Skip to main content

Advertisement

SpringerLink
Log in

Relation of anatomy with function following the surgical treatment of idiopathic epiretinal membrane: a multicenter retrospective study

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

A Correction to this article was published on 24 February 2021

This article has been updated

Abstract

Purpose

To investigate the prognostic factors associated with functional and anatomical outcomes and to assess the longitudinal course of visual acuity and retinal morphology after vitreoretinal surgery for idiopathic epiretinal membrane (ERM).

Methods

This multicenter, retrospective study included a total of 634 eyes who underwent surgery for idiopathic ERM in 22 academic centers nationwide in Turkey. Data on best-corrected visual acuity (BCVA) and optical coherence tomography features (central foveal thickness (CFT), ERM and foveal contour morphology, ellipsoid zone (EZ) integrity) were collected and compared at baseline, 6-month, 12-month, and 24-month follow-ups. Prognostic factors for functional (having ≥ 20/25 Snellen BCVA) and anatomical (having normal/shallow foveal contour) recoveries after surgery were investigated by means of multivariate regression analyses. A cutoff value of preoperative BCVA optimizing functional recovery was calculated using receiver operating characteristic curve analysis.

Results

At a median follow-up of 24 months, 37.4% of the eyes achieved ≥ 20/25 BCVA and 54% regained normal or shallow foveal contour. Functional recovery was more likely in eyes with better baseline BCVA and intact EZ (R2 = 0.356, p < 0.001). The cutoff baseline BCVA value for good visual prognosis was 0.35 logarithm of the minimum angle of resolution (Snellen 20/44) (sensitivity 60%, specificity 85%, p < 0.001). Anatomical recovery was negatively associated with advanced age, higher baseline CFT, foveal herniation–type ERM morphology, and internal limiting membrane (ILM) peeling (R2 = 0.225, p < 0.001). The negative effect of ILM peeling on anatomical recovery was not significant after the first postoperative year (p = 0.05). Mean BCVA values and foveal morphology progressively improved at each visit. Cases with convex baseline foveal contour continued to change towards normal foveal depression over 24 months of follow-up, which took longer than the eyes with shallow/flat contoured cases. One-third of eyes with severe baseline EZ defects showed recovery at follow-up and achieved significantly greater visual acuity gains than the remaining eyes with persistent defects (p < 0.001).

Conclusions

Functional and anatomical restoration of the eyes appears to be a slow process after ERM surgery. This process may take much longer in eyes with worse foveal morphology at baseline. Although photoreceptor disruption may be reversible in some eyes, full functional recovery is unlikely when it persists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

Data is available upon request.

Change history

References

  1. Fraser-Bell S, Guzowski M, Rochtchina E et al (2003) Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains eye study. Ophthalmology 110:34–40

    Article  Google Scholar 

  2. McCarty DJ, Mukesh BN, Chikani V et al (2005) Prevalence and associations of epiretinal membranes in the visual impairment project. Am J Ophthalmol 140:288.e1

    Article  Google Scholar 

  3. Ng CH, Cheung N, Wang JJ et al (2011) Prevalence and risk factors for epiretinal membranes in a multi-ethnic United States population. Ophthalmology 118:694–699

    Article  Google Scholar 

  4. Massin P, Allouch C, Haouchine B et al (2000) Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery. Am J Ophthalmol 130:732–739

    Article  CAS  Google Scholar 

  5. Kauffmann Y, Ramel JC, Lefebvre A et al (2015) Preoperative prognostic factors and predictive score in patients operated on for combined cataract and idiopathic epiretinal membrane. Am J Ophthalmol 160:185–192.e5

    Article  Google Scholar 

  6. Kim JH, Kim YM, Chung EJ et al (2012) Structural and functional predictors of visual outcome of epiretinal membrane surgery. Am J Ophthalmol 153:103–10.e1

    Article  Google Scholar 

  7. Wong JG, Sachdev N, Beaumont PE, Chang AA (2005) Visual outcomes following vitrectomy and peeling of epiretinal membrane. Clin Exp Ophthalmol 33:373–378

