Abstract
Purpose We aimed to describe the visual prognosis of eyes with ectopic inner foveal layers (EIFLs) after epiretinal membrane (ERM) surgery. Methods This retrospective study enrolled patients diagnosed with stage 3 ERM based on the EIFL staging scheme who underwent ERM surgery with a minimum follow-up period of 12 months. Central foveal thickness (CFT), EIFL thickness, and the length of the ellipsoid zone defect were evaluated at baseline and at 1 month, 6 months, and 12 months after surgery based on pre- and postoperative swept-source optical coherence tomography (OCT) images. The association of EIFL thickness and other OCT parameters with pre- and postoperative best-corrected visual acuity (BCVA) was analyzed. Results Sixty-nine eyes with stage 3 ERMs were analyzed. Preoperative BCVA was correlated with preoperative CFT (r = 0.517, p < 0.001) and preoperative EIFL thickness (r = 0.652, p < 0.001). At 12 months, postoperative BCVA was correlated negatively with preoperative CFT (r = 0.470, p=0.016) and preoperative EIFL thickness (r = 0.582, p=0.004). The improvement in BCVA was not associated with postoperative reduction in CFT (p=0.06), although it was significantly associated with postoperative reduction in EIFL thickness (r = 0.635, p=0.007). Conclusions EIFL thickness should be considered a negative prognostic factor for postoperative anatomical and functional recovery in patients with stage 3 ERMs.
Highlights
Published visual prognostic spectral-domain optical coherence tomography (OCT) findings regarding epiretinal membrane (ERM) surgery may be divided into inner and outer segment factors. e inner segment factor associated with poor visual prognosis after ERM surgery is foveal inner retinal layer thickness [8, 9]; outer segment factors associated with poor visual prognosis include an outer nuclear complex, cone outer segment tip defect length, and ellipsoid zone (EZ) defect length [10, 11]
ectopic inner foveal layer (EIFL) thickness measurements in patients with stage 4 ERMs are unreliable because of the remarkable preoperative disruption of the retinal layers. erefore, we excluded patients with stage 4 ERMs. e aim of the current study was to investigate the relationship between OCT parameters and visual prognosis in stage 3 ERM patients who underwent 25gauge vitrectomy
We reviewed clinical records of 69 patients diagnosed with stage 3 ERMs; the patients comprised 25 (36.2%) men and 44 (63.8%) women. e mean age of the patients was 67.78 ± 6.69 years; 52 of 69 eyes (75.4%) exhibited mild cataract (2.06 ± 0.64 using the lens opacity classification (LOCS III) scale) [22] and underwent combined phacoemulsification. e mean preoperative best-corrected visual acuity (BCVA) was 0.47 ± 0.16 logarithm of the minimal angle of resolution (logMAR), and the mean Central foveal thickness (CFT) was 480.08 ± 60.47 μm. e mean EIFL thickness was 183.41 ± 89.50 μm, and the mean outer nuclear layer thickness (ONL) was 163.04 ± 46.3 μm; the mean EZ defect length was 480.3 ± 162.1 μm
Summary
Microincision vitrectomy has been widely used recently and has shown higher rates of anatomical success [2, 3]. These anatomical outcomes do not correspond with better visual prognosis. Visual prognostic factors for ERM surgery, using spectral-domain optical coherence tomography (OCT), have been published [4,5,6,7]. Published visual prognostic spectral-domain OCT findings regarding ERM surgery may be divided into inner and outer segment factors. Govetto et al [12] recently suggested a new OCT-based grading system to classify ERMs based on the presence of a continuous ectopic inner foveal layer (EIFL) as a new finding in advanced stages (i.e., stages 3 and 4). EIFL thickness measurements in patients with stage 4 ERMs are unreliable because of the remarkable preoperative disruption of the retinal layers. erefore, we excluded patients with stage 4 ERMs. e aim of the current study was to investigate the relationship between OCT parameters and visual prognosis in stage 3 ERM patients who underwent 25gauge vitrectomy
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