Visual Recovery after Surgery in Epiretinal Membrane Eyes with Retinal Nerve Fiber Layer Schisis and Internal Limiting Membrane Tears.

PURPOSE: To determine whether tractional inner retinal changes, including schisis of the retinal nerve fiber layer (sRNFL) and internal limiting membrane (ILM) tears, represent a surgically irreversible stage of the epiretinal membrane (ERM).

DESIGN

Retrospective study.

PARTICIPANTS

Patients who underwent vitrectomy with ERM and ILM peeling.

METHODS

Visual acuity and metamorphopsia were assessed at baseline and at 1, 3, 6, and 12 months after operation, whereas retinal sensitivity was evaluated at baseline and 3 and 12 months after operation. Metamorphopsia was quantified using M-CHARTS, and retinal sensitivity was measured within the central 10° of the macula using microperimetry. Visual outcomes were compared between eyes with and without sRNFL and ILM tears.

MAIN OUTCOME MEASURES: Visual acuity, metamorphopsia, and retinal sensitivity at 12 months and their changes from baseline.

RESULTS

Among 129 eyes (129 patients), sRNFL was observed in 62 eyes (48%) and ILM tears in 49 eyes (38%), all of which co-occurred with sRNFL. Eyes with sRNFL or ILM tears had worse baseline visual function across all 3 parameters, greater central foveal thickness, and a more advanced ERM stage (all P < 0.01). However, visual function in eyes with sRNFL or ILM tears significantly improved (P < 0.001), resulting in comparable postoperative outcomes regardless of their presence. Multivariate analyses showed that baseline visual function independently predicted postoperative visual acuity (β = 0.292, P = 1.5 × 10-4), metamorphopsia (β = 0.251, P = 0.017), and retinal sensitivity (β = 0.422, P = 4.9 × 10-4), excluding sRNFL or ILM tears. In functional changes, sRNFL remained independently associated with greater improvements in visual acuity (β = -0.144, P = 5.9 × 10-4) and retinal sensitivity (β = 1.140, P = 0.028), whereas ILM tears were associated only with visual acuity improvement (β = -0.167, P = 1.0 × 10-4) after adjusting for age, sex, and phacovitrectomy.

CONCLUSIONS

Schisis of the RNFL and ILM tears represent extrafoveal tractional markers in ERM and do not necessarily indicate irreversible visual dysfunction. Recovery patterns may differ across visual function domains with increasing inner retinal tractional changes, whereas visual acuity may remain recoverable even in eyes with advanced traction. These findings may help inform prognostic counseling before surgery.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.