Surgery Restores Vision in Eyes With Idiopathic Epiretinal Membrane, Foveal Herniation

Retina, LM
Retina. Light micrograph (LM) of a section through a retina. The eye works by allowing light to be focused by the lens onto the retina. The retina contains specialised light sensitive photoreceptor cells (top) used to distinguish between colours (cone cells) and to see at night (rod cells). The light is relayed as electrical signals through sensory nerve cells, called bipolar cells ( centre purple cells). The two layers above and below the bipolar nerve cells are synaptic layers, where the dendrites and axons of the photoreceptors and neurons pass on the signals to others below them. The lowest layers are made up of ganglion nerve cells which pass the signals to the brain and the choroid layer that lines the inside of the eye underneath the retina and is pigmented to prevent light reflecting inside the eye distorting the image. Magnification: x120 when printed 10cm wide.
Baseline acuity is a predictive factor for the postoperative vision changes for these patients, the study shows.

Macular surgery can restore vision in eyes with idiopathic epiretinal membrane (iERM) and foveal herniation (FH), although the foveal morphology does not fully recover, according to a study published in Eye.

Researchers retrospectively analyzed clinical findings and optical coherence tomography (OCT) features of patients with iERM and FH. The primary study outcome were changes of the best-corrected-visual-acuity (BCVA) and OCT features from baseline to the final visit. The team divided FH patients into 2 groups according to herniated layers: ganglion cell complex (GCC)-group and subGCC-group. They also evaluated surgical outcomes. Macular surgery involved a 23-gauge pars plana vitrectomy, a peeling of all epiretinal membranes and internal limiting membrane (ILM) utilizing a dye. 

Between March 1, 2008 and December 31, 2020, a total of 3882 patients with iERM were screened, of whom 51 (1.3%) had FH. The mean age of the patients with FH was 72.67±7.11 years (age range: 57-91 years, 27 women, 24 men). Compared with the subGCC-group (n=35), the GCC-group (n=16) had a better baseline BCVA and thinner central foveal thickness (CFT), but this was not statistically significant (P =.330, P =.417, respectively). The average BCVA improvement in the GCC and subGCC groups were 0.28±0.13 logMAR, and 0.32±0.19 logMAR (P =.499), respectively.

Between the 2 groups, the postoperative BCVA-improvement was similar (P =.280). Fibrillary surface changes were identified in 42 of 51 (82.3%) patients, significantly more frequently in the sub-GCC group (P =.020). Baseline BCVA was a predictive factor for the postoperative vision change, the researchers note.

“FH presents with a unique macular morphology in eyes with iERM,” according to the researchers. “Macular surgery is successful in restoring vision, even though foveal morphology does not fully recover.” 

Limitations of the study included its retrospective design, the limited number of cases with FH, and time-dependent changes in visual acuity were not precisely documented. 


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