Glaucoma-related central visual field deterioration after vitrectomy for epiretinal membrane: topographic characteristics and risk factors

Abstract

Background/Objectives To identify risk factors for glaucoma-related central visual field (VF) deterioration after vitrectomy with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM). Subjects/Methods A prospective cohort study consisting of cases with or without glaucoma (33 eyes of 33 patients in each group) who underwent vitrectomy with ILM peeling for ERM. Humphrey 10-2 VFs and ganglion cell complex (GCC) thickness were measured at baseline and about 3, 6, and 12 months postoperatively. Longitudinal changes in VF indices and factors associated with their postoperative changes were investigated using mixed-effects models, as was sectorwise total deviation (TD) analysis using six sectors consisting of outer/inner arcuate and cecocentral sectors in each hemifield.Results VF mean deviation significantly deteriorated postoperatively only in the glaucoma group (P < 0.001). Older age, longer axial length, preoperative worse mean deviation, and thinner GCC were significant risk factors for postoperative deterioration (coefficient ± standard errors: −0.139 ± 0.067, −0.740 ± 0.241, 0.16 ± 0.07, 0.050 ± 0.020; P = 0.038, P = 0.002, P = 0.024, P = 0.012, respectively). Sectorwise analysis revealed that TD in the superior/inferior outer arcuate sectors significantly deteriorated only in the glaucoma group. Preoperative worse TD and thinner GCC were significant risk factors for deterioration in the superior outer arcuate sector (0.65 ± 0.11, 0.08 ± 0.03; P < 0.001, P = 0.042, respectively). Conclusions Central VF deterioration, especially in the outer arcuate sectors, found to be glaucoma-related changes after vitrectomy with ILM peeling for ERM. Preoperative worse VF and thinner GCC were identified as risk factors for postoperative VF deterioration.

Visual field changes in glaucoma patients after blepharoptosis surgery

“…Sector analysis of TD has been reported to be effective in the evaluation of visual fields in glaucoma. 14,15,[18][19][20] In this study, there were no significant changes in MD and PSD values before and after ptosis surgery. However, in the sector analysis of TD values, while there were no significant changes in inferior TD values, there was a significant improvement in superior TD values.…”

Factors Related to Unfavorable Visual Outcome After Idiopathic Epiretinal Membrane Surgery in Patients With Glaucoma

“…Nevertheless, the decision of nonintervention to preserve visual function is difficult to make while facing patients with ERM and visual symptoms during 2012 to 2018 before extensive studies on ERM and glaucoma were available. 6,7,17,20,21 Several studies have demonstrated a worsening of visual sensitivity of the macular area after ERM/ILM peeling, especially in the nasal area, which corresponds to the ganglion cell layer and inner plexiform layer thinning in the temporal region of the macula after surgery in glaucomatous rather than nonglaucomatous eyes. 6,7,20,22 The worsening is more likely to occur in the central field, or in the damaged hemifield, than the normal functioning hemifield.…”

Effect of idiopathic epiretinal membrane on macular ganglion cell complex measurement in eyes with glaucoma

“…Therefore, measuring the true thickness of the GCC layer is critical for monitoring glaucoma progression. The comorbidity of ERM and glaucoma increases the difficulty of using GCC to monitor glaucoma, whereas ERM removal has been shown to increase visual functional deterioration (26,27). The comorbidity of ERM and glaucoma is problematic not only for the diagnosis and monitoring of glaucoma but also for its pathology.…”