SCIENTIFIC POSTER 2016_Idiopathic ERM and Metamorphopsia A New Tool for Pre- and Post-operative Evaluation Elisa Buschini

Idiopathic epiretinal membrane (IERM) is defined as an avascular proliferation of different types of cells between the posterior vitreous cortex (PVC) and the internal limiting membrane (ILM). A premacular membrane can remain asymptomatic for much time or it can cause blurred vision. Furthermore, IERM can contract causing distortion of central vision, such as metamorphopsia. The current treatment for symptomatic IERM with high visual acuity (VA) impairment is pars plana vitrectomy (PPV), combined with phacoemulsification and IOL implant, when indicated. Several previous studies analyzed metamorphopsia and VA in IERM patients, trying to identify the anatomic basis of this type of functional alterations. They found a relationship between metamophopsia and inner retinal layer thickness and between VA and photoreceptor integrity. The presence of visual distortion is usually diagnosed using the Amsler test. Recently, new tools for metamorphopsia quantification have been developed, such as M-charts. In this study we evaluate the MetaMorphoMetry (MMM), a computerized test which aims to evaluate the severity of the perceived metamorphopsia.

Furthermore, it is able to give us new important information about:
– defect localization;
– quantification of its area on the visual field;
– and its distance from foveal central vision.
Our purpose is to correlate MMM findings to OCT central thickness (total, inner and outer layers) and best corrected visual acuity (BCVA), pre- and post-operatively. We considered a pool of phakic patients with symptomatic IERM who underwent combined surgery consisting in phacoemulsification with IOL implantation and PPV 25 G with IERM and ILM peeling. Operations were performed by the same surgeon at the Ophthalmic Hospital, Eye Clinic, in Turin (Italy). All patients were evaluated pre- and post-operatively (30, 90, 180 days) by the same exams protocol, including BCVA (ETDRS, LogMar), OCT (Spectral Domain, Optovue), M-Charts, MMM. Only patients > 55 years, phakic, with no more significant ocular or systemic pathologies were included. A small group of these patients was preoperatively tested twice with MMM, performed by two different examiners. The results were similar. In all patients we compared metamorphopsia degree suggested by M-charts and MMM. In a second analysis we correlated the OCT thickness to BCVA and MMM outcome during the follow up (in terms of severity, area and distance from the center of the perceived defect).

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Elisa Buschini