Macular Surgery Can Repair Vision in Eyes With Foveal Herniation

Epiretinal membrane, OCT scan
Epiretinal membrane. Optical coherence tomography (OCT) scan of a section through the retina of the eye of a patient with an epiretinal membrane. An epiretinal membrane is a layer of scar tissue that grows across the macula (centre) and distorts the retinal tissue as it contracts and thickens. The macula (centre) is the central area of the retina that contains the highest density of rod and cone cells. This impairs sight by distorting the central area of vision, but does not cause total blindness. Treatment is by removing the membrane in a procedure known as a vitrectomy.
The study shows patients with foveal herniation in the subganglion cell complex had more severely affected macular morphology.

Foveal herniation (FH) is a rare feature of idiopathic epiretinal membrane (iERM), affecting approximately 1.3% of those patients. However, macular surgery can effectively restore vision, even if it cannot completely repair foveal morphology, according to research published in Eye (Lond).

Researchers reviewed patients with a diagnosis of iERM from March 2008 to December 2020. Experienced physicians were recruited to assess for FH and record central foveal thickness (CFT), fibrillary surface changes (FSC), intercrystoid space, cotton ball sign, and integrity of ellipsoid zone (EZ). BCVA and status of the fellow eye were measured at baseline and during the participants last visit to the clinic. 

The researchers looked over 3882 records of patients with iERM and found 51 (1.3%) patients had FH. The mean age of these 51 participants was 72.67±7.11 years and 27 (52.9%) were women. Participants were divided into 2 groups based on whether their FH was located within the ganglion cell complex (GCC) (n=16), or the subganglion cell complex (subGCC) (n=35). If they underwent macular surgery, pre- and postoperative measurements were also recorded. 

For the 43 participants who underwent surgery, researchers received follow-up data from 31 (mean age 72.67±7.11 years). Their baseline BCVAs were 0.55±0.21 logMAR (Snellen equivalent 20/70) and baseline CFT was 677.14±97.36 μm. Twenty-one eyes (41.1%) had intraretinal cystoid space, 10 eyes (19.6%) had cotton ball signs, 42 (82.3%) had FSB, and 3 (5.8%) had partially disrupted EZ. 

The analysis shows that baseline BCVA is a predictive factor for postoperative BCVA in those who undergo surgery (P =.001).

“The lower the baseline BCVA, the greater was the postoperative vision increase,” the researchers report, concluding that macular surgery could be beneficial for those with iERM and accompanying FH. 

Additionally, the research shows that patients with FH in the subGCC layer had more severely affected macular morphology than those with FH in the GCC layer. FSC was identified in 42 participants in total, 32 from the subGCC group, significantly more than the 10 from the GCC group (P =.020).

This study is limited by its inconsistent follow-up periods, preventing the measurement of visual acuity changes over short time periods. Also, the cohort of participants with FH was not large enough. 


Uzel MM, Gelisken F, Konrad E, Neubauer J. Clinical and morphological characteristics of patients with idiopathic epiretinal membrane with foveal herniation. Eye (Lond). Published online June 13, 2022. doi:10.1038/s41433-022-02094-3