Postoperative OCT Microstructural Changes as Predictors of Visual Prognosis Following Epiretinal Membrane Peeling: A...

Idiopathic macular epiretinal membrane (iERM) induces traction and deformation of the macular retina, significantly impairing function and quality of life. This study aimed to evaluate the predictive value of early postoperative optical coherence tomography (OCT) microstructural changes for visual prognosis in patients undergoing vitrectomy with membrane peeling for iERM.

A total of 110 patients diagnosed with iERM at Huzhou Aier Eye Hospital between January 2021 and July 2024 were retrospectively enrolled. According to OCT findings, patients were divided into stage I (n = 38), stage II (n = 52), and stage III (n = 20). All patients underwent 23-gauge minimally invasive vitrectomy combined with indocyanine green staining and peeling of the epiretinal membrane and internal limiting membrane. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), choroidal thickness at 1000 μm from the nasal side of the macular fovea (NFCT), and choroidal thickness at 1000 μm from the temporal side of the macular fovea (TFCT) were assessed before surgery and at 1 and 3 months postoperatively. Repeated-measures analysis of variance was used to compare intergroup differences over time, and multivariate logistic regression was performed to identify indicators associated with a favorable visual prognosis.

Significant gradient differences were observed among the three groups in CMT, SFCT, NFCT, TFCT, and BCVA, with stage I patients exhibiting significantly lower values than those in stage II and stage III (all p < 0.05). During postoperative follow-up, OCT parameters and visual acuity improved in all groups, with significantly greater improvement in stage I patients compared with stage II or stage III (all p < 0.05). Repeated-measures analysis demonstrated a significant time × group interaction effect for CMT (F = 2.334, p = 0.032), with a greater rate of CMT reduction in stage I patients. At 6 months postoperatively, 71 patients (64.55%) achieved a favorable visual prognosis. Multivariate logistic regression analysis indicated that lower CMT at 1 month postoperatively (OR = 0.98, 95% CI: 0.97-0.99, p < 0.05) was significantly associated with favorable visual outcomes at 6 months.

Postoperative anatomical and functional recovery in iERM patients is stage-dependent. Lower CMT at 1 month after surgery is significantly associated with favorable visual outcomes at 6 months, suggesting its potential value as an early postoperative prognostic indicator. These findings underscore the importance of incorporating early postoperative OCT assessment into clinical follow-up to facilitate individualized prognosis and patient counseling.