Improvement of horizontal macular contraction after surgical removal of epiretinal membranes

Abstract

Purpose To determine whether horizontal macular contraction caused by epiretinal membranes (ERMs) improves after surgical removal. Methods In this prospective, single-center, observational study, 63 consecutive patients with unilateral idiopathic ERM in one eye and no retinal disease in the fellow eye underwent pars plana vitrectomy. Fundus photography and optical coherence tomography (OCT) were performed preoperatively and at 3 months postoperatively. The area enclosed by superior and inferior major vessels from the optic disc to the fovea (area under major vessel (AUV)) and the macroscopic diverging angle (MDA) between superior and inferior major vessels were calculated using digital image analysis of fundus photographs and compared pre-and postoperatively. Results AUV was significantly smaller in the eyes with ERM compared with the normal fellow eyes (Po0.001). Significant postoperative change in AUV and MDA was demonstrated after ERM removal (Po0.001). However, postoperative AUV of grade 2 and 3 ERM eyes was still significantly smaller than that of normal fellow eyes. Macular thickness differences measured with stratus OCT were positively correlated with AUV differences. Conclusions Retinal topographic changes caused by ERM improved in part after ERM removal. The improvement of topographic changes were correlated with tomographic changes detected with OCT.

Retinal Nerve Fiber Layer Configuration in Eyes with Epiretinal Membrane

“…4,31 In the present study, we hypothesized that contraction of the ERM may affect the ONH and peripapillary RNFL beyond the macula. 4,31 In the present study, we hypothesized that contraction of the ERM may affect the ONH and peripapillary RNFL beyond the macula.…”

Retinal Changes Induced by Epiretinal Tangential Forces

“…The retinal changes induced by tangential traction may appear on the fundus examination as follows: irregular wrinkling, nerve fiber layer dragging, ectopic fovea, winding corkscrew vessels surrounding the overlying ERM, or major vessel straightening and crowding [ 99 ]. Fundus photography and, in particular, red-free or blue-reflectance imaging, can highlight the presence of ERM [ 17 ].…”

Retinal relaxation following membrane peeling: Effect on vision, central macular thickness, and vector analysis of motion

“…Vitreomacular surgery releases these tractional forces, by eliminating points of attachment between the membrane and the retina and leading to visual improvement over several months [7][8][9]. On OCT, lowering of CMT is observed, but a return to a completely normal contour with its characteristic foveal depression is seldom realized [8,10].Pre-operative predictive signs of post-operative vision improvement remain difficult to establish.…”

“…Vitreomacular surgery releases these tractional forces, by eliminating points of attachment between the membrane and the retina and leading to visual improvement over several months [7][8][9]. On OCT, lowering of CMT is observed, but a return to a completely normal contour with its characteristic foveal depression is seldom realized [8,10].Pre-operative predictive signs of post-operative vision improvement remain difficult to establish. OCT characteristics in patients with ERM have been extensively studied but these have not been found so far to be predictive of visual outcome [11].Based on autofluorescence images before and after vitreoretinal surgery, Nitta et al suggested that if pre-operative hyperfluorescent lines present in a number of ERM eyes disappeared postoperatively, a better visual outcome was possible [12].…”

“…A number of studies have attempted to quantify the outward displacement of vessels following surgery using photographic images or scanning laser ophthalmoscopy (SLO) [5,8,13,14]. SLO provides a high spatial resolution of the retinal surface with an X-Y precision between 7 and 10µm.…”