Functional and morphological outcomes of En-bloc technique for removal of ERM-ILM complex in the management of idiopathic ERM

Abstract Background En-bloc removal of ILM-ERM complex provides a radical intervention that treats not only the ERM but also the underlying diseased ILM in one step ensuring complete removal of the ERM and preventing recurrence. The aim of the study is to investigate visual and macular structural and vascular perfusion changes after En-bloc removal of ERM-ILM complex for management of idiopathic ERM. Methods A prospective interventional study included patients with idiopathic ERM. PPV with removal of ERM and ILM as one unit (En-bloc removal) was performed. Structural OCT was used to classify ERMs according to EIFL stage, Enface OCT was used to demonstrate ERM effect on VMI and OCT-A to highlight vascular perfusion changes at baseline and 3 months post-operatively. Results Twenty-three patients were recruited for the study, 2 patients were excluded because of failure to perform En-bloc removal of ERM-ILM complex. A significant improvement in BCVA was noted at 3 months (0.35 ± 0.16, at 3 months vs 0.16 ± 0.08 at baseline, p-value: 0.005). Macular thickness decreased from 414.76 ± 63.22 to 336.95 ± 43.01 µm at 3 months (p-value: 0.005). Enface OCT revealed significant retinal folds in 16 eyes at baseline that disappeared after surgery in 14 out of 16 eyes. Retinal vascular wrinkling and straightening on OCT-A were significantly ameliorated after surgery with enhancement of vascular perfusion maps (vascular density at 1 mm 17.06 ± 1.59 at baseline and 24.13 ± 2.40 at 3 months (p-value; 0.013). Conclusion En-bloc removal of ERM-ILM complex provides satisfactory visual and macular morphological improvement.