Comparing Spectral Domain Optical Coherence Tomography Findings With Visual Acuity Outcome in Patients With Macular Pucker Surgery

Abstract

Purpose: : To correlate the visual acuity (VA) outcome in eyes with the diagnosis of macular pucker after epiretinal membrane peel surgery with findings on Heidelberg Spectral Domain Optical Coherence Tomography (OCT)

Methods: : This study was a retrospective analysis of 30 patients who underwent pars plana vitrectomy and epiretinal membrane peel for macular pucker between January 2009 and November 2009. A pre and post operative OCT was done at 3 months follow-up. The surgery was performed with a 23 gauge vitrectomy system and membrane peel was assisted with Indocianine Green stain.

Results: : Of the 30 patients 12 were female (40%) and 18 male (60%) with an average age of 70 years. 6 patients were diabetic. Visual acuity improved in 16 patients (54%), remained stable in 7 (23%), and worsened in 7 (23%). 11 (69%) of the 16 patients who improved VA gained more than 2 lines, and central macular thickness (CMT) improved by >10% in 10 (63%) of these. 6 (86%) of the 7 patients that decreased vision dropped 2 or more lines of VA, even though all of those (100%) improved CMT by >10%. Of these, 3 showed a disruption in the RPE-photoreceptor layers in the foveal or perifoveal area, 2 had intraretinal cysts (findings that were persistent through the pre and post-operative follow-up); and 2 patients developed cataracts secondary to gas used in surgery. In all, preoperative CMT was of 428 µm and 347µm postoperative (19% improvement).

Conclusions: : Epiretinal membrane peel surgery proved to be beneficial in reducing CMT to a great degree. Although most patients improved vision significantly, the drop of VA in others is attributed to changes in the RPE-photoreceptor layer, intraretinal cysts (easily observable in the preoperative stages on Spectral Domain OCT), or development of postoperative cataracts.

Keywords: vitreoretinal surgery • visual acuity • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)