Value of preoperative optical coherence tomography for predicting visual outcome after epiretinal membrane surgery

Abstract

We assessed the value of preoperative optical coherence tomography (OCT) for predicting the visual outcome for patients undergoing macular surgery for epiretinal membranes (ERMs). In a retrospective trial, we analyzed the medical charts of patients who had received surgery for ERMs between January and August 2011. The best-corrected pre- and postoperative logMAR visual acuity was assessed. We pre- and postoperatively measured the central foveal thickness with high-resolution spectral-domain OCT and analyzed the structure of the outer retinal layers (retinal pigment epithelium, photoreceptors, and external limiting membrane) before and after surgery. The study included 49 patients (23 male, 27 female) with an average age of 69 years (SD 6.7) who had received macular surgery during the above-mentioned period. For phakic eyes (n = 34), treatment had also included phacoemulsification and intraocular lens implantation. Postoperative follow-up examinations and OCT controls had been conducted after an average of 9 weeks (SD 5). The mean improvement in visual acuity was 2.4 lines (SD 2.3; p < 0.001). For patients with phakic eyes, the combination of vitrectomy and cataract surgery resulted in a slightly better, but insignificant increase in visual acuity than for patients with primary pseudophakia (Δ = 0.05, p = 0.46). On average, central foveal thickness regressed by 94 μm (SD 129 μm). Linear regression showed a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity (R (2) = 0.16, B = 0.71, p = 0.004). A decrease in foveal thickness by 100 μm resulted in an increase in visual acuity by 0.71 lines. Visual improvement did not significantly differ between the group of patients with intact outer retinal layers before surgery and the group of patients with preoperative defects of the retina (p = 0.085). We found a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity for patients undergoing surgery for ERM. However, the preoperative OCT status (intact vs. broken) of the outer retinal layers did not correlate with the change in visual acuity.

Associations between preoperative OCT parameters and visual outcome 3 months postoperatively in patients undergoing vitrectomy for idiopathic epiretinal membrane

“…They may cause reduced visual acuity and metamorphopsia, and with appropriate case selection, often benefit from surgery [2,3].…”

“…Generally, only patients with symptomatic visual impairment undergo surgery, because not all patients will benefit [2,4]. Therefore, identifying patients with good postoperative visual prognosis is important, and optical coherence tomography (OCT) is starting to provide a good clinicopathological correlation [3,[5][6][7][8].…”

“…A number of studies have directed particular attention towards central foveal thickness (CFT) [3,[8][9][10][11][12][13][14][15][16], and several studies have found a correlation between a reduced CFT and better postoperative visual acuity [3,14,16], while others have not [7,8,15]. Numerous studies have also found that an intact preoperative ellipsoid zone (previously known as the inner/outer segment junction line) [17] is significantly correlated with better postoperative visual acuity [6,7,[18][19][20][21].…”

Epiretinal Membrane Peeling in Patients With Good Preoperative Vision

“…[8][9][10] Several other groups have looked at postoperative anatomic details to predict the same thing. 7,10,15,16 In general, the most consistent result is that a reduction in central macula thickness typically results in improved visual acuity. Other factors, such as foveal contour, are less predictive.…”

Visual and Anatomical Outcomes of Macular Epiretinal Membrane Peeling After Previous Rhegmatogenous Retinal Detachment Repair

“…[11][12][13] Multiple studies explored OCT prognostic factors in patients with primary ERMs. 12,[14][15][16][17][18][19][20] However, there is paucity of publications reporting on OCT parameters in patients with secondary ERMs. One study reported a high incidence of inner segment/outer segment (IS/ OS) junction and external limiting membrane (ELM) line disruptions in patients undergoing ERM peeling secondary to RRD surgery, and found that the integrity of the outer retinal layers was the main prognosticator of final visual acuity in these patients.…”