Epiretinal membrane surgery outcome in eyes with abnormalities of the central bouquet

Abstract

Background Clinical studies have shown that epiretinal membranes (ERM) as well as abnormalities of the central foveal bouquet (CB) can be classified in different stages according to their morphological appearance. Furthermore, visual acuity correlates with the different stages of these features. The present study evaluated how these findings change after the surgical removal of the ERM and their impact on functional outcomes. Methods In this retrospective study eyes with ERM were evaluated by SD-OCT scans before and after pars plana vitrectomy (PPV) with macular ERM and internal limiting membrane (ILM) peeling. CB abnormalities were classified according to their morphological appearance from stage 0 (no abnormalities) to stage 3 (acquired vitelliform lesion). ERMs were classified ranging from stage 0 (absence of ERM) to stage 4 (ERM with significant anatomic disruption of macula). Changes in morphology were correlated with visual acuity before and after surgery. Results 151 eyes were included into the study. Before surgery 27.2% (n = 41) of eyes showed CB abnormalities with stage 1 being the most common (11.9%, n = 18). Before surgery ERM was seen in all patients. The most common form was stage 1 (28.5%, n = 43), followed by stage 3 (27.8%, n = 42) and 2 (25.2%, n = 38). Only 18.5% (n = 28) presented with stage 4 ERM. The mean BCVA was 0.42 (logMAR) before and increased to 0.19 (logMAR) 8 weeks after vitrectomy (95% CI 0.20–0.28; p < 0.001). Patients who suffered from CB abnormalities had less increase in BCVA than patients who had no evidence of CB (0.28 vs. 0.14 logMAR; p < 0.001). Of all the patients with CB abnormalities at baseline, 68% had lower CB grading after the surgery (n = 28; 95% CI; p < 0.001). All patients showed an improvement of their ERM grading, with 98.7% reaching stage 0 (n = 151 vs. n = 149; 95% CI; p < 0.001). Conclusions The study indicates that the presence of CB abnormalities correlates with worse visual function. They are furthermore associated with worse visual outcomes after PPV with ERM and ILM peeling. These findings are valuable for deciding on PPV in patients with ERM.

Influences of Central Bouquet Alterations on the Visual Outcome in Eyes Receiving Epiretinal Membrane Surgery

“…Looking at the presented long-term results, CB stage at baseline did not prove to be a significant predictor of BCVA change after surgery (p = 0.939). This is contrary to the findings of our earlier results, where we found that the presence of alterations of the CB appeared to be an indicator for poorer functional outcomes in short-term followup [29]. According to the results of the present study, the observed short-term effect of CB alterations on BCVA diminishes in the long-term.…”

“…These findings are coherent with those of other groups which have evaluated the influence of ERM removal on visual acuity outcome [25,26]. Kim et al and Dawson et al similarly described improvements in BCVA of more than two lines in 77% and 70% of their patients respectively [29,30].…”

“…Confirming the results of our short-term follow-up study [29], the preoperative stage of ERM did not have a statistically significant impact on the mean BCVA change following surgery (p = 0.528). Looking at the presented long-term results, CB stage at baseline did not prove to be a significant predictor of BCVA change after surgery (p = 0.939).…”

“…Additionally, these changes were categorized into progressive stages beginning with the cotton ball sign, followed by foveolar detachment and resulting in an acquired vitelliform lesion as the final stage [7]. While a progression in the stage of CB alteration has already been linked to a decrease in BCVA [7], the influences of surgical removal of ERM on specific changes in the CB and the associated functional outcome have, to our knowledge, only been evaluated for short-term follow-up [29]. Comparing the composition of our cohort to that of Govetto et al, CB alterations were more frequent (34% vs. 22%); however, the distribution of the different stages of CB alterations was comparable to their group (stage 1: 55% vs. 62.1%; stage 2: 23% vs. 17.2%; and stage 3: 23% vs. 20.7%).…”

“…To our knowledge, previous studies have already described irregularities of the outer retinal anatomy in the context ERMs [27,28]. However, the influences of their surgical removal on specific changes in the CB morphology and correlations with functional outcome have only been investigated in the short-term [29].…”