Functional and structural outcomes after vitrectomy: The role of macular contour restoration

INTRODUCTION: Idiopathic epiretinal membrane (ERM) is a fibroglial proliferation on the retinal surface that distorts the macular contour and impairs visual acuity. Restoration of the foveal pit following pars plana vitrectomy (PPV) is considered a key determinant of postoperative outcomes. This study aimed to evaluate the relationship between macular contour recovery and functional improvement after ERM surgery.
METHODS: This retrospective study included 168 eyes of 155 patients who underwent PPV for idiopathic ERM between January 2009 and January 2011. Patients were grouped according to pre- and postoperative macular contour (MC) as regular or irregular. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured using the Snellen chart and spectral-domain optical coherence tomography (SD-OCT) before and 6 months after surgery. Statistical analyses were performed using paired t-tests, ANOVA, and Tukey’s post hoc tests (p<0.05).
RESULTS: The mean age differed significantly among groups (p=0.03). Preoperative BCVA was higher in patients with regular MC (0.37±0.23) than in those with irregular MC (0.16±0.11; p=0.02). Postoperative BCVA improved significantly in all groups (p=0.01). The greatest CMT reduction occurred in patients whose MC normalized postoperatively (CMT=-338.9±159.2 µm; p=0.01), indicating concordant structural and visual recovery.
DISCUSSION AND CONCLUSION: PPV for idiopathic ERM provides significant visual and anatomical improvement. Postoperative restoration of the foveal pit is strongly associated with superior BCVA gain and CMT reduction, highlighting foveal morphology as a key prognostic marker for surgical success.

Keywords: Epiretinal membrane, foveal contour, optical coherence tomography, pars plana vitrectomy, visual acuity.