkers of Visual Outcomes in 322 Eyes

Published:October 26, 2021DOI:https://doi.org/10.1016/j.oret.2021.10.008

      Abstract

      Objective

      To investigate optical coherence tomography (OCT)-based biomarkers of visual acuity (VA) in eyes with idiopathic epiretinal membranes (ERM) undergoing surgical intervention.

      Purpose

      To assess surgical outcomes of pars plana vitrectomy (PPV) and membrane peel (MP) surgery in eyes with idiopathic ERM and identify potential imaging-based biomarkers of vision outcomes.

      Methods

      Retrospective, consecutive case series of eyes with idiopathic ERM that underwent PPV and MP surgery between 1/1/2017 and 1/1/2019. A previously described ERM grading scale was utilized for OCT analysis. The primary outcome was VA at post-operative month 6 and final follow-up. A secondary outcome was the association of OCT structural features, including ectopic inner foveal layers (EIFL), inner microcystoid changes, and ellipsoid zone (EZ) disruption, with VA outcomes.

      Results

      A total of 322 eyes with idiopathic ERM were included. Mean (± SD) follow-up was 506.6 ± 324.6 days after MP surgery. VA improved from logMAR 0.49 ± 0.27 (Snellen 20/61) pre-MP to 0.41 ± 0.30 (Snellen 20/51, p< 0.001) at 6 months after MP and 0.31 ± 0.29 (Snellen 20/41, p<0.001) at final follow-up. A total of 21 (6.5%) eyes were graded as Stage 1, 38 (11.8%) as Stage 2, 188 (58.4%) as Stage 3, and 75 (23.3%) as Stage 4, with higher ERM stages associated with worse pre-MP VA (p<0.001). Presence of inner microcystoid changes was associated with worse pre-MP VA (p=0.04). Stage 4 ERM characteristics (p=0.03), presence of EZ disruption (p=0.01) at month 3, and presence of inner microcystoid changes at month 3 (p=0.02) were associated with worse VA at 6 months. Presence of EIFL was not associated with 6 month or final VA on multivariate analysis. When analyzed within defined age groups, patients older than 80 years old had worse final VA (p=0.02) and were more likely to have inner microcystoid changes on OCT (p=0.01).

      Conclusions

      VA improvement was noted after surgery in eyes with idiopathic ERM across all stages. Pre-operative stage 4 characteristics were associated with worse VA at 6 months. Post-operative inner microcystoid changes and EZ disruption at month 3 were additional OCT biomarkers associated with worse 6 month and final VA outcomes.

      Key words

      Acronyms:

      CFT (central foveal thickness), EIFL (ectopic inner foveal layer), ERM (epiretinal membrane), ILM (internal limiting membrane), LogMAR (logarithm of the minimal angle resolution), MP (membrane peeling), OCT (optical coherence tomography), ON (outer nuclear layer), INL (inner nuclear layer), PPV (pars plana vitrectomy), RPE (retinal pigment epithelium), VA (visual acuity), BCVA (best corrected visual acuity)
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