    Article  Google Scholar 

  8. Inoue M, Morita S, Watanabe Y et al (2011) Preoperative inner segment/outer segment junction in spectral-domain optical coherence tomography as a prognostic factor in epiretinal membrane surgery. Retina 31:1366–1372

    Article  Google Scholar 

  9. Cobos E, Arias L, Ruiz-Moreno JM et al (2013) Preoperative study of the inner segment/outer segment junction of photoreceptors by spectral-domain optical coherence tomography as a prognostic factor in patients with epiretinal membranes. Clin Ophthalmol 7:1467–1470

    Article  CAS  Google Scholar 

  10. Pesin SR, Olk RJ, Grand MG et al (1991) Vitrectomy for premacular fibroplasia: prognostic factors, long-term follow-up, and time course of visual improvement. Ophthalmology 98:1109–1114

    Article  CAS  Google Scholar 

  11. Rice TA, De Bustros S, Michels RG et al (1986) Prognostic factors in vitrectomy for epiretinal membranes of the macula. Ophthalmology 93:602–610

    Article  CAS  Google Scholar 

  12. Kim J, Rhee KM, Woo SJ et al (2010) Long-term temporal changes of macular thickness and visual outcome after vitrectomy for idiopathic epiretinal membrane. Am J Ophthalmol 150:701–709

    Article  Google Scholar 

  13. Hamoudi H, Correll Christensen U, La Cour M (2018) Epiretinal membrane surgery: an analysis of 2-step sequential- or combined phacovitrectomy surgery on refraction and macular anatomy in a prospective trial. Acta Ophthalmol 96:243–250

    Article  Google Scholar 

  14. Aso H, Iijima H, Imai M, Gotoh T (2009) Temporal changes in retinal thickness after removal of the epiretinal membrane. Acta Ophthalmol 87:419–423

    Article  Google Scholar 

  15. Jeon S, Jung B, Lee WK (2019) Long-term prognostic factors for visual improvement after epiretinal membrane removal. Retina 39:1786–1793

    Article  Google Scholar 

  16. Nadri G, Saxena S, Stefanickova J et al (2019) Disorganization of retinal inner layers correlates with ellipsoid zone disruption and retinal nerve fiber layer thinning in diabetic retinopathy. J Diabetes Complicat 33:550–553

    Article  Google Scholar 

  17. Sharma SR, Saxena S, Mishra N et al (2014) The association of grades of photoreceptor inner segment-ellipsoid band disruption with severity of retinopathy in type 2 diabetes mellitus. J Case Reports Stud 2:1–5

    Google Scholar 

  18. Bae K, Choi JH, Kim KT, Kang SW (2019) En-face optical coherence tomography in patients with epiretinal membrane. Retina. https://doi.org/10.1097/IAE.0000000000002686

  19. Rahman R, Stephenson J (2014) Early surgery for epiretinal membrane preserves more vision for patients. Eye 28:410–414

    Article  CAS  Google Scholar 

  20. Kinoshita T, Kovacs KD, Wagley S, Arroyo JG (2011) Morphologic differences in epiretinal membranes on ocular coherence tomography as a predictive factor for surgical outcome. Retina 31:1692–1698

    Article  Google Scholar 

  21. Kunikata H, Abe T, Kinukawa J, Nishida K (2011) Preoperative factors predictive of postoperative decimal visual acuity ≥ 1.0 following surgical treatment for idiopathic epiretinal membrane. Clin Ophthalmol 5:147

    Article  Google Scholar 

  22. Shiono A, Kogo J, Klose G et al (2013) Photoreceptor outer segment length: a prognostic factor for idiopathic epiretinal membrane surgery. Ophthalmology 120:788–794

    Article  Google Scholar 

  23. Suh MH, Seo JM, Park KH, Yu HG (2009) Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal. Am J Ophthalmol 147:473–80.e3

    Article  Google Scholar 

  24. Falkner-Radler CI, Glittenberg C, Hagen S et al (2010) Spectral-domain optical coherence tomography for monitoring epiretinal membrane surgery. Ophthalmology 117:798–805

