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Yap A, Lu LM, Sims JL, Welch S, Niederer RL. Epiretinal membrane in uveitis: Rate, visual prognosis, complications and surgical outcomes. Clin Exp Ophthalmol 2024; 52:54-62. [PMID: 38108156 DOI: 10.1111/ceo.14338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Epiretinal membrane (ERM) is a common finding in patients with uveitis that contributes to visual impairment. We describe the long-term visual acuity (VA) and morphometric progression in patients with uveitis and epiretinal membrane (ERM). METHODS Retrospective cohort study of patients with uveitic ERM from a tertiary centre database. Multivariate analysis of risk factors for ERM progression was calculated using a marginal Cox regression model to estimate hazard ratios (HR). RESULTS Two hundred and sixteen eyes (4%) of a total 5450 eyes with uveitis were identified to have an ERM. The most common diagnosis was idiopathic uveitis in 45 patients (28.7%), followed by sarcoidosis in 21 (13.4%), HLAB27-related uveitis in 15 (9.6%) and toxoplasmosis in 15 (9.6%). Risk factors for ERM development include age (HR 1.03), intermediate uveitis (HR 2.33), posterior uveitis (HR 1.53) and ERM fellow eye (HR 18.28). Anterior uveitis (HR 0.53) and alternating disease (HR 0.53) were protective. Median VA was 20/40 at diagnosis of ERM and 20/40 at final follow up. Progression of ERM grade occurred in 17 eyes (7.9%) during the study period. ERM peel was performed in 44 eyes (20.4%). Median VA was 20/60 and 20/40 at baseline and 12 months after surgery, respectively. Improvement in visual acuity occurred in 23 eyes (60.5%) following surgery. CONCLUSIONS In addition to intermediate and posterior uveitis, fellow eye involvement is a strong risk factor for ERM development. In treated uveitis, the majority maintain their long-term vision and rates of ERM progression are low.
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Affiliation(s)
- Aaron Yap
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Lucy M Lu
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Joanne L Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Sarah Welch
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
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2
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Hung CL, Lin KH, Lee YK, Mrozek D, Tsai YT, Lin CH. The Classification of Stages of Epiretinal Membrane using Convolutional Neural Network on Optical Coherence Tomography Image. Methods 2023; 214:28-34. [PMID: 37116670 DOI: 10.1016/j.ymeth.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/18/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The gold standard for diagnosing epiretinal membranes is to observe the surface of the internal limiting membrane on optical coherence tomography images. The stages of the epiretinal membrane are used to decide the condition of the health of the membrane. The stages are not detected because some of them are similar. To accurately classify the stages, a deep-learning technology can be used to improve the classification accuracy. METHODS A combinatorial fusion with multiple convolutional neural networks (CNN) algorithms are proposed to enhance the accuracy of a single image classification model. The proposed method was trained using a dataset of 1947 optical coherence tomography images diagnosed with the epiretinal membrane at the Taichung Veterans General Hospital in Taiwan. The images consisted of 4 stages; stages 1, 2, 3, and 4. RESULTS The overall accuracy of the classification was 84%. The combination of five and six CNN models achieves the highest testing accuracy (85%) among other combinations, respectively. Any combination with a different number of CNN models outperforms any single CNN algorithm working alone. Meanwhile, the accuracy of the proposed method is better than ophthalmologists with years of clinical experience. CONCLUSIONS We have developed an efficient epiretinal membrane classification method by using combinatorial fusion with CNN models on optical coherence tomography images. The proposed method can be used for screening purposes to facilitate ophthalmologists making the correct diagnoses in general medical practice.
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Affiliation(s)
- Che-Lun Hung
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taiwan R.O. C; Computer Science and Communication Engineering, Providence University, Taiwan R.O. C.
| | - Keng-Hung Lin
- Department of Ophthalmology, Taichung Veterans General Hospital, Taiwan R.O.C
| | - Yu-Kai Lee
- Department of Computer Science and Information Engineering, Providence University, Taiwan R.O.C.
| | - Dariusz Mrozek
- Department of Applied Informatics, Silesian University of Technology.
| | - Yin-Te Tsai
- Computer Science and Communication Engineering, Providence University, Taiwan R.O. C.
| | - Chun-Hsien Lin
- Department of Ophthalmology, Taichung Veterans General Hospital, Taiwan R.O.C.
