Preoperative Classification of Submembrane Spaces for Optical Coherence Tomography-Guided Epiretinal Membranectomy

Area of Science:

• Ophthalmology
• Retinal Surgery
• Medical Imaging

Background:

• Epiretinal membrane (ERM) surgery is a common procedure.
• Current surgical techniques lack precise preoperative planning tools.
• Improving surgical outcomes and reducing complications are key goals.

Purpose of the Study:

• To evaluate an optical coherence tomography (OCT)-guided approach for epiretinal membrane (ERM) surgery.
• To assess the utility of a preoperative retinal evaluation system for classifying ERM surgical complexity.
• To compare the outcomes of OCT-guided ERM surgery with conventional methods.

Main Methods:

• A retrospective, comparative case series involving 137 eyes undergoing OCT-guided ERM surgery and 71 controls receiving conventional surgery.
• Preoperative classification of ERMs into 4 categories using spectral-domain OCT based on submembrane space characteristics.
• Evaluation of first-attempt surgical success, complications (petechial hemorrhage, macular breaks), operative time, and visual acuity at 3 months.

Main Results:

• OCT-guided surgery achieved significantly higher first-attempt success (89.2% vs. 57.2%) and lower rates of petechial hemorrhage (40.0% vs. 85.0%) and macular breaks (0% vs. 8.0%).
• Mean operative time was reduced by 28% in the OCT-guided group (19.6 vs. 25.1 minutes).
• Greater visual improvement was observed in the OCT-guided group at 3 months (+16.2 vs. +11.2 ETDRS letters).

Conclusions:

• The preoperative retinal evaluation system provides a practical framework for ERM surgical planning.
• The OCT-guided approach stratifies surgical risk, identifies optimal engagement points, and guides technique selection.
• Preoperative OCT-guided planning offers significant advantages, leading to improved success rates and reduced complications compared to conventional ERM surgery.