gms | German Medical Science

Background: To date, a reliable prediction of outcome after pars plana vitrectomy (PPV) and surgical membrane peeling in patients with epiretinal membrane formation remains difficult.

Methods: We investigated 40 eyes (40 patients) with idiopathic epiretinal membranes who underwent 23- or 20 gauge three-port PPV with surgical membrane peeling. Pre- and postoperative morphological features were assessed by using high-definition optical coherence tomography (Carl Zeiss Meditec). OCT patterns were correlated with clinical course and visual outcome. The significance of prognostic factors was examined with Fisher’s exact test.

Results: Based on OCT, we identified four morphological features termed “flat” (<450 µm), “prominent” (≥450 µm), “surface wrinkling” and “smooth”. Of those patients with prominent membranes and surface wrinkling (n=24), 13 (54%) exhibited a significant improvement in visual acuity (≥3 lines), whereas only 1 individual (11%) in the sugroup of patients with flat and smooth membranes (n=8) showed a comparable visual outcome. This difference was statistically significant (p=0,0466). Intraoperatively, flat and smooth membranes were more frequently judged to be tightly adherent than prominent membranes with surface wrinkling.

Conclusions: The assessment of specific morphological features with high-definition OCT may be useful in characterizing the surgical prognosis of eyes with an epiretinal membrane. It seems plausible that an association between morphology and visual outcome is causally related to the degree of membrane adherence to the retinal surface.