The outcomes of epiretinal membrane peeling in patients with foveal herniation

Abstract

BackgroundTo evaluate the surgical outcomes of vitrectomy in patients with foveal herniation associated with epiretinal membrane (ERM).MethodsThis was a retrospective case series. The patients who had a foveal herniation associated with ERM, underwent vitrectomy, and had a minimum follow-up period of 12 months were included. The visual and anatomical outcomes were assessed during the first 12 months of follow-up and at the last follow-up visit. The main outcome measure was the reorganization pattern of foveal pit at month 12.ResultsEleven eyes of 11 patients were included. The mean postoperative follow-up period was 14.8 ± 2.6 months. The foveal contour was completely restored in 5 eyes (45.5%), partially restored in 5 eyes (45.5%), and was not restored in 1 eye (9.1%) at postoperative month 12 follow-up visit. The mean preoperative best corrected visual acuity was 0.61 ± 0.16 LogMAR and increased to 0.49 ± 0.16 LogMAR at month 12 (p < 0.0001). The mean preoperative central retinal thickness was 476 ± 128 micrometers and decreased to 302 ± 70 micrometers at month 12 (p < 0.0001).ConclusionThe foveal contour was restored in 45.5% of the eyes and visual acuity was significantly increased by a mean of 1.2 LogMAR lines at month 12 in patients with foveal herniation associated with ERM.

Clinical and morphological characteristics of patients with idiopathic epiretinal membrane with foveal herniation

“…Similar to other reports, a visual gain was found in our study with an average of three lines after the macular surgery. Restoration of the foveal contour was achieved in 35.5%, which was comparable to previous studies reporting between 32.2% and 45.4% of successful restoration [ 12 , 13 ]. In our population, eyes having intraocular gas (16.2%) had higher chance of restoration of the foveal contour.…”

“…In our population, eyes having intraocular gas (16.2%) had higher chance of restoration of the foveal contour. Intraocular gas tamponade was used more frequently in other studies (54.5–86%) than in our study [ 12 , 13 ]. No correlation between the improvement of the vision and the use of tamponade or restoration of the foveal contour was found.…”

“…In 2017, Ozdemir and Karacorlu reported a case with FH in an eye with ERM [ 15 ]. A multicentre, retrospective study by Ozdek et al and a retrospective case series by Ozkaya et al analysed the surgical outcome of the eyes with iERM and among them FH [ 12 , 13 ]. The incidence of FH were reported as 20.1% in 634 eyes that underwent a macular surgery for iERM [ 12 ].…”

Epiretinal Membrane With Foveal Herniation

“…8–10 Previous studies have suggested that excessive centripetal forces from the ERM formed on the surface may create sufficient traction to pull the inner retinal layers into the vitreous through the central operculum leading to the herniation. 2,6,7 However, we believe that the increased volume of retina within the sub-ERM compartment after the ERM traction-related inner retinal layer thickening causes increased tissue pressure and retinal herniation through a central aperture within the ERM. Oellers and Eliott 2 suggest that retinal edema secondary to ERM traction may also result in the foveal tissue protrusion.…”

“…5 Francis et al 4 reported a series of six patients with foveal herniation who had improved visual and anatomical outcomes after surgical ERM peeling. Ozkaya et al 6 described a retrospective case series of outcomes of ERM peeling in 11 patients with foveal herniation. Similar to our study, their findings included complete restoration of the foveal contour in approximately half the patients with an improvement in visual acuity postoperatively.…”