The role of optical coherence tomography biomarkers in predicting the outcome of epiretinal membrane removal surgery

Abstract

Epiretinal membrane (ERM) is a common condition that can cause visual impairment. ERM removal surgery is an effective treatment option, but predicting postoperative visual outcomes is challenging. Imaging modalities, particularly optical coherence tomography (OCT), have emerged as valuable tools for preoperative evaluation and predicting surgical outcomes. This presentation focuses on the role of preoperative OCT biomarkers in estimating postoperative vision improvement after ERM removal surgery. Such biomarkers include the disorganization of retinal inner layers (DRIL), the presence of ectopic inner foveal layer (EIFL), the cotton ball sign, the cone outer segment tips (COST) line, the photoreceptor outer segment (PROS) length, the inner retina irregularity index, and the presence of posterior vitreous detachment (PVD).DRIL refers to the abnormal appearance of the inner retinal layers on OCT, and has been found to be associated with poorer postoperative visual outcomes in ERM removal surgery. Significant EIFL has also been associated with poorer visual outcomes after surgery. The cotton ball sign, which appears as a hyper‐reflective area in the inner nuclear layer, has been found to be associated with increased difficulty in ERM removal and poorer visual outcomes. These biomarkers suggest that a greater degree of retinal disorganization and irregularity may lead to more challenging surgeries and poorer visual outcomes.In contrast, the presence of intact COST line and normal PROS length have been associated with better visual function. PVD, which represents separation of the vitreous from the retina, has been shown to be associated with less surgical trauma and better postoperative outcomes. The inner retina irregularity index, which measures the extent of disorganization of the inner retinal layers, has also been found to correlate with the changes in metamorphopsia and quality of vision after surgery.These biomarkers have the potential to improve the accuracy of preoperative evaluation and prediction of surgical outcomes in ERM removal surgery. By identifying patients with a greater degree of retinal disorganization and irregularity, we can anticipate more challenging surgeries and poorer visual outcomes. Conversely, patients with minimal COST line defects, normal PROS length and full PVD may have better postoperative visual outcomes.In summary, preoperative OCT findings can help predict postoperative visual outcomes in ERM removal surgery. The use of imaging modalities and specific biomarkers can provide useful insight in management decisions, case selection, and timing of surgery.