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Chua PY, Sandinha MT, Steel DH. Idiopathic epiretinal membrane: progression and timing of surgery. Eye (Lond) 2022; 36:495-503. [PMID: 34290446 PMCID: PMC9074182 DOI: 10.1038/s41433-021-01681-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 02/01/2023] Open
Abstract
Primary idiopathic epiretinal membrane (iERM) is a common finding, particularly so in the era of high street spectral-domain optical coherence tomography. Clinicians often face the dilemma of early versus delayed surgical intervention in the management of iERM with macular pucker, especially in those patients with good vision. The aim of this review is to assist clinicians in their understanding of the natural history of iERM to enable decision-making and optimally advising patients. We systematically searched the Medline and EMBASE databases for relevant publications from 2001 onwards using defined search terms with pre-planned inclusion and exclusion criteria. In this article, we review the epidemiology of iERM, classifications, their effect on visual function, the natural history and factors predicting progression and finally, factors which might predict the visual outcome with surgery.
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Affiliation(s)
- Paul Y. Chua
- grid.415970.e0000 0004 0417 2395St. Paul’s Eye Unit, The Royal Liverpool University Hospital, Liverpool, UK
| | - Maria T. Sandinha
- grid.415970.e0000 0004 0417 2395St. Paul’s Eye Unit, The Royal Liverpool University Hospital, Liverpool, UK ,grid.10025.360000 0004 1936 8470Department of Eye and Vision Science, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
| | - David H. Steel
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Science, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK ,grid.419700.b0000 0004 0399 9171Sunderland Eye Infirmary, Sunderland, Sunderland, UK ,grid.1006.70000 0001 0462 7212Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
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4
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Mandelcorn ED, Al‐Falah M, Zhao LD, Kertes P, Devenyi R, Lam W. A prospective randomized clinical trial comparing nepafenac, intravitreal triamcinolone and no adjuvant therapy for epiretinal membrane. Acta Ophthalmol 2022; 100:e297-e303. [PMID: 33847066 DOI: 10.1111/aos.14873] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post-operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA). METHODS Design: Prospective randomized clinical trial Setting: Multi-centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post-operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best-corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post-operation. RESULTS Although all three groups showed reduction in macular thickness post-operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 μm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post-operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1-month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post-operation (2.72 and 1.58 mmHg, respectively). CONCLUSION Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post-vitrectomy ERM surgery.
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Affiliation(s)
- Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Mohammed Al‐Falah
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
- College of Medicine King Faisal University Al‐Ahsa Saudi Arabia
| | - Lei Di Zhao
- Division of Ophthalmology McMaster University Hamilton ON Canada
| | - Peter Kertes
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
- The John and Liz Tory Eye Centre Sunnybrook Health Sciences Centre Toronto ON Canada
| | - Robert Devenyi
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Wai‐Ching Lam
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
- Department of Ophthalmology University of Hong Kong Hong Kong Hong Kong
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Kim DI, Kim BH, Bae KW, Park UC. Comparison of surgical outcomes after removal of epiretinal membrane associated with retinal break and idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2022; 260:2121-2128. [PMID: 35029729 DOI: 10.1007/s00417-021-05550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/14/2021] [Accepted: 12/31/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To compare the surgical outcomes of epiretinal membranes (ERMs) associated with retinal break and idiopathic ERMs. METHODS This retrospective study included patients with an idiopathic ERM or an ERM associated with retinal break, who were followed up for ≥ 6 months after ERM removal. The postoperative functional and anatomical outcomes were compared between the groups. RESULTS A total of 160 and 38 eyes (198 patients) were in the idiopathic and retinal break groups, respectively. There was no significant difference in the baseline anatomical and functional parameters between the groups. At 6 months after surgery and at the final follow-up, best-corrected visual acuity, central foveal thickness, and ectopic inner foveal layer improved significantly in both groups, but there was no significant difference between the groups. In latter 49.0% of patients, tests for metamorphopsia and aniseikonia were performed. There was a significant improvement in the scores of metamorphopsia (0.40 ± 0.38 to 0.27 ± 0.28; p < 0.001) and aniseikonia (6.07 ± 4.46 to 4.11 ± 3.52; p < 0.001) in the idiopathic group at 6 months after surgery, but not in the retinal break group. The idiopathic group had significantly greater circularity of ERM extent compared to the retinal break group (p = 0.025). CONCLUSION Visual and anatomical improvements after removal of ERMs associated with retinal break and idiopathic ERMs were comparable. However, metamorphopsia and aniseikonia improved only after removal of idiopathic ERMs.
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Affiliation(s)
- Dong Ik Kim
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea
| | - Bo Hee Kim
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea
| | - Ki Woong Bae
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea
| | - Un Chul Park
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea.
