J Korean Ophthalmol Soc.  2019 Nov;60(11):1080-1088. 10.3341/jkos.2019.60.11.1080.

Visual and Structural Differences in Idiopathic Epiretinal Membrane According to the Presence of Retinoschisis

• Lee MS
• Bang CW
• Song DY
• Bang JW
• Jeon HM
• Yoon HS

• KMID: 2463359
• DOI: http://doi.org/10.3341/jkos.2019.60.11.1080

Abstract

PURPOSE
To present differences in visual acuity and macular structure before and after surgery in patients with idiopathic epiretinal membrane (ERM) according to the presence of retinoschisis.
METHODS
This retrospective observational study included 324 eyes with idiopathic ERM, that underwent pars plana vitrectomy with ERM and internal limiting membrane peeling, and were followed for more than 6 months. Subjects were classified into two groups according to the presence of retinoschisis using preoperative optical coherence tomography (OCT; group 1, ERM with retinoschisis; group 2, ERM without retinoschisis). Preoperative and postoperative macular structure changes and surgical outcomes were compared.
RESULTS
Group 1 included 61 eyes, and group 2 included 263 eyes. Group 1 had a significantly higher preoperative and final postoperative best-corrected visual acuity compared with group 2 (p = 0.01, p = 0.02). Preoperative disorganization of retinal inner layers (DRIL) was significantly less in group 1 than group 2 (p = 0.01). Preoperative central macular thickness was not significantly different between the two groups. However, postoperative central macular thickness was significantly lower in group 1 than group 2 (p = 0.02, p = 0.01, p < 0.01). The ratio of the inner or outer layer in the total retinal thickness before surgery was significantly smaller in group 1 than in group 2 (p = 0.02, p = 0.04).
CONCLUSIONS
Preoperative visual acuity was better and the occurrence of DRIL was less in idiopathic ERM with retinoschisis than without retinoschisis. Postoperative visual and structural outcome was better in idiopathic ERM with retinoschisis than without retinoschisis. Retinoschisis may have played a role in reducing the tractional force given to the inner and outer retina.

Keyword

Idiopathic epiretinal membrane; Optical coherence tomography; Pars plana vitrectomy; Retinal layer thickness; Retinoschisis

MeSH Terms

Epiretinal Membrane*
Humans
Membranes
Observational Study
Retina
Retinaldehyde
Retinoschisis*
Retrospective Studies
Tomography, Optical Coherence
Traction
Visual Acuity
Vitrectomy
Retinaldehyde

Figure

• 

  Figure 1 Representative group 2 (A, right eye, epiretinal membrane without retinoschisis) and group 1 (B, left eye, epiretinal membrane with retinoschisis) spectral-domain optical coherence tomography images in a 56-year-old woman. Note the presence of disorganization of retinal inner layers (DRIL, yellow arrows) (A). The retinoschisis is located between inner nuclear layer and outer plexiform layer red arrow heads (B).

• 

  Figure 2 Segmentation of inner retina (IR) and outer retina (OR) with epiretinal membrane. The mean IR and OR thickness was measured at the upper, lower, nasal, and temporal sides, 500 µm away from the fovea center.

• 

  Figure 3 Mean BCVA changes at baseline (preoperative) and at 1, 3, 6 months postoperatively and at the final visit for ERM patients with retinoschisis (group 1) or without retinoschisis (group 2). BCVA = best corrected visual acuity; logMAR = logarithm of minimal angle of resolution; ERM = epiretinal membrane; M = month(s); preop = preoperative; postop = postoperative. *p < 0.05 compared to baseline BCVA.

• 

  Figure 4 Mean CFT changes at baseline (preoperative) and at 1, 3, 6 months postoperatively and at the final visit for ERM patients with retinoschisis (group 1) or without retinoschisis (group 2). CFT = central foveal thickness; ERM = epiretinal membrane; M = month(s); preop = preoperative; postop = postoperative. *p < 0.05 compared to baseline CFT.

• 

  Figure 5 Spectral domain optical coherence tomography (SD-OCT) image changes after surgery of the left eye in a 65-year-old man. (A) Preoperative SD-OCT images with visual acuity logMAR 0.40. The inner retina at the nasal side (red outline) is relatively thickened, whereas the inner retina at the temporal side (blue outline) is preserved due to presence of retinoschisis (yellow arrowheads). (B) SD-OCT image at 12 months after operation with visual acuity logMAR 0.05. The thickness of inner retina at nasal side is not completely recovered compared with the temporal side of inner retina.

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