Effect of Iatrogenic Traction during Macular Peeling Surgery on Postoperative Microperimetry

Abstract

Introduction: Vitrectomy with peeling of epiretinal membrane (ERM) and inner limiting membrane (ILM) offers the chance for improvement of metamorphopsia and visual acuity. Microscope integrated intraoperative optical coherence tomography (iOCT) enables real-time imaging of retinal alterations during peeling, such as intraoperative transient retinal thickening owing to tractional forces during peeling. Aim of our study was to measure the amounts of transient retinal thickening due to tractional forces during membrane peeling, as documented with iOCT, and to analyze possible effects on postoperative retinal function. Methods: This prospective, monocenter study included patients scheduled for pars plana vitrectomy with membrane peeling due to an idiopathic ERM. During peeling, an iOCT device (ReScan700, Carl Zeiss Meditec AG, Germany) with continuous OCT-assistance during the peeling procedure, and video-documentation of the peeling procedure was used for assessment of intraoperative transient retinal thickening owing to tractional forces during peeling. Directly before and three months after surgery, macular-OCT scans and microperimetry were performed. Results: Twenty-five eyes of 25 patients were included into the study. Microperimetry could be performed in all patients, while iOCT documentation could be analyzed in 22 patients. Transient retinal thickening owing to tractional forces during peeling could be observed in 14 patients (64%), with a median thickening to 143% of the normal (preoperative) retinal thickness at that location (IQR: 132 to 163). Six patients (24%) developed new deep microscotomata as seen in microperimetry 3 months after surgery, among them were two patients that had transient retinal thickening during peeling, too. Conclusion: New deep microscotomata developed only in a minority of patients with transient retinal thickening owing to tractional forces during peeling.