    Article  Google Scholar 

  25. Inoue M, Arakawa A, Yamane S, Kadonosono K (2012) Long-term outcome of preoperative disrupted inner/outer segment junctions assessed using spectral-domain optical coherence tomography in patients with idiopathic epiretinal membrane. Ophthalmologica 228:222–228

    Article  Google Scholar 

  26. Mathews NR, Tarima S, Kim DG, Kim JE (2014) Foveal contour changes following surgery for idiopathic epiretinal membrane. Investig Ophthalmol Vis Sci 55:7754–7760

    Article  Google Scholar 

  27. Hwang JU, Sohn J, Moon BG et al (2012) Assessment of macular function for idiopathic epiretinal membranes classified by spectral-domain optical coherence tomography. Investig Ophthalmol Vis Sci 53:3562–3569

    Article  Google Scholar 

  28. Ozdemir H, Karacorlu M (2017) Epiretinal membrane with foveal herniation. Retina 6:71–72

    Article  Google Scholar 

  29. Ozkaya A, Erdogan G, Demir G (2018) The outcomes of epiretinal membrane peeling in patients with foveal herniation. Int J Retin Vitr 4:1–7

    Article  Google Scholar 

  30. Chang S, Gregory-Roberts EM, Park S et al (2013) Double peeling during vitrectomy for macular pucker. JAMA Ophthalmol 131:525

    Article  Google Scholar 

  31. Lee JW, Kim IT (2010) Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling: a comparative study. Jpn J Ophthalmol 54:129–134

    Article  Google Scholar 

  32. Schechet SA, Devience E, Thompson JT (2017) The effect of internal limiting membrane peeling on idiopathic epiretinal membrane surgery, with a review of the literature. Retina 37:873–880

    Article  Google Scholar 

  33. Pournaras CJ, Emarah A, Petropoulos IK (2011) Idiopathic macular epiretinal membrane surgery and ILM peeling: anatomical and functional outcomes. Semin Ophthalmol 26:42–46

    Article  Google Scholar 

  34. Ahn SJ, Ahn J, Woo SJ, Park KH (2014) Photoreceptor change and visual outcome after idiopathic epiretinal membrane removal with or without additional internal limiting membrane peeling. Retina 34:172–181

    Article  Google Scholar 

  35. Ripandelli G, Scarinci F, Piaggi P et al (2015) Macular pucker: to peel or not to peel the internal limiting membrane? A microperimetric response. Retina 35:498–507

    Article  Google Scholar 

  36. Díaz-Valverde A, Wu L (2018) To peel or not to peel the internal limiting membrane in idiopathic epiretinal membranes. Retina 38:S5–S11

    Article  Google Scholar 

  37. Leisser C, Hirnschall N, Döller B et al (2020) Effect of air tamponade on postoperative visual acuity and intraretinal cystoid changes after peeling of idiopathic epiretinal membranes in pseudophakic patients. Ophthalmologica 243:37–42

    Article  Google Scholar 

  38. Chabot G, Bourgault S, Cinq-Mars B et al (2017) Effect of air and sulfur hexafluoride (SF6) tamponade on visual acuity after epiretinal membrane surgery: a pilot study. Can J Ophthalmol 52:269–272

    Article  Google Scholar 

  39. Mitamura Y, Hirano K, Baba T, Yamamoto S (2009) Correlation of visual recovery with presence of photoreceptor inner/outer segment junction in optical coherence images after epiretinal membrane surgery. Br J Ophthalmol 93(2):171–175

    Article  CAS  Google Scholar 

Download references

Code availability

Not applicable.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, School of Medicine, Gazi University, 06500, Ankara, Turkey

    Sengul Ozdek & Ece Ozdemir Zeydanli

  2. Department of Ophthalmology, Ardahan State Hospital, 75000, Ardahan, Turkey

    Ece Ozdemir Zeydanli

  3. Department of Ophthalmology, School of Medicine, Kocaeli University, Kocaeli, Turkey

    Levent Karabas

  4. Ulucanlar Eye Training and Research Hospital, Ankara, Turkey

    Mehmet Yasin Teke & Mehmet Citirik

  5. Department of Ophthalmology, School of Medicine, Başkent University, Ankara, Turkey

    Gursel Yilmaz

  6. Department of Ophthalmology, School of Medicine, Dokuz Eylul University, Izmir, Turkey

    Nilufer Kocak

  7. Department of Ophthalmology, Gulhane Education and Research Hospital, Ankara, Turkey

    Hakan Durukan

Authors
  1. Sengul Ozdek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ece Ozdemir Zeydanli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Levent Karabas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet Yasin Teke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gursel Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mehmet Citirik
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nilufer Kocak
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hakan Durukan
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the Turkish ERM Study Group

Corresponding author

Correspondence to Sengul Ozdek.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was conducted in accordance with the ethical standards of the Turkish Ophthalmological Association-Vitreoretinal Surgery Research Committee and with the tenets of Helsinki Declaration. The study was approved by the Ethics Committee of the Turkish Ophthalmological Association.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(PDF 96 kb)

ESM 2

(PDF 93 kb)

Appendix

Appendix

Turkish ERM (TERM) Study Group

Mehmet Numan Alp, MD; Eye Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey

Remzi Avci, MD; Bursa Retina Eye Hospital, Bursa, Turkey

Mehmet Citirik, MD; Ulucanlar Eye Training and Research Hospital, Ankara, Turkey

Sibel Demirel, MD; Department of Ophthalmology, School of Medicine, Ankara University, Ankara, Turkey

Hakan Durukan, MD; Department of Ophthalmology, Gulhane Education and Research Hospital, Ankara, Turkey

Cuneyt Erdurman, MD; Department of Ophthalmology, Gulhane Education and Research Hospital, Ankara, Turkey

Nur Acar Gocgil, MD; Department of Ophthalmology, Medical Faculty, Acıbadem University, Istanbul, Turkey

Hulya Gungel, MD; Eye Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey

Dilek Guven, MD; Eye Clinic, Şişli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey

Defne Kalayci, MD; Eye Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey

Ziya Kapran, MD; Private Eye Clinic, NeoRetina, Istanbul, Turkey

Levent Karabas, MD; Department of Ophthalmology, School of Medicine, Kocaeli University, Kocaeli, Turkey

Murat Karacorlu, MD; Istanbul Retina Institute, Istanbul, Turkey

Ozcan R. Kayıkcıoglu, MD; Department of Ophthalmology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey

Suleyman Kaynak, MD; Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

Nilufer Kocak, MD; Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

Rengin Aslıhan Kurt, MD; Department of Ophthalmology, Başkent University Istanbul Hospital, Istanbul, Turkey

Ozay Oz, MD; Private Eye Clinic, Adana Retina, Adana, Turkey

Sengul Ozdek MD, FEBO; Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey

Hakan Ozdemir, MD; Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

Berna Ozkan, MD; Department of Ophthalmology, School of Medicine, Kocaeli University, Kocaeli, Turkey

Abdullah Ozkaya, MD; Beyoglu Eye Training and Research Hospital, Istanbul, Turkey

Ozlem Sahin, MD; Department of Ophthalmology, School of Medicine, Marmara University, Istanbul, Turkey

Figen Sermet, MD; Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey

Sinan Tatlipinar, MD; Department of Ophthalmology, School of Medicine, Yeditepe University, Istanbul, Turkey

Mehmet Yasin Teke, MD; Ulucanlar Eye Training and Research Hospital, Ankara, Turkey

Melih Unal, MD; Private Eye Clinic, Istanbul, Turkey

Gursel Yilmaz, MD; Department of Ophthalmology, School of Medicine, Başkent University, Ankara, Turkey

Sami Yilmaz, MD; Retinagoz, Private Eye Clinic, Bursa, Turkey

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ozdek, S., Ozdemir Zeydanli, E., Karabas, L. et al. Relation of anatomy with function following the surgical treatment of idiopathic epiretinal membrane: a multicenter retrospective study. Graefes Arch Clin Exp Ophthalmol 259, 891–904 (2021). https://doi.org/10.1007/s00417-020-05002-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-05002-1

Keywords

Search

Navigation