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      Idiopathic epiretinal membrane surgery: safety, efficacy and patient related outcomes

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          Abstract

          This review aims to give to the reader an overview selectively oriented on safety and efficacy of surgery, providing concise and direct answers about crucial questions of trainees and experts. Surgery for idiopathic epiretinal membrane (ERM) is a safe and effective procedure that can achieve long-term stable postoperative visual and anatomical improvement, with an overall low recurrence and complication rate. Young patients, with a short onset of symptoms and with better initial visual acuity achieve higher levels of visual outcome. The preoperative degree of metamorphopsia is the prognostic factor for their postoperative degree. Successful results may be obtained in eyes with specific optical coherence tomography criteria, such as thin ganglion cell layers, thin internal plexiform layer, longer photoreceptors outer segment, regular ellipsoid zone and cone outer segment tips line, and without ectopic inner foveal layer. Internal limiting membrane peeling demonstrates positive anatomical and functional outcomes, but final positions about its safety remain controversial.

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          Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removal.

          R Tadayoni, P Massin, A Gaudric … (2001)
          To report the appearance of the fundus, that is seen frequently after removal of an idiopathic epiretinal membrane and which we refer to as the dissociated optic nerve fiber layer appearance. Interventional, noncomparative retrospective case series. One hundred consecutive patients with an epiretinal membrane who underwent pars plana vitrectomy and epiretinal membrane peeling in one eye. Only patients with an idiopathic epiretinal membrane or a membrane associated with a peripheral retinal tear, but without retinal detachment, were considered for this study. Sixty-one patients met these criteria for one eye. Preoperative and postoperative best-corrected visual acuity and preoperative and postoperative blue filter fundus photographs were reviewed. Histopathologic specimens of epiretinal membranes were available for 14 eyes. The postoperative incidence of the dissociated optic nerve fiber layer appearance on blue filter photographs, visual acuity changes, and the presence of internal limiting membrane in epiretinal membrane specimens. The postoperative incidence of this feature on blue filter fundus photographs was 43%. No difference was found between eyes with or without this feature concerning the average preoperative and postoperative best-corrected visual acuity or the average change in visual acuity. Internal limiting membrane was present in all 14 epiretinal membrane specimens available. Five of these 14 patients concerned exhibited a dissociated optic nerve fiber layer appearance and 9 did not. The dissociated optic nerve fiber layer appearance occurred frequently after removal of an epiretinal membrane. As far as we know, this feature has not been previously reported. It consisted of numerous arcuate striae within the posterior pole in the direction of the optic nerve fibers and slightly darker than the surrounding retina. This feature had no functional effect noticeable by the patient and did not preclude good visual recovery. The small number of histologic samples and the impossibility of quantifying the area of internal limiting membrane peeled off did not allow us to supply proof that this feature is due to the extensive peeling of the internal limiting membrane, although this is the most likely hypothesis.
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            Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal.

            Min Suh, Jong Seo, Kyu Park … (2009)
            To identify characteristics measured by optical coherence tomography (OCT) that are correlated with visual outcome after epiretinal membrane (ERM) removal by pars plana vitrectomy (PPV). Interventional, prospective, randomized case series. One hundred and one eyes of 101 patients with idiopathic ERM underwent PPV for ERM removal. Ophthalmic evaluations included best-corrected visual acuity (BCVA) and Stratus OCT preoperatively at 3 and 6 months postoperatively. Relations between three OCT features including integrity of junction between inner and outer segments of photoreceptors (IS/OS junction), macular thickness, foveal contour and the three visual acuity parameters such as preoperative BCVAs, postoperative BCVAs, and the differences between preoperative and postoperative BCVAs (BCVA differences) were evaluated with respect to time. Eyes with disruption of IS/OS junction had significantly lower postoperative BCVA and BCVA differences than those without disruption (P 0.25; P .05, respectively). Photoreceptor disruption detected by OCT was found to be a predictor of poor visual outcome in eyes with idiopathic ERM, and it was found that this disruption may be irreversible. Thus, early membrane removals may beneficially prevent further progression of photoreceptor damage in ERM patients with photoreceptor disruption.
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              The significance of cone outer segment tips as a prognostic factor in epiretinal membrane surgery.

              Masataka Shimozono, Akio Oishi, Masayuki Hata … (2012)
              To evaluate the prognostic value of the cone outer segment tips (COST) and other features using spectral-domain optical coherence tomography (SD-OCT) in patients undergoing epiretinal membrane (ERM) surgery. Retrospective observational case series. Fifty eyes of 49 patients that underwent vitrectomy for idiopathic ERM were studied. Best-corrected visual acuity (BCVA) and SD-OCT images were examined preoperatively and at 1 and 6 months postoperatively. The SD-OCT features evaluated included central foveal thickness (CFT) and the status and defect diameter of the external limiting membrane (ELM), the photoreceptor inner/outer segment (IS/OS) junction, and the COST line. The associations between SD-OCT parameters and BCVA were analyzed. There was no ELM disruption found, and thus the eyes were categorized into 3 groups: Group A, with a continuous IS/OS and COST line; Group B, with a continuous IS/OS but disrupted COST line; and Group C, with a disrupted IS/OS and COST line. At 6 months, Group A showed a significantly better BCVA than Group B (P<.005), and poorer BCVA was noted in Group C (P=.034). Defect diameters of IS/OS and COST line were also significantly correlated with BCVA postoperatively. The BCVA at 6 months was better in order of Group A, B, and C as assigned at baseline (P<.05) or 1 month (P<.001). There was no significant correlation between CFT and BCVA. The status of the COST line, in conjunction with the IS/OS junction, is a useful prognostic factor after ERM surgery. Copyright © 2012 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Ophthalmol
                Journal ID (iso-abbrev): Clin Ophthalmol
                Journal ID (publisher-id): OPTH
                Journal ID (pmc): clinop
                Title: Clinical Ophthalmology (Auckland, N.Z.)
                Publisher: Dove
                ISSN (Print): 1177-5467
                ISSN (Electronic): 1177-5483
                Publication date (Electronic): 15 July 2019
                Publication date Collection: 2019
                Volume: 13
                Pages: 1253-1265
                Affiliations
                [1 ]Ospedale San Raffaele Scientific Institute, Vita-Salute University , Milan, Italy
                [2 ]Ospedali Riuniti di Ancona, Università Politecnica Delle Marche , Ancona, Italy
                Author notes
                Correspondence: Lorenzo IulianoOspedale San Raffaele Scientific Institute, Vita-Salute University , Via Olgettina 6021032, Milan, ItalyTel +39 022 643 2648 Email iuliano.lorenzo@ 123456hsr.it
                Article
                Publisher ID: 176120
                DOI: 10.2147/OPTH.S176120
                PMC ID: 6643061
                PubMed ID: 31409964
                SO-VID: 7786c2e3-e995-4243-ae81-f29e753b5b2c
                Copyright © © 2019 Iuliano et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 14 April 2019
                Date accepted : 01 July 2019
                Page count
                Figures: 4, Tables: 1, References: 94, Pages: 13
                Categories
                Subject: Review

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: idiopathic epiretinal membrane,outcome,safety,efficacy,prognostic factor
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: idiopathic epiretinal membrane, outcome, safety, efficacy, prognostic factor

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