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Kim BH, Kim DI, Bae KW, Park UC. Influence of postoperative ectopic inner foveal layer on visual function after removal of idiopathic epiretinal membrane. PLoS One 2021; 16:e0259388. [PMID: 34735519 PMCID: PMC8568108 DOI: 10.1371/journal.pone.0259388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To investigate the functional and anatomical parameters and their postoperative changes according to the ectopic inner foveal layer (EIFL) staging scheme for idiopathic epiretinal membrane (ERM). Methods In this prospective study, patients with idiopathic ERM underwent pars plana vitrectomy and ERM removal, and were followed-up for 6 months. The associations of EIFL with pre- and postoperative functional and anatomical parameters were analyzed. Results A total of 84 eyes (84 patients) were included: 39 (46.4%), 33 (39.3%), and 12 (14.3%) as EIFL stages 2, 3, and 4, respectively. At 6 months after surgery, the mean best-corrected visual acuity (BCVA) significantly improved in all EIFL stages (P ≤ 0.003); however, metamorphopsia improved only in eyes with EIFL stage 2 (P = 0.039) and 3 (P = 0.011). The aniseikonia and foveal avascular zone (FAZ) area showed no significant postoperative changes in any of the EIFL stages. Both preoperatively and during 6 months after surgery, the EIFL stage showed a significant correlation with BCVA (P ≤ 0.033), metamorphopsia (P ≤ 0.008), central macular thickness (P < 0.001), and FAZ parameters (P ≤ 0.016) at each time point, but not with aniseikonia. Significant correlations of EIFL thickness with BCVA (P = 0.028) and metamorphopsia (P = 0.006) before surgery were not persistent after surgery. Conclusion Both pre- and postoperatively, the staging of EIFL, rather than its thickness, is a simple and adequate surrogate marker for visual acuity and metamorphopsia in eyes with idiopathic ERM.
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Affiliation(s)
- Bo Hee Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ik Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Woong Bae
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Un Chul Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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7
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Khateb S, Aweidah H, Halpert M, Jaouni T. Postoperative Macular Proliferative Vitreoretinopathy: A Case Series and Literature Review. Case Rep Ophthalmol 2021; 12:464-472. [PMID: 34177543 PMCID: PMC8215993 DOI: 10.1159/000512285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/10/2020] [Indexed: 12/02/2022] Open
Abstract
Premacular membranes developing following pars plana vitrectomy (PPV) can cause significant anatomical and functional deficits to the macula. Recent reports showed that postoperative premacular membranes are a localized presentation of macular proliferative vitreoretinopathy (mPVR). Here, we report retrospectively a case series of 5 patients with severe mPVR which developed following uneventful PPV and were followed up to 32 months in the Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, between October 2016 and February 2020. All patients underwent primary repair of rhegmatogenous retinal detachment (RRD) before mPVR developed. Mean best-corrected visual acuity (BCVA) at presentation was 20/76 Snellen (0.58 LogMAR). Median duration of the retinal detachment time until surgery was 1.5 days (range 1–21 days). Mean interval time from last normal follow-up exam to diagnosis of mPVR was 19 days (range 10–28). BCVA dropped from a mean of 20/38 Snellen (0.28 LogMAR) prior to mPVR development to 20/166 Snellen (0.92 LogMAR) following its development, recovering to 20/57 Snellen (0.45 LogMAR) after peeling of membranes. Mean central macular thickness measured by optical coherence tomography decreased from 711 to 354 μm postsurgery. In conclusion, short-term mPVR is a different entity from macular pucker in terms of rapid development, structural distortion, and visual compromise. Surgical treatment significantly restores macular function and anatomy.
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Affiliation(s)
- Samer Khateb
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hamzah Aweidah
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michael Halpert
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tareq Jaouni
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Fung AT, Galvin J, Tran T. Epiretinal membrane: A review. Clin Exp Ophthalmol 2021; 49:289-308. [PMID: 33656784 DOI: 10.1111/ceo.13914] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Abstract
The prevalence of epiretinal membrane (ERM) is 7% to 11.8%, with increasing age being the most important risk factor. Although most ERM is idiopathic, common secondary causes include cataract surgery, retinal vascular disease, uveitis and retinal tears. The myofibroblastic pre-retinal cells are thought to transdifferentiate from glial and retinal pigment epithelial cells that reach the retinal surface via defects in the internal limiting membrane (ILM) or from the vitreous cavity. Grading schemes have evolved from clinical signs to ocular coherence tomography (OCT) based classification with associated features such as the cotton ball sign. Features predictive of better prognosis include absence of ectopic inner foveal layers, cystoid macular oedema, acquired vitelliform lesions and ellipsoid and cone outer segment termination defects. OCT-angiography shows reduced size of the foveal avascular zone. Vitrectomy with membrane peeling remains the mainstay of treatment for symptomatic ERMs. Additional ILM peeling reduces recurrence but is associated with anatomical changes including inner retinal dimpling.
