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Epiretinal membrane removal disrupts photoreceptors, diminishes visual outcomes
Am J Ophthalmol. 2009;147(3): 473-480.
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Photoreceptor disruption identified by optical coherence tomography portended poor visual outcomes in eyes undergoing idiopathic epiretinal membrane removal. The disruption may be irreversible, the study authors said.
The prospective randomized study included 101 eyes of 101 patients with idiopathic epiretinal membrane who underwent pars plana vitrectomy and epiretinal membrane removal. Investigators evaluated best corrected visual acuity and anatomic features at 3 months and 6 months after surgery.
Stratus OCT (Carl Zeiss Meditec) was used to measure integrity of junction between inner and outer segments of photoreceptors (IS/OS junction), macular thickness and foveal contour. Relations between OCT characteristics and preoperative and postoperative BCVA — and differences between those visual acuity parameters — were also analyzed.
Study data showed eyes with disruption of IS/OS junction had markedly lower postoperative BCVA and smaller BCVA changes than those with no disruption. A higher portion of eyes with photoreceptor disruption was seen at 3 months after surgery; the increase persisted at 6 months.
Results showed a positive correlation between preoperative macular thickness and BCVA differences and a negative correlation between postoperative macular thickness and postoperative BCVA (P < .05).
"Early membrane removals may beneficially prevent further progression of photoreceptor damage in [epiretinal membrane] patients with photoreceptor disruption," the authors said. "We also emphasize that membrane removals should be performed carefully to avoid further photoreceptor disruption."