Epiretinal Membrane Increases Risk for Failure of Full-Thickness Macular Hole Closure

Madrid, Spain, optometrist optician doctor examines eyesight of woman
Researchers explain the connection between the presence of epiretinal membranes and poor outcomes in macular hole surgeries.

Adverse surgical outcomes after full-thickness macular hole (FTMH) closure are more likely among patients with epiretinal membranes (ERM), according to results of a nested case-control study published in Retina.

All patients (N=534) who underwent vitrectomy for FTMH at the Asan Medical Center in South Korea between 2011 and 2020 were included in this study. Adverse surgical outcomes through 6 months were associated with the presence of ERM or epiretinal proliferation, or both.

Study participants had a mean age of 66.0±8.1 years and 35.3% were men. A total of 163 (30.1%) had FTMH with ERM. On the basis of ERM status, patient cohorts differed significantly for age (P =.012), sex (P =.007), preoperative logMAR (P =.003), macular hole size (P =.004), RPE disruption (P =.022), presence of epiretinal proliferation (P <.001), operculum (P<.001), and vitreomacular traction (P =.047).

To account for cohort differences, the investigators used a propensity matching approach, selecting 127 patients from each group. After matching, significant cohort imbalances were not observed.

FTMH failure occurred among 21.3% of patients with ERM and 11.8% of patients without ERM.

Patients with ERM were at increased risk for FTMH hole closure failure (adjusted odds ratio [aOR], 2.71; 95% CI, 1.19-6.14) as were patients with both hole-marginal ERM and epiretinal proliferation (aOR, 9.09; 95% CI, 1.75-47.29). Neither patients with extra hole-marginal ERM (aOR, 1.92; 95% CI, 0.81-4.56) nor hole-marginal ERM alone (aOR, 1.48; 95% CI, 0.70-3.12) were at increased risk for failure.

Unfavorable hole closure was more likely among patients with hole-marginal ERM (aOR, 2.13; 95% CI, 1.12-4.07) or total ERM (aOR, 2.07; 95% CI, 1.16-3.71). Neither extra hole-marginal ERM (aOR, 1.24; 95% CI, 0.54-2.82) nor hole-marginal ERM and epiretinal proliferation (aOR, 1.82; 95% CI, 0.34-9.89) associated with increased risk for unfavorable hole closure.

The investigators reported they did not assess whether innovative surgical techniques ameliorated the risk for FTMH closure failure among patients at high risk for poor surgical outcomes.

These data indicated that patients with ERM with or without epiretinal proliferation were at increased risk for adverse surgical outcomes from vitrectomy for FTMH.


Yang JM, Choi SU, Kim YJ, et al. Association between epiretinal membrane, epiretinal proliferation, and prognosis of full-thickness macular hole closure. Retina. Published online July 12, 2021. doi:10.1097/IAE.0000000000003262