Abstract
Purpose:
To evaluate the difference of epiretinal membrane surgery with and without gas tamponade concerning visual function and macular morphology.
Methods:
69 eyes of 69 consecutive patients who had undergone pars plana vitrectomy with peeling of epiretinal membranes from 2009 to 2011 at the University Eye Hospital of Wuerzburg and had a pre-operative measurement with spectral domain optical coherence tomography (Cirrus® OCT, Carl Zeiss Meditec), were included in this study. In 43 cases, a gas tamponade (air or non-expanding SF6/air or C3F8/air mixture) was used during surgery whereas in 26 cases the surgery was done without gas. Best-corrected visual acuity (BCVA) was determined and retinal thickness was measured using OCT before epiretinal membrane surgery, as well as in a follow-up examination at least 6 months after surgery. Primary outcome measure was the correlation between functional and morphological changes for both groups.
Results:
Overall, BCVA improved in 58 eyes (84,1%), remained stable in 10 eyes (14,5%), and deteriorated in only one eye (1,4%). In 35 of 43 eyes without gas tamponade (81,4%) BCVA improved, remained stable in 7 of 43 eyes (16,3%) and deteriorated in one eye (2,3%). In the gas tamponade group, BCVA improved in 23 of 26 patients (88,5%), remained stable in 3 cases (11,5%), and was reduced in none of the patients. Foveal retinal thickness decreased in 89,9% of all patients, 96,2% and 86,0% in patients with and without gas tamponade, respectively. The reduction in foveal thickness compared to baseline was highly significant in both groups. There was a significant greater reduction in retinal thickness in patients with gas tamponade and also a trend towards a slightly greater increase of visual acuity. The preoperative statistically significant correlation between foveal retinal thickness and visual acuity is postoperatively not significant anymore.
Conclusions:
The use of a gas tamponade during epiretinal membrane surgery shows a statistically significant improvement in morphologic outcome and also a tendency towards a better functional outcome. Although the effect on visual acuity is not statistically significant, this trend is of particular interest because a gas tamponade was primarily used in eyes with more pronounced retinal folds and additional vitreoretinal traction.
Keywords: 762 vitreoretinal surgery •
688 retina •
585 macula/fovea