ABSTRACT

Purpose:

With the advent of modern spectral domain optical coherence tomography (SD-OCT) instruments, anatomical changes that occur in the macular architecture both before and after ERM surgery can now be readily identified. However, the SD- OCT’s predictive value for surgical planning and for predicting ease or difficulty of surgical removal remains unclear. This study therefore aims to evaluate if specific characteristics of pre-operative SD-OCT can predict the intraoperative course of epiretinal membrane (ERM) removal.

Setting:

Retrospective clinical single-surgeon intervention study.

Methods:

In 160 patients presenting for 23g/25g vitrectomy and ERM peel, pre-operative SD-OCT data in three sections (superior, foveal, inferior) were collected on retinal thickness, focal ERM detachment size, presence of cystoid macular edema, fibrillary changes, ERM and/or internal limiting membrane (ILM) rips. Intraoperatively, characteristics of removal were divided in two groups; ERM and ILM peeling in two separate layers, ERM and ILM peeling in separate layers. These characteristics were compared to the pre-operative findings on SD-OCT. Results: Patients in whom the ERM and ILM came off as two separate layers (N=77) had significantly thicker retinae in all three OCT sections (superior, foveal and inferior with ps=0.022, 0.02, and 0.025 respectively) and were significantly older (p=0.002) than patients in whom the ERM and ILM were peeled as a single connected layer (N=83). The former group also showed significantly larger ERM detachments in the superior and foveal OCT sections (ps = 0.003 and 0.019 respectively). Conversely, the latter group showed significantly more often a fully attached ERM in the superior section (p=0.021).

Conclusion:

Preoperative SD-OCT can indicate the risk of ILM persistence during ERM surgery. We found that the chance of peeling the ERM and ILM together as one single block decreases with higher central retinal thickness and younger age. When peeling large ERM detachments, the ILM tends to stay attached to the retina, necessitating separate removal. Future studies should further assess long-term visual outcomes and complications after removing ERMs with differing SD-OCT characteristics.


CONTACT DETAILS

 

Niels CRAMA, Jan O. HUELLE*, Ann-Laure DELBECQ, N. SAKSENS, T. THEELEN, B. KLEVERING
Radboud University Medical Centre
Nijmegen
Netherlands
Email : jan.huelle@doctors.org.uk
Cell Phone: +491797524359
Work Phone: +491797524359