BACKGROUND: Macular pucker or epiretinal membrane (ERM) is a fibrocellular proliferation over the internal limiting membrane (ILM), and exerts progressive retinal traction inducing the increase of macular thickness and structural changes in retinal layers. Pars plana vitrectomy (PPV) with ERM peeling is performed when significant visual decline occurs, though not always combined with cataract surgery. Pre-operative retinal conditions as well as anterior segment opacities could have undermined functional improvement evaluation. Finally, long-term individual retinal layers changes have not been widely studied yet.
AIM: to evaluate the functional recovery and variation in macular retinal layers volume after successful vitrectomy for macular pucker with a 12-month follow-up.
DESIGN: single-center retrospective cross-sectional study with fellow-eye comparison.
METHODS: thirty pseudophakic eyes of thirty patients with macular pucker treated by pars plana vitrectomy and ERM peel will be included. Strict inclusion and exclusion criteria will be applied in order to exclude confounding factors. Preoperative evaluation - besides accurate eye examination - will include accurate ERM staging, retinal layers measurements assessed by Spectral-Domain Optical coherence tomography (SD-OCT) with a focus on macular ganglion cell and inner plexiform layers (GCL-IPL) thickness. Same evaluation will be repeated at 1, 3, 6 and 12 months after surgery - comparing with the values recorded at baseline - to estimate functional and anatomical recovery.
Pars plana vitrectomy combined with ERM peeling is certainly the best option to treat macular pucker with vision impairment. However, previous retrospective studies have used indulgent inclusion and exclusion criteria resulting in several bias and confounding factors with a short follow-up. For example, including both phakic and pseudophakic patients, visual outcomes could not be correctly estimated since anterior segment opacities could not be accurately excluded. In addition, even if several staging systems for macular pucker have been proposed, most of the studies did not stratified ERM stage with post-surgical outcomes. Finally, while many studies have analyzed overall macular region thickness, retinal layers measurements have not been widely included.
In our project, we aim to exclude all ocular pathologies that can affect visual outcomes. In other words, we aim to include idiopathic ERM in pseudophakic eyes with a follow-up of 12 months. We will stratify ERM staging macular pucker from stage 2 to stage 4 in order to evaluate functional and anatomical improvement according to the pre-operative macular condition.