Visual field changes after vitrectomy with internal limiting membrane peeling for epiretinal membrane or macular hole in glaucomatous eyes

Abstract

PurposeTo investigate visual field changes after vitrectomy for macular diseases in glaucomatous eyes.MethodsA retrospective review of 54 eyes from 54 patients with glaucoma, who underwent vitrectomy for epiretinal membrane (ERM; 42 eyes) or macular hole (MH; 12 eyes). Standard automated perimetry (Humphrey visual field 24–2 program) was performed and analyzed preoperatively and twice postoperatively (1st and 2nd sessions; 4.7 ± 2.5, 10.3 ± 3.7 months after surgery, respectively). Postoperative visual field sensitivity at each test point was compared with the preoperative value. Longitudinal changes in mean visual field sensitivity (MVFS) of the 12 test points within 10° eccentricity (center) and the remaining test points (periphery), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and ganglion cell complex (GCC) thickness, and the association of factors with changes in central or peripheral MVFS over time were analyzed using linear mixed-effects models. In addition, 45 eyes from 45 patients without glaucoma who underwent vitrectomy for epiretinal membrane (ERM; 34 eyes) or macular hole (MH; 11 eyes) were similarly examined and statistically analyzed (control group).ResultsIn glaucomatous eyes, visual field test points changed significantly and reproducibly; two points deteriorated only at the center and twelve points improved only at the periphery. Central MVFS decreased (p = 0.03), whereas peripheral MVFS increased postoperatively (p = 0.010). In the control group, no visual field test points showed deterioration, and central MVFS did not change significantly after vitrectomy. BCVA improved, GCC thickness decreased, and IOP did not change postoperatively in both groups. The linear mixed-effects models identified older age, systemic hypertension, longer axial length, and preoperative medication scores of ≥2 as risk factors for central MVFS deterioration in glaucomatous eyes.ConclusionsVisual field sensitivity within 10° eccentricity may deteriorate after vitrectomy for ERM or MH in glaucomatous eyes.

Efficacy of 27-Gauge Vitrectomy with Internal Limiting Membrane Peeling for Epiretinal Membrane in Glaucoma Patients

“…Previously, there have been two reports describing the effects of vitrectomy in macular diseases, including ERM, in glaucomatous eyes [13,14]. e report by Moroi et al was a small case series (ERM: 5 eyes, MH: 2 eyes; total: 7 eyes) that showed an improvement in visual acuity of at least 2 lines in 5 of 7 eyes after 20-gauge pars plana vitrectomy (PPV) without combined cataract surgery [13].…”

“…e report by Moroi et al was a small case series (ERM: 5 eyes, MH: 2 eyes; total: 7 eyes) that showed an improvement in visual acuity of at least 2 lines in 5 of 7 eyes after 20-gauge pars plana vitrectomy (PPV) without combined cataract surgery [13]. Journal of Ophthalmology eccentricity) decreased postoperatively, while it increased in the peripheral area, in an analysis of 54 eyes (ERM: 42 eyes, MH: 12 eyes) followed for an average of 10.3 months [14]. MIVS in that study used various instrument gauges, including 23-, 25-, and 27-gauge.…”

“…Various intraoperative factors can increase retinal damage caused by vitrectomy surgery and affect the postoperative visual field. Previous studies investigating the effects of macular surgery in glaucomatous eyes included cases not only with ERM but also with MH [13,14]. However, we consider that these diseases cannot be studied together because of critical differences in the surgical procedures used to treat them.…”

“…Interestingly, the current study found that there were no visual field test points in the glaucomatous eyes in which retinal sensitivity significantly decreased after ERM surgery. Two HFA 24-2 test points, both located in the nasal area and corresponding to the temporal quadrant of the macula, have previously been reported to show significant and sustained deterioration after macular surgery for ERM or MH in glaucomatous eyes [14]. Generally, the nasal visual field is prone to complications, such as paracentral scotomas and decreased retinal sensitivity, after ILM peeling for MH, even in nonglaucomatous eyes [19,29].…”

“…Previously, only two studies have examined the effects of vitrectomy for ERM or macular hole (MH) on the visual field in patients with glaucoma [13,14]. Despite these reports, it is still unclear whether the risks of ERM surgery are acceptable in patients with glaucoma, even when MIVS is used.…”