title: Retinal adherence and fibrillary surface changes correlate with surgical difficulty of epiretinal membrane removal.
abstract: OBJECTIVE
  To correlate surgical difficulty of epiretinal membrane (ERM) removal with characteristics of ERM adherence seen by spectral-domain optical coherence tomography (SD-OCT).
  
  
  METHODS
  Prospective observational case series.
  
  
  METHODS
  Surgical difficulty was correlated with extent of ERM adherence by SD-OCT using masked observers in consecutive eyes undergoing ERM removal (N=31). Surgical videos were analyzed and difficulty of ERM removal (grade 1-3) was determined in 4 quadrants as well as the fovea by consensus of observers masked to SD-OCT findings. Extent of ERM adhesion was categorized (focal, broad, or complete) by masked observers using SD-OCT. The presence of fibrillary changes between the ERM and retinal nerve fiber layer (RNFL) was also evaluated. Surgical difficulty of ERM removal for each quadrant and fovea was compared to extent of ERM adherence and presence of fibrillary changes.
  
  
  RESULTS
  Assessment of ERM adherence using SD-OCT between masked observers was highly concordant (kappa=0.9178). Surgical difficulty of ERM removal was strongly associated with more extensive ERM adherence to the retina observed by SD-OCT. Complete ERM adherence correlated with an 8.6-fold increased surgical difficulty of ERM removal compared to focal adherence (P<.0001). The presence of fibrillary changes between the ERM and RNFL also correlated with a 25.5-fold increased difficulty of surgical removal compared to the absence of fibrillary changes (P<.0001).
  
  
  CONCLUSIONS
  Extent of ERM-retinal adhesion and presence of fibrillary changes determined by SD-OCT provide reliable preoperative assessment of surgical difficulty. Furthermore, SD-OCT analysis may help localize surgically advantageous coordinates to initiate ERM removal.
authors.affiliation: Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, California 92093-0946, USA.
authors.forename: Jae Suk
authors.initials: JS
authors.lastname: Kim
authors.forename: Jay
authors.initials: J
authors.lastname: Chhablani
authors.forename: Candy K
authors.initials: CK
authors.lastname: Chan
authors.forename: Lingyun
authors.initials: L
authors.lastname: Cheng
authors.forename: Igor
authors.initials: I
authors.lastname: Kozak
authors.forename: Kathrin
authors.initials: K
authors.lastname: Hartmann
authors.forename: William R
authors.initials: WR
authors.lastname: Freeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D012165:Retinal Ganglion Cells / Q000473:pathology*; D013499:Surface Properties; D000267:Tissue Adhesions; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology