Abstract
Purpose To evaluate the efficacy of epiretinal membrane (ERM) surgery for patients with ERM and glaucoma. Methods We reviewed the medical records of 20 consecutive ERM patients with glaucoma, who underwent 27-gauge microincision vitrectomy surgery (27GMIVS) with internal limiting membrane (ILM) peeling. The preoperative and 6-month postoperative visual field was tested with the Humphrey Field Analyzer (HFA) 24-2 program. Changes in threshold sensitivity in the HFA test points were analyzed point-by-point, with points classified into groups based on sensitivity as abnormal (less than 5th percentile in pattern deviation) or normal (all other points) and based on location as central (12 central points) or peripheral (all other points) with a linear mixed-effects model. Results Visual acuity and mean deviation improved postoperatively (P < 0.001 for both) in all patients. Threshold sensitivity in central or peripheral points that were abnormal preoperatively improved postoperatively (P=0.006 or P < 0.001, respectively). Threshold sensitivity also improved in the central normal test points (P=0.03), but not in the peripheral normal points (P=0.12). Conclusion Visual acuity improved, and there was no visual field progression, after ERM surgery in glaucomatous eyes during a 6-month postoperative follow-up, suggesting that ERM and ILM removal using 27GMIVS may be effective even in glaucomatous eyes.
Highlights
An epiretinal membrane (ERM) is a thin layer of fibrous tissue that can form on the inner surface of the central retina, causing metamorphopsia, monocular diplopia, and decreased vision [1,2,3]
internal limiting membrane (ILM) peeling is still a difficult technique and can inflict mechanical stress on the central retina, including the nerve fiber layer and ganglion cell layer [8,9,10]. These layers are affected by glaucoma, which is associated with thinning of the retinal nerve fiber layer (RNFL) and the death of retinal ganglion cells (RGCs), causing visual field defects
There have been two reports describing the effects of vitrectomy in macular diseases, including ERM, in glaucomatous eyes [13, 14]
Summary
An epiretinal membrane (ERM) is a thin layer of fibrous tissue that can form on the inner surface of the central retina, causing metamorphopsia, monocular diplopia, and decreased vision [1,2,3]. ILM peeling is still a difficult technique and can inflict mechanical stress on the central retina, including the nerve fiber layer and ganglion cell layer [8,9,10] These layers are affected by glaucoma, which is associated with thinning of the retinal nerve fiber layer (RNFL) and the death of retinal ganglion cells (RGCs), causing visual field defects [11, 12]. 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. We evaluated visual field sensitivity changes in patients with ERM and glaucoma, in visual field test points that were divided into abnormal and normal groups, after 27-gauge MIVS (27GMIVS) with ILM peeling
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