J Korean Ophthalmol Soc.  2018 Jul;59(7):637-649. 10.3341/jkos.2018.59.7.637.

Choroidal Thickness Changes Following Vitrectomy in Epiretinal Membrane Based on the Optical Coherence Tomography Pattern

• Park JM
• Yeom MI
• Park JM

• KMID: 2416266
• DOI: http://doi.org/10.3341/jkos.2018.59.7.637

Abstract

PURPOSE
To analyze the influence of morphological classification in epiretinal membrane (ERM) based on surgical outcomes and optical coherence tomography (OCT) of the postoperative choroidal thickness.
METHODS
This observational study included 122 eyes with ERM who underwent vitrectomy. Using OCT, the preoperative ERM was classified into six types: cystoid macular edema (CME), convex, flat, normal foveal contour (Normal), pseudolamellar hole (PLH), and vitreomacular traction (VMT). The preoperative multifocal electroretinogram (mfERG), postoperative change in subfoveal choroidal thickness (SCT), central macular thickness (CMT), and best-corrected visual acuity (BCVA) were compared.
RESULTS
Preoperative subfoveal choroidal thickness increased in the VMT type compared to the fellow eye (207 µm vs. 234 µm, p = 0.028). Choroidal thickness decreased in all types at 12 months after vitrectomy (all, P < 0.05). There was a positive linear correlation between the mfERG and the preoperative BCVA (p = 0.001). The initial visual acuity was best in the Normal type followed by the flat, PLH, convex, CME, and VMT types (p = 0.001). The final visual acuity was the best in the Normal type, followed by the PLH, Flat, VMT, Convex, and CME types (p = 0.030). Gas tamponade during the surgery did not affect the surgical outcomes of the CMT (p = 0.458), BCVA (p = 0.550), and SCT (p = 0.127).
CONCLUSIONS
Preoperative SCT increased only in the VMT type, but choroidal thickness decreased in all types after vitrectomy, regardless of the preoperative morphology.

Keyword

Choroidal thickness; Idiopathic epiretinal membrane; Multifocal electroretinogram; Optical coherence tomography; Visual acuity

MeSH Terms

Choroid*
Classification
Epiretinal Membrane*
Macular Edema
Observational Study
Tomography, Optical Coherence*
Traction
Visual Acuity
Vitrectomy*

Figure

• 

  Figure 1. The type of epiretinal membrane in optical coherence tomography images. (A) The cystoid macular edema type shows globally adherent membrane and formation of intraretinal cystoid space. (B) The convex type shows globally adherent membrane and dome shaped retina due to diffuse thickening of neurosensory retina. (C) The flat type shows globally adherent membrane and flat foveal contour. (D) The normal type shows normal foveal contour. (E) The pseudolamellar hole type shows steepened foveal fit. (F) The vitreomacular traction type shows focal adherent membrane bridging between vitreous and retina.

• 

  Figure 2. Longitudinal changes of the best corrected visual acuity (BCVA) before and after epiretinal membrane surgery. BCVA significantly increased in all types after surgery. CME = cystoid macular edema type; Convex = convex type; Flat = flat type; Normal = normal foveal contour type; PLH = pseudolamellar hole type; VMT = vitreomacular traction type.

• 

  Figure 3. Scattergram demonstraing the relation between preoperative multifocal electroretinogram (Ring1 amplitude) and best corrected visual acuity (BCVA). (A) Ring1 amplitude is significantly related to the preoperative BCVA (rho = −0.316, R2 = 0.126, p = 0.001*). (B) Ring1 amplitude is not significantly related to the postoperative BCVA (rho = −0.113, R2 = 0.022, p = 0.308*). Regression lines are shown on the scattergram as the red lines. M = months; mfERG = multifocal electroretinogram. * Spearman correlation analysis.

• 

  Figure 4. Scattergram demonstraing the relation between the preoperative central macular thickness (CMT) and best corrected visual acuity (BCVA). (A) Preoperative CMT is significantly related to the preoperative BCVA (rho = 0.587, R2 = 0.398, p < 0.001*). (B) Preoperative CMT is significantly related to the BCVA change (at 12 months) (rho = 0.244, R2 = 0.061, p = 0.009*). (C) Preoperative CMT is significantly related to the CMT change (at 12 months) (rho = 0.860, R2 = 0.758, p < 0.001*). M = months. Regression lines are shown on the scattergram as the red lines. * Spearman correlation analysis.

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