Surgical Treatment of Epiretinal Membranes: a Comparative Analysis of Various Removal Techniques.

Abstract

In most cases, vitreoretinal surgery is the only way to treat epiretinal membrane (ERM). For a long time, surgeons only removed epiretinal fibrosis. But relapse of ERM took place in 10% of cases. Internal limiting membrane (ILM) peeling reduced the number of relapses, but this membrane is connected closely with terminal legs of Müller cells and its removal leads to mechanical and functional damage of the latter. In addition, frequent cases of "dissociation of the optic nerve fiber layer" were noticed in the long term after ILM removal, which caused a deterioration in the functional state of the retina. Purpose. The purpose of study was to conduct a comparative analysis of various methods of surgical treatment of epiretinal membrane. Materials and methods. On the base of the National Medical Center of Ophthalmology 75 patients with epiretinal membrane were treated with vitreoretinal surgery. All patients were divided into 3 groups. Patients of the first group were operated according to the standard procedure with the removal both ERM and ILM. The second group included patients after ERM removal without ILM peeling. The third group of patients were operated according to the original method – after ERM removal specific "debilitating notches" were performed on ILM. A complete ophthalmological examination was conducted for all patients in the pre- and postoperative period (1,3,6,12 months after surgical treatment). There were no significant differences between groups in age, gender, preoperative BCVA, preoperative intraocular pressure, preoperative CMT on optical coherence tomography, and cataract status. Results. Analysis of the results in the postoperative period revealed a significant improvement in BCVA at 6 months after surgery in the 2nd and 3rd groups of patients in comparison to the 1st group of patients. Assessment of morphological parameters of the retina in the postoperative period showed a significant improvement of condition in epiretinal fibrosis in groups 2 and 3 at 6 and 12 months after surgery. The reduce of foveolar thickness was more noticeable in groups 2 and 3 during all the period. In the postoperative period, a statistically significant improvement in central light sensitivity was revealed in patients of the 2nd and 3rd groups in comparison to similar parameters of patients of the 1st group at 3 months after surgical treatment. The same trend took place at 6 and 12 months after surgery. Conclusion. Our results showed that surgical treatment of ERM without ILM peeling yielded a better functional result compared to a group where peeling was performed within up to 12 months of follow-up. In order to reduce the risks of ERM relapse, we have developed an innovative technique of "debilitating notches", which allows us to achieve higher functional results than traditional ILM peeling and reduces the risks of relapse.