[Surgical Treatment for Idiopathic Epiretinal Membrane].

Aim: To assess effectiveness of surgical treatment for idiopathic epiretinal membrane.

Material And Methods: Retrospective study included on 44 eyes out of 46 patients operated for idiopathic ERM in OFTAL Zvolen with a 20G PPV (32 patients) and posterior vitreous membrane ablation and 23G PPV (14 patients) from August 2008 to December 2014. After the extraction of epiretinal membrane, a peeling of ILM has been implemented following its Blue Membrane identification. Mean follow-up time was 18 months.

Results: Best corrected visual acuity (BCVA) before the surgery was 0.37 (SD 0.15) whereas post-surgery indicated 0.63 (SD 0.25). In 35 eyes (76.1%) was BCVA after the surgery 0,5 and better and in 2 eyes (4.3%) was BCVA 0,16 and worse. 29 eyes (63.0%) acquired 2 and more rows. BCVA improved in 40 eyes (87.0%) and remained the same in 3 eyes (6.5%). Degeneration of BCVA in 3 eyes (6.5%) was due to retinal detachment in one case, to retinal pigment epithelium (RPE) atrophy in the second case and to ischemic optic nerve head atrophy in the last case. According to OCT, the average mean of foveal thickness before the surgery was 496 (SD 88) µm and decreased to 356 (SD 59) µm after the surgery (thus average reduction of 140 µm). In 30 eyes (65.2%), we achieved a reduced foveal thickness of more than 100 µm, in comparison to 15 eyes (32.6%) of less than 100 µm. In no case after the surgery did retinal thickness increase comparing to finding before the surgery. Foveal contour restitution was present in 14 eyes (30.4%). There were no preoperative/ intraoperative complications. In 3 eyes (10.3%) a combined cataract surgery with PPV was performed. Cataract progression was seen in 20 phakic eyes (76.9%) out of 26 where all of them were treated surgically at an average time 13 (3-34) months after the PPV. As postoperative complication shows, a retinal detachment occurred in one eye (2.2%) 5 months after the surgery and in 1 eye (2.2%) a cystoid macular edema turned out as the reason of residual posterior vitreous adhesion.

Conclusion: PPV with membranectomy and internal limiting membrane peeling is a safe and effective method in idiopathic epiretinal membrane treatment. It leads to a function improvement and foveal thickness reduction in most of the patients diagnosed with IEM. Because phakic eyes conduce cataract progression (76.9%), on older patients with no transparent lens we now perform a combination of surgical operations--pars plana vitrectomy and cataract extraction.