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Affiliation(s)
- Adrian T Fung
- Westmead Clinical School, Discipline of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, Central Clinical School, Discipline of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Justin Galvin
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tuan Tran
- Save Sight Institute, Central Clinical School, Discipline of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia
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Angulation of the inner nuclear layer as an indicator of the severity of macular pseudohole. Graefes Arch Clin Exp Ophthalmol 2020; 259:69-79. [DOI: 10.1007/s00417-020-04822-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/20/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
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Schuster AK, Kluck A, Korb CA, Stoffelns B, Nickels S, Schulz A, Münzel T, Wild PS, Beutel ME, Schmidtmann I, Lackner KJ, Peto T, Pfeiffer N. Characteristics and pathologies of the vitreo-macular interface-results from the Gutenberg Health Study. Acta Ophthalmol 2020; 98:e273-e281. [PMID: 31680456 DOI: 10.1111/aos.14285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to determine the prevalence of characteristics and pathologies of the vitreo-macular interface within the general population. METHODS The Gutenberg Health Study is a population-based study in Germany, including an ophthalmological examination with refraction, biometry and optical coherence tomography (OCT) imaging. Characteristics of the vitreo-macular interface were graded on volume scans including visibility of an epiretinal membrane, full-thickness macular hole, lamellar hole and pseudohole. Overall and age-specific prevalences including 95% confidence intervals [95%-CI] were calculated. Association analyses were conducted to determine systemic and ocular factors that are associated with epiretinal membranes (the most common pathology) using multivariable logistic regression. RESULTS A total of 1890 people aged 40-80 years were included in the study. Of these, 4.7% (95%-CI: 3.8%-5.8%) had an epiretinal membrane in at least one eye, 0.1% a full-thickness macular hole, 0.6% a lamellar hole and 0.6% a pseudohole. The presence of an epiretinal membrane was associated with higher age, myopic refractive error and prior retinal laser therapy, but not with gender, body height, body weight, smoking, prior cataract surgery or intraocular pressure. CONCLUSIONS Epiretinal membranes are more frequent in older and myopic subjects and in those with prior retinal laser therapy.
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Affiliation(s)
| | - Anne‐Kristin Kluck
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Christina A. Korb
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Bernhard Stoffelns
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Stefan Nickels
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine Center for Cardiology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Thomas Münzel
- Center for Cardiology I University Medical Center Mainz Mainz Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine Center for Cardiology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
- Center for Thrombosis and Hemostasis University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
- DZHK (German Center for Cardiovascular Research), partner site Rhine‐Main Mainz Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy University Medical Center Mainz Mainz Germany
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine University Medical Center Mainz Mainz Germany
| | - Tunde Peto
- Centre for Public Health Queen's University Belfast Northern Ireland UK
| | - Norbert Pfeiffer
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
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Maitra P, Kumar DA, Agarwal A. Epiretinal membrane profile on spectral domain optical coherence tomography in patients with uveitis. Indian J Ophthalmol 2019; 67:376-381. [PMID: 30777956 PMCID: PMC6407406 DOI: 10.4103/ijo.ijo_650_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose: To study the epiretinal membrane (ERM) profile on the spectral-domain optical coherence tomography (SDOCT) in eyes with uveitis. Methods: In this prospective observational study, macula of uveitic eyes were evaluated by SDOCT (Cirrus, model 5000) for ERM. ERM was quantified (in microns) and were followed up along with the best-corrected visual acuity (BCVA) and treatment profile for 1 year. ERM morphology (focal, global, or mixed) and characteristics (thickness at fovea, maximum thickness, and location of maximum thickness in relation to fovea) were documented. Changes in altered foveal contour, cystoid macular edema (CME), and central foveal thickness were also noted. BCVA was noted when the inflammation subsided and it was correlated to specific ERM characteristics. SDOCT characteristics were compared in three treatment groups (no oral steroids, oral steroids with, and without immunomodulators). Results: Thirty-four eyes of 25 patients were evaluated. Mean logMAR BCVA decreased from 0.25 to 0.35 (P = 0.005). Foveal involvement with ERM (P = 0.011), lost foveal contour (P = 0.043), and ellipsoid layer disruption (P = 0.017) were associated significantly with reduced BCVA. Focal attachment of ERM was more commonly associated with CME (P = 0.03). Median ERM thickness showed significant increase (P < 0.001). Significant ERM progression from parafoveal to foveal (P = 0.02), significant progression of the thickest area of ERM closer to fovea (P = 0.0006) indicated a strong tendency of foveal involvement and this was correlated with worse BCVA (P = 0.009, r = −0.44) Oral steroids/immunomodulators showed no significant benefit on ERM progression. Conclusion: ERM progression in uveitis has a tendency to involve the fovea and is associated with significant vision loss, particularly in foveal ERM, focal attachment, and IS-OS disruption. Oral steroids and immunomodulators have no role in halting progression.
