Longitudinal Change in Retinal Nerve Fiber Layer Thickness and Its Association With Central Retinal Sensitivity After Epiretinal Membrane Surgery

Purpose: To investigate the longitudinal changes in the peripapillary retinal nerve fiber layer (pRNFL) thickness after epiretinal membrane (ERM) vitrectomy with internal limiting membrane (ILM) peeling, examine associations between pRNFL thickness and central retinal sensitivity, and identify predictors of postoperative pRNFL thickness. Design: Prospective, observational, cohort study. Methods: This study enrolled 82 eyes of 82 Japanese patients that underwent surgery for unilateral idiopathic ERM, with their fellow eyes as controls. pRNFL thickness was measured in 4 (superior, temporal, inferior, and nasal) quadrants preoperatively and at 1, 3, 6, and 12 months postoperatively. Microperimetry was performed at 12 months postoperatively to evaluate central retinal sensitivity. Regression tree analysis was performed to predict pRNFL thickness at 12 months postoperatively. Results: The temporal quadrant showed continuous pRNFL thinning after surgery, reaching statistical significance at 3, 6, and 12 months postoperatively (all P < 0.001). The pRNFL thicknesses in the fellow eyes significantly increased at all postoperative time points (all P < 0.001). At 12 months postoperatively, the average central retinal sensitivity was significantly correlated with the temporal pRNFL thickness in the eyes with ERM (r = 0.372, P < 0.001); no significant correlation was found in the fellow eyes. Regression tree analysis showed that the preoperative pRNFL thickness in the temporal quadrant and patient age were the main determinants of the temporal pRNFL thickness at 12 months postoperatively. Conclusions: The risk of deterioration of central retinal sensitivity after ERM vitrectomy with internal limiting membrane peeling should be considered for patients with thin temporal pRNFLs and older adults.