Ophthalmology Division, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Private Retina Practice, University of Buenos Aires, Buenos Aires, Argentina.
Am J Ophthalmol. 2018 Dec;196:129-135. doi: 10.1016/j.ajo.2018.08.037. Epub 2018 Sep 1.
Epiretinal membrane (ERM) can cause distortion and disorganization of all inner retinal layers. The purpose of our study was to evaluate the extent of disorganization of the retinal inner layers (DRIL) and to investigate its predictive value for visual outcome in cases of idiopathic ERM that were treated by pars plana vitrectomy (PPV) and ERM peeling.
Multicenter international retrospective case series.
In 90 eyes from 90 patients with idiopathic ERM treated by PPV and membrane peeling with 12-month follow-up, optical coherence tomography (OCT) scans previous to surgery were evaluated for presence and severity of DRIL, central foveal subfield thickness (CST), maximal retinal thickness (MRT), presence of intraretinal cystoid changes and subretinal fluid, and integrity of the inner/outer segment layer and of the interdigitation zone. Best-corrected visual acuity (BCVA), CST, and MRT were recorded at baseline and at 3, 6, and 12 months after surgery. Correlations between baseline OCT measures (DRIL) and functional and visual outcome were analyzed. Main outcome measures are presence and severity of DRIL at baseline; anatomic and functional outcomes after 3, 6, and 12 months; and the correlation between DRIL and baseline characteristics and outcome measures.
Patients without and with mild DRIL had a significantly better baseline BCVA compared with patients with severe DRIL (0.61 ± 0.13, 0.56 ± 0.23, 0.73 ± 0.20 [logMAR], respectively). BCVA, CST, and MRT at baseline were statistically significantly correlated with DRIL severity (P = .003, P < .001, and P < .001, respectively). DRIL status before surgery showed a statistically significant interaction with change in BCVA, CST, and MRT over 12 months (P < .001 for all). Patients without and with mild DRIL gained a mean of 3 lines of vision after 12 months, in contrast to 1 line in patients with severe DRIL.
DRIL grading correlates with functional and anatomic measures in patients with idiopathic ERM and could serve as a biomarker to predict outcome after surgery. Patients with severe DRIL have limited benefits from surgery. This should be considered in the decision process whether to perform ERM peeling in this patient group.
视网膜内表面膜（ERM）可导致所有内层视网膜的扭曲和紊乱。本研究的目的是评估内层视网膜紊乱（DRIL）的程度，并探讨其对特发性ERM 经玻璃体切除术（PPV）和 ERM 剥除术后视力结果的预测价值。
多中心国际回顾性病例系列。
对 90 例 90 只眼特发性 ERM 患者进行 PPV 和膜剥除术，并在 12 个月的随访中，对术前光学相干断层扫描（OCT）进行评估，以评估 DRIL 的存在和严重程度、中心凹视网膜下小凹厚度（CST）、最大视网膜厚度（MRT）、视网膜内囊样改变和视网膜下积液的存在情况以及内/外节层和内插区的完整性。在基线和术后 3、6 和 12 个月时记录最佳矫正视力（BCVA）、CST 和 MRT。分析基线 OCT 测量值（DRIL）与功能和视力结果之间的相关性。主要观察指标为基线时 DRIL 的存在和严重程度；术后 3、6 和 12 个月的解剖和功能结果；以及 DRIL 与基线特征和结果测量值之间的相关性。
无和轻度 DRIL 患者的基线 BCVA 明显优于重度 DRIL 患者（0.61 ± 0.13、0.56 ± 0.23、0.73 ± 0.20[logMAR]）。BCVA、CST 和 MRT 与 DRIL 严重程度在基线时呈统计学显著相关（P=0.003、P<0.001 和 P<0.001）。术前 DRIL 状态与术后 12 个月 BCVA、CST 和 MRT 的变化呈统计学显著交互作用（所有 P<0.001）。无和轻度 DRIL 患者在 12 个月后平均增加 3 行视力，而重度 DRIL 患者仅增加 1 行。
DRIL 分级与特发性 ERM 患者的功能和解剖学测量相关，可作为术后结果的预测生物标志物。重度 DRIL 患者手术获益有限。在决定是否对该患者群体进行 ERM 剥除术时，应考虑这一点。