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Affiliation(s)
- Puja Maitra
- Department of Uvea and Oncology Services, Dr Agarwal's Eye Hospital, 19 Cathedral Road, Chennai, Tamil Nadu, India
| | - Dhivya Ashok Kumar
- Department of Uvea and Oncology Services, Dr Agarwal's Eye Hospital, 19 Cathedral Road, Chennai, Tamil Nadu, India
| | - Amar Agarwal
- Department of Uvea and Oncology Services, Dr Agarwal's Eye Hospital, 19 Cathedral Road, Chennai, Tamil Nadu, India
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CORRELATION BETWEEN OUTER RETINAL THICKENING AND RETINAL FUNCTION IMPAIRMENT IN PATIENTS WITH IDIOPATHIC EPIRETINAL MEMBRANES. Retina 2019; 39:331-338. [DOI: 10.1097/iae.0000000000001971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Vogt D, Vielmuth F, Wertheimer C, Hagenau F, Guenther SR, Wolf A, Spindler V, Priglinger SG, Schumann RG. Premacular membranes in tissue culture. Graefes Arch Clin Exp Ophthalmol 2018; 256:1589-1597. [PMID: 29931427 DOI: 10.1007/s00417-018-4033-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/04/2018] [Accepted: 05/31/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To investigate integrity and characteristics of human premacular membranes (PMM) with and without standard tissue culturing using mechanical traction. METHODS Premacular membranes were harvested from 32 eyes of 32 patients with idiopathic macular pucker during standard vitrectomy. By flat-mount preparation with phase contrast and interference microscopy, specimens were prepared for time-lapse microscopy, immunocytochemistry, and transmission electron microscopy. Sixteen of 32 specimens were held in tissue culture with tangential traction by using entomological pins. Of these, specimens of 7 eyes were analyzed with and without tissue culturing for comparison. Primary antibodies were used for myofibroblasts, hyalocytes, macro-/microglial cells, and retinal pigment epithelial and immune cells. RESULTS Hyalocytes, macroglia, and microglia composed the main cell composition of surgically removed PMM. Correlation of time-lapse microscopy with immunofluorescence microscopy identified fast and unidirectional moving small round cells as microglia. Slowly moving elongated large cells were characterized as alpha-smooth muscle actin (α-SMA)-positive myofibroblasts. Following tissue culturing with tangential stretch, enhanced positive immunolabelling for α-SMA and integrins-αv was seen. All other labelling results were demonstrated to be similar with pre-culture conditions. Ultrastructural analysis revealed fibroblasts, myofibroblasts, and proliferation of glial cells following tissue culture. CONCLUSION This study demonstrates abundance of fibroblasts, myofibroblasts, and glial cells in PMM from idiopathic macular pucker following tissue culture with tangential stretch application. We found enhanced contractive properties of the cultured PPM that appear to indicate transdifferentiation of the cell composition. This in vitro model may improve understanding of pathogenesis in traction maculopathies and help to establish further anti-fibrosis treatment strategies.
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Affiliation(s)
- Denise Vogt
- Department of Ophthalmology, Vitreoretinal Pathology Unit, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany.
| | - Franziska Vielmuth
- Institute of Anatomy and Cell Biology, Department I, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Wertheimer
- Department of Ophthalmology, Vitreoretinal Pathology Unit, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Felix Hagenau
- Department of Ophthalmology, Vitreoretinal Pathology Unit, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Stefanie R Guenther
- Department of Ophthalmology, Vitreoretinal Pathology Unit, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, Vitreoretinal Pathology Unit, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Volker Spindler
- Institute of Anatomy and Cell Biology, Department I, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Vitreoretinal Pathology Unit, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Ricarda G Schumann
- Department of Ophthalmology, Vitreoretinal Pathology Unit, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
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Doguizi S, Sekeroglu MA, Ozkoyