Visual outcomes of monocular idiopathic epiretinal membrane removal: a prospective follow-up study
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 4 (2024),
2 March 2025
,
Page 160-168
https://doi.org/10.51329/mehdioptometry211
Abstract
Background: Surgical intervention for an idiopathic epiretinal membrane (iERM) could alleviate metamorphopsia or improve vision. We evaluated changes in vision in patients undergoing treatment for monocular iERMs during a 6-month period. We investigated the rate of posterior vitreous detachment (PVD) using optical coherence tomography (OCT) imaging in eyes with iERM and in normal fellow eyes. We also examined the intraoperative rate of PVD in iERM eyes following the administration of triamcinolone acetonide (TA).Methods: This prospective interventional case series recruited all eligible individuals with treatment-naive monocular iERM who were scheduled for pars plana vitrectomy (PPV) due to reduced best-corrected distance visual acuity (BCDVA) or metamorphopsia. OCT at baseline was used to determine the presence and stage of PVD in the eyes with iERM and the normal fellow eyes. Intraoperative TA-based PVD staging was performed for affected eyes.
Results: Participants comprised 32 cases, with 32 eyes with iERM and 32 normal fellow eyes. The mean (standard deviation [SD]) age was 60.9 (9.7) years, and the majority were men (n = 18, 56.2%). The baseline mean (SD) of BCDVA in affected eyes was 0.50 (0.21) logarithm of the minimum angle of resolution (logMAR), which improved to 0.34 (0.20) logMAR at the 1-month visit, representing a significant mean difference of 0.15 (0.20) logMAR (P < 0.001). At the 6-months visit, the mean (SD) BCDVA had further improved to 0.26 (0.19) logMAR, representing a significant mean difference of 0.23 (0.26) logMAR (P < 0.001) from the baseline value. The mean (SD) visual improvement between the 1- and 6-months follow-ups was 0.07 (0.14) logMAR, which was statistically significantly (P < 0.05). The mean changes in BCDVA were more pronounced in patients aged < 60 years than in those aged ? 60 years. The proportion of eyes at each stage of PVD detected by preoperative OCT in eyes with iERM differed from that detected by intraoperative TA staining. By both methods, the stages advanced significantly with increasing age (both P < 0.001). Similarly, the proportion of eyes at each stage of PVD detected by preoperative OCT in the normal fellow eyes was also higher and advanced significantly with increasing age (P < 0.001).
Conclusions: Continuous visual improvement is anticipated up to 6 months after surgery in eyes with iERM, and this improvement is likely to be more significant in younger individuals. The incidences of each PVD stage varies depending on the use of preoperative OCT or intraoperative TA in these cases. A higher rate of PVD observed in fellow eyes may suggest that PVD progresses through its stages simultaneously and without complications in normal eyes. Further studies are needed to validate our preliminary results and confirm these conclusions.
Keywords:
- posterior vitreous detachment
- epiretinal membranes
- vitrectomies
- optical coherence tomography
- metamorphopsia
- visual acuities
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3. Cheung N, Tan SP, Lee SY, Cheung GCM, Tan G, Kumar N, Cheng CY, Wong TY. Prevalence and risk factors for epiretinal membrane: the Singapore Epidemiology of Eye Disease study. Br J Ophthalmol. 2017 Mar;101(3):371-376. doi: 10.1136/bjophthalmol-2016-308563. Epub 2016 Jun 24. PMID: 27343209.
4. Gelormini F, Ricardi F, Parisi G, Vallino V, Ghezzo B, Cucciarelli C, Marolo P, Cicinelli MV, Govetto A, Romano MR, Borrelli E, Reibaldi M. Visual Performance and Predictive OCT Biomarkers in Epiretinal Membrane Assessment: Beyond Distance Visual Acuity. Invest Ophthalmol Vis Sci. 2025 Jan 2;66(1):31. doi: 10.1167/iovs.66.1.31. PMID: 39804627; PMCID: PMC11734757.
