Abstract
PurposeTo evaluate the visual outcome and macular anatomic structures on spectral-domain optical coherence tomography (SD-OCT) of patients with epiretinal membrane (ERM) foveoschisis who underwent vitrectomy.MethodsA retrospective cohort, interventional, case series.ParticipantsFourteen patients (14 eyes) with central vision loss from an ERM foveoschisis underwent vitrectomy at Chiang Mai University Hospital from 2017 to 2018 and had a follow-up period of 12 months.InterventionsThe 23G vitrectomy with ERM and internal limiting membrane (ILM) peeling was performed by a single surgeon.Main outcomesBest-corrected visual acuity (BCVA) and anatomic appearance on SD-OCT were assessed at the time of preoperative evaluations and post-operative follow-ups at 1, 3, 6, and 12 months.ResultsFourteen patients with a mean (SD) age of 67.9 (7.9) years and a mean (SD) visual acuity (VA) of 0.6 (0.1) LogMAR units were included in this study. Significant VA improvements were observed at the 3-month (0.43 (0.14) LogMAR unit), 6-month (0.45 (0.16) LogMAR unit) and 12-month (0.37 (0.21) LogMAR unit) post-operative visits compared to baseline, all with P-values < 0.001. At month 12, there were vision improvements of ≥3 lines in 8 (57.2%) patients, vision improvements of 1 or 2 lines in 2 (14.3%) patients, vision remained at the same line of pre-operation in 3 (21.4%) patients, and vision decreased by 1 line in 1 (7.1%) patient. Regarding the anatomical outcomes, 13 (92.9%) patients achieved anatomical foveal restoration, while one had persistent intraretinal schisis at the 12-month follow-up. The median time to achieve a foveal restoration was 3 months. No significant visual impairments were observed post-operatively.ConclusionIn patients with central vision loss from ERM foveoschisis, vitrectomy with ILM stripping tended to improve both visual and anatomical outcomes.
Highlights
In the past, Gass and Allen described lamellar macular hole (LMH) as a round reddish partial-thickness macular lesion observed by slit-lamp biomicroscopic examination in patients with pseudophakic cystoid macular edema [1]
Fourteen patients with a mean (SD) age of 67.9 (7.9) years and a mean (SD) visual acuity (VA) of 0.6 (0.1) LogMAR units were included in this study
The epiretinal membrane (ERM) foveoschisis was diagnosed with OCT characteristics in accordance with the OCTbased definition proposed by Hubschman et al Only the patients with the agreements by two opthalmologists (CP and SC) on the OCT findings were included in the study
Summary
Gass and Allen described lamellar macular hole (LMH) as a round reddish partial-thickness macular lesion observed by slit-lamp biomicroscopic examination in patients with pseudophakic cystoid macular edema [1]. Several distinct irregular foveal contours from OCT have been categorized regarding their possible underlying pathophysiologies [2,3,4,5,6]. Controversies have been reported regarding the natural history, surgical outcomes and prognostic predictors of these irregular foveal contours due to inconsistent definition criteria [7,8,9]. To facilitate universal understanding between studies, a panel of international retinal experts has recently proposed a consensus OCT-based definition for irregular inner foveal contour lesions. LMH is characterised as an irregular inner foveal contour with disruption of the inner retinal layer, having an undermined foveal cavitation edge, and presumed to be related with a degenerative mechanism. Macular pseudohole (MPH) is defined as a non-foveal involved ERM with a verticalized foveal edge [10, 11]
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