Effect of foveal herniation on surgical outcomes in patients with idiopathic epiretinal membrane

Ozdemir, Hakan; Karacorlu, Murat; Elbay, Ahmet; Kirik, Furkan

doi:10.5935/0004-2749.20220047

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ORIGINAL ARTICLE • Arq. Bras. Oftalmol. 85 (05) • Sep-Oct 2022 • https://doi.org/10.5935/0004-2749.20220047 copy

Effect of foveal herniation on surgical outcomes in patients with idiopathic epiretinal membrane

O Efeito da herniação foveal nos resultados cirúrgicos em pacientes com membrana epirretiniana idiopática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

This study aimed to compare the anatomical and visual outcomes of idiopathic epiretinal membrane peeling surgery, with and without foveal herniation.

Methods:

This retrospective, comparative, two-center study included age- and sex-matched patients exhibiting an idiopathic epiretinal membrane with and without foveal herniation (epiretinal membrane + foveal herniation group and epiretinal-membrane-only group, respectively). The baseline best-corrected visual acuity and central foveal thickness were compared within the groups through months 1, 3, 6, and 12 of follow-up postoperatively. Then, changes in these two parameters at all follow-up points were compared between the groups.

Results:

We enrolled 16 patients per study group. The baseline best-corrected visual acuity and central foveal thickness were not significantly different between the two groups (p>0.05). Compared with the baseline, both the best-corrected visual acuity and central foveal thickness improved significantly in both groups in all follow-ups (p<0.05), except for the best-corrected visual acuity of the epiretinal-membrane-only group after month 1 (p<0.05). The mean best-corrected visual acuity improvement after month 1 and the mean central foveal thickness reduction after months 1, 3, and 6 were significantly better in the foveal herniation + epiretinal membrane group than in the epiretinal-membrane-only group (p<0.05). However, the best-corrected visual acuity and central foveal thickness changes were not significantly different between the groups at the final visit (p>0.05).

Conclusions:

Although epiretinal membrane + foveal herniation demonstrated prompt anatomical and functional improvement, foveal herniation occurrence did not affect the final surgical outcomes in patients with idiopathic epiretinal membrane.

Keywords:
Epiretinal membrane; Tomography, optical coherence; Fovea centralis; Vitrectomy; Visual acuity

	ERM + FH (n=16)	ERM-only (n=16)	p value
Age, mean ± SD	67.66 ± 8.67	68.06 ± 4.51	0.903^* * Independent t-test.
Gender, %			1.000^† † Chi-square test.
Female	56.3	56.3
Male	43.7	43.7
Baseline BCVA ± SD logMAR	0.47 ± 0.22	0.57 ± 0.21	0.166^‡ ‡ Mann-Whitney U test.Values with p<0.05 are shown in bold.
Changes in BCVA ± SD logMAR
Month 1	0.10 ± 0.13	0.01 ± 0.05	0.017^‡ ‡ Mann-Whitney U test.Values with p<0.05 are shown in bold.
Month 3	0.13 ± 0.16	0.12 ± 0.11	0.91^‡ ‡ Mann-Whitney U test.Values with p<0.05 are shown in bold.
Month 6	0.20 ± 0.16	0.22 ± 0.13	0.52^‡ ‡ Mann-Whitney U test.Values with p<0.05 are shown in bold.
Month 12	0.26 ± 0.16	0.27 ± 0.13	0.84^‡ ‡ Mann-Whitney U test.Values with p<0.05 are shown in bold.
Baseline CFT ± SD, mm	665.06 ± 140.51	626.75 ± 82.76	0.677^* * Independent t-test.
Changes in CFT ± SD, mm
Month 1	240.50 ± 133.92	42.31 ± 50.27	<0.001^‡ ‡ Mann-Whitney U test.Values with p<0.05 are shown in bold.
Month 3	281.38 ± 131.35	107.00 ± 54.64	<0.001^* * Independent t-test.
Month 6	306.94 ± 133.88	195.81 ± 55.46	0.002^‡ ‡ Mann-Whitney U test.Values with p<0.05 are shown in bold.
Month 12	321.81 ± 124.63	267.75 ± 54.35	0.293^‡ ‡ Mann-Whitney U test.Values with p<0.05 are shown in bold.
Lens status at baseline, n (pseudophakic-phakic)	9-7	10-6	0.719^† † Chi-square test.
Surgical approach, n (Only PPV-Phaco + PPV)	12-4	13-3	0.674^† † Chi-square test.
Lens status at final visit, n (pseudophakic-phakic)	15-1	15-1	1.000^† † Chi-square test.

		Baseline	Month 1	Month 3	Month 6	Month 12
BCVA (logMAR) mean ± SD p value	ERM + FH	0.47 ± 0.22	0.37 ± 0.14	0.34 ± 0.15	0.27 ± 0.09	0.21 ± 0.10
			*p=0.011^ * Paired t-test.**	*p=0.007^ * Paired t-test.**	*p=0.001^ * Paired t-test.**	*p=0.001^ * Paired t-test.**
	ERM-only	0.57 ± 0.21	0.56 ± 0.21	0.45 ± 0.13	0.35 ± 0.12	0.30 ± 0.14
			p=0.317^† † Wilcoxon signed-rank test. Values with p<0.05 are shown in bold.	p=0.003^† † Wilcoxon signed-rank test. Values with p<0.05 are shown in bold.	p<0.001^† † Wilcoxon signed-rank test. Values with p<0.05 are shown in bold.	p<0.001^† † Wilcoxon signed-rank test. Values with p<0.05 are shown in bold.
CFT (mm) p value	ERM + FH	665.06 ± 140.51	424.56 ± 65.06	383.69 ± 57.76	358.13 ± 42.27	343.25 ± 51.64
			*p<0.001^ * Paired t-test.**	*p<0.001^ * Paired t-test.**	*p<0.001^ * Paired t-test.**	*p<0.001^ * Paired t-test.**
	ERM-only	626.75 ± 82.76	584.44 ± 101.36	519.75 ± 89.81	430.94 ± 68.20	359.00 ± 50.25
			*p=0.004^ * Paired t-test.**	*p<0.001^ * Paired t-test.**	*p<0.001^ * Paired t-test.**	*p<0.001^ * Paired t-test.**

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[1] Corresponding author: Hakan Ozdemi. E-mail: MOzdemir@bezmialem.edu.tr