Abstract
PurposeTo identify preoperative markers on spectral domain optical coherence tomography (SD-OCT) for residual inner limiting membrane (ILM) in epiretinal membrane (ERM) peeling.MethodsIn this retrospective case series the preoperative SD-OCTs from 119 eyes of 119 consecutive patients who underwent surgery for idiopathic ERM by a single surgeon were evaluated for markers predisposing for ILM persistence after ERM removal. ILM persistence was determined via intraoperative indocyanine green staining. The main outcome measures were correlation of central foveal thickness (CFT), ERM thickness, extent of elevated ERM and retinal folding, intraretinal cysts, and discontinuation of the ERM, with ILM persistence after ERM peeling.ResultsThe persistence of the ILM was found in 50.4% (n = 60). After Bonferroni correction for multiple testing, a greater extent of elevated ERM and thicker ERMs were associated with persistence of the ILM (p<0.005). The other parameters showed no statistically significant correlations with the persistence of the ILM (p≥0.005).ConclusionResidual ILM can be found in nearly half of the eyes after ERM peeling. A loose connection between the ERM and the retinal surface predisposes for ILM persistence. Preoperative SD-OCT is helpful in identifying risk markers for the persistence of the ILM in ERM surgery.
Highlights
Epiretinal membranes (ERMs) are avascular tissue sheets that grow on the retinal surface
Repeating the indocyanine green (ICG) staining after complete ERM removal showed persistence of the inner limiting membrane (ILM) in 60 out of 119 eyes (50.4%)
To detect predictive factors for combined or separate removal of the ERM and ILM we tested for the following parameters: age, sex, preoperative BCVA, lens status, intraoperative vitreoretinal status, central foveal thickness (CFT), ERM thickness (ERM-Th), ERM elevation, retinal folding, discontinuation of the ERM, and intraretinal cysts
Summary
Epiretinal membranes (ERMs) are avascular tissue sheets that grow on the retinal surface. They consist to varying degrees of glial cells, hyalocytes, fibroblast-like cells, and retinal pigment epithelial cells.[1], [2] ERMs can contract, causing disturbance of the retinal architecture, which may subsequently lead to metamorphopsia and decreased central visual acuity. The inner limiting membrane (ILM) serves as a scaffold for ERM growth and it has been shown that after removal of only the ERM, glial cells, hyalocytes, and myofibroblasts remain on the ILM.[3] This is thought to be a major factor for ERM recurrences. This study demonstrates predisposing markers on preoperative high-resolution spectral domain optical coherence tomography (SD-OCT) for the persistence of the ILM after ERM removal
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