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Published on: May 25, 2020
RISK FACTORS AND PREDICTIVE CUTOFF VALUES FOR NEW-ONSET MICROSCOTOMA AFTER VITRECTOMY WITH INTERNAL LIMITING MEMBRANE
Takumi Ando1, Hiroko Terashima1, Kotaro Tsuboi2
1Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan ; and.
Purpose:
To identify the risk factors and predictive cutoff values for new-onset microscotoma after vitrectomy with internal limiting membrane peeling for epiretinal membrane.
Methods:
This retrospective study included patients who underwent vitrectomy with epiretinal membrane and internal limiting membrane peeling. Visual acuity, metamorphopsia, and visual field (Humphrey Field Analyzer 10-2 program) were evaluated preoperatively and at 3 to 6 months and 12 months postoperatively. New-onset microscotoma was defined as any test points decreasing from ≥10 dB preoperatively to <10 dB at 3 months to 6 months. Risk factors, vulnerable regions, and preoperative threshold cutoff values for new-onset microscotoma were analyzed.
Results:
New-onset microscotoma was observed in 31 (17.8%) of 174 eyes (174 patients; 67.7 ± 8.2 years). Visual acuity and metamorphopsia improved significantly at 12 months postoperatively (both P < 0.0001). A multivariate analysis identified glaucoma (odds ratio = 8.18), secondary epiretinal membrane (odds ratio = 4.45), indocyanine green usage (odds ratio = 3.70), and male sex (odds ratio = 2.46) as significant risk factors. Vulnerable regions corresponded to the temporal and inferior macula ( P < 0.01). The overall preoperative threshold cutoff value was 27.5 dB (area under the curve = 0.85, P < 0.001), whereas in eyes with glaucoma (n = 18), it was 26.5 dB (area under the curve = 0.90, P < 0.001). Both analyses demonstrated a negative predictive value exceeding 99%.
Conclusion:
The identified risk factors, vulnerable regions, and cutoff values may guide preoperative patient counseling and development of safe strategies to prevent postoperative microscotoma. The high negative predictive values highlight reliable identification of low-risk areas, contributing to internal limiting membrane peeling approach optimization.
Insights
This study identified risk factors like glaucoma and male sex for new-onset microscotoma after internal limiting membrane (ILM) peeling during epiretinal membrane (ERM) surgery. Predictive cutoff values can help optimize surgical strategies and patient counseling.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Visual Electrophysiology
Background:
- Epiretinal membrane (ERM) surgery often involves internal limiting membrane (ILM) peeling.
- Postoperative microscotoma can affect visual function after ILM peeling.
- Identifying risk factors is crucial for improving surgical outcomes.
Purpose of the Study:
- To determine risk factors for new-onset microscotoma following vitrectomy with ERM and ILM peeling.
- To establish predictive cutoff values for identifying eyes at risk of microscotoma.
- To guide strategies for preventing postoperative visual field defects.
Main Methods:
- Retrospective analysis of 174 patients undergoing vitrectomy with ERM and ILM peeling.
- Evaluation of visual acuity, metamorphopsia, and visual field (Humphrey Field Analyzer 10-2) preoperatively and postoperatively.
- Definition of new-onset microscotoma based on changes in visual field sensitivity (dB).
Main Results:
- New-onset microscotoma occurred in 17.8% of eyes.
- Significant risk factors included glaucoma, secondary ERM, indocyanine green use, and male sex.
- Predictive cutoff values were identified, with high negative predictive values (>99%) for low-risk areas.
Conclusions:
- Glaucoma, secondary ERM, ICG use, and male sex are key risk factors for postoperative microscotoma.
- Established cutoff values and identified vulnerable macular regions (temporal, inferior) aid in risk stratification.
- Findings support optimizing ILM peeling techniques and preoperative patient counseling to minimize microscotoma risk.
