Vitrectomy for Epiretinal Membranes: Ganglion Cell Features Correlate with Visual Function Outcomes

Abstract

To evaluate the relationship between retinal microstructure and central visual field sensitivity (CVFS) after vitrectomy with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM) using swept-source (SS) OCT and Humphrey Field Analyzer (HFA) (Zeiss, Dublin, CA) 10-2 program. Retrospective, interventional case series. Forty-five eyes in 45 patients with unilateral ERM who were treated with vitrectomy with ILM peeling using indocyanine green (ICG) or triamcinolone acetonide (TA) staining. We evaluated retinal microstructure (full thickness of the retina, thickness of the retinal ganglion cell complex [GCC], and thickness of the outer retinal layer) with SS-OCT and CVFS using HFA 10-2 before and 3 and 12 months after vitrectomy with ILM peeling. Data were analyzed using a standard Early Treatment of Diabetic Retinopathy Study (ETDRS) grid, with thresholds measured at 68 points corresponding to ETDRS grid locations using HFA 10-2. Retinal microstructure and CVFS in normal contralateral eyes were also measured and used as controls. We also compared the ICG-stained group (27 eyes), TA-stained group (18 eyes), and control group as subgroup analysis on ILM peeling staining dyes. Changes in retinal microstructure and CVFS before and 3 and 12 months after vitrectomy, and the correlation between retinal microstructure and mean CVFS postoperatively. Inner and outer temporal GCC thickness after vitrectomy significantly decreased compared with control eyes (P= 0.019 and P= 0.002, respectively). Mean CVFS in ERM eyes was significantly lower than control eyes at baseline (P < 0.001). Although change in overall CVFS was not significantly different 3 and 12 months postvitrectomy (P= 0.394 and P= 0.337, respectively), outer nasal CVFS was significantly lower 3 months postvitrectomy (P= 0.039). The CVFS on the nasal region and temporal GCC thickness were significantly decreased only in the ICG staining group postoperatively. Postoperatively, mean CVFS significantly correlated with GCC thickness (P < 0.001, r= 0.557). In ERM eyes after vitrectomy with ILM peeling, CVFS was associated with GCC thickness. Combined SS-OCT and HFA 10-2 analysis using the ETDRS grid offers more detailed measurements that effectively evaluate postoperative retinal microstructure and function.