5. Karasavvidou EM, Panos GD, Koronis S, Kozobolis VP, Tranos PG. Optical coherence tomography biomarkers for visual acuity in patients with idiopathic epiretinal membrane. Eur J Ophthalmol. 2021 Nov;31(6):3203-3213. doi: 10.1177/1120672120980951. Epub 2020 Dec 14. PMID: 33307784.
6. Kanukollu VM, Agarwal P. Epiretinal Membrane. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32809538.
7. Chatzistergiou V, Papasavvas I, Ambresin A, Pournaras JC. Prediction of Postoperative Visual Outcome in Patients with Idiopathic Epiretinal Membrane. Ophthalmologica. 2021;244(6):535-542. doi: 10.1159/000517193. Epub 2021 Jun 1. PMID: 34062549.
8. Pournaras CJ, Emarah A, Petropoulos IK. Idiopathic macular epiretinal membrane surgery and ILM peeling: anatomical and functional outcomes. Semin Ophthalmol. 2011 Mar;26(2):42-6. doi: 10.3109/08820538.2010.544237. PMID: 21469962.
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10. Matoba R, Morizane Y. Surgical Treatment of Epiretinal Membrane. Acta Med Okayama. 2021 Aug;75(4):403-413. doi: 10.18926/AMO/62378. PMID: 34511606.
11. Lee J, Lee J, Lee CS, Kim M, Byeon SH, Kim SS, Kang HG. Clinical factors and predictors for spontaneous separation of epiretinal membranes. Graefes Arch Clin Exp Ophthalmol. 2024 Oct 2. doi: 10.1007/s00417-024-06646-z. Epub ahead of print. PMID: 39354154.
12. Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Idiopathic Epiretinal Membrane and Vitreomacular Traction Preferred Practice Pattern®. Ophthalmology. 2020 Feb;127(2):P145-P183. doi: 10.1016/j.ophtha.2019.09.022. Epub 2019 Sep 25. Erratum in: Ophthalmology. 2020 Sep;127(9):1280. doi: 10.1016/j.ophtha.2020.06.045. PMID: 31757497.
13. Hwang ES, Kraker JA, Griffin KJ, Sebag J, Weinberg DV, Kim JE. Accuracy of Spectral-Domain OCT of the Macula for Detection of Complete Posterior Vitreous Detachment. Ophthalmol Retina. 2020 Feb;4(2):148-153. doi: 10.1016/j.oret.2019.10.013. Epub 2019 Nov 2. PMID: 31864940; PMCID: PMC7008078.
14. Albabtain B, Mura M, Schatz P, Alsulaiman SM, Alsakran WA, Semidey VA. Comparison of Posterior Hyaloid Assessment Using Preoperative Optical Coherence Tomography and Intraoperative Triamcinolone Acetonide Staining During Vitrectomy. Clin Ophthalmol. 2021 Sep 29;15:3939-3945. doi: 10.2147/OPTH.S331700. PMID: 34616138; PMCID: PMC8488048.
15. Johnson MW. Perifoveal vitreous detachment and its macular complications. Trans Am Ophthalmol Soc. 2005;103:537-67. PMID: 17057817; PMCID: PMC1447588.
16. Uchino E, Uemura A, Ohba N. Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography. Arch Ophthalmol. 2001 Oct;119(10):1475-9. doi: 10.1001/archopht.119.10.1475. PMID: 11594947.
17. Christodoulou E, Batsos G, Galanis P, Kalogeropoulos C, Katsanos A, Alamanos Y, Stefaniotou M. Vitrectomy for the removal of idiopathic epiretinal membrane with or without internal limiting membrane peeling: a meta-analysis. Ther Adv Ophthalmol. 2020 Aug 20;12:2515841420927133. doi: 10.1177/2515841420927133. PMID: 32923936; PMCID: PMC7446271.
18. Manousaridis K, Peter S, Mennel S. 20 g PPV with indocyanine green-assisted ILM peeling versus 23 g PPV with brilliant blue G-assisted ILM peeling for epiretinal membrane. Int Ophthalmol. 2016 Jun;36(3):407-12. doi: 10.1007/s10792-015-0148-5. Epub 2015 Oct 23. PMID: 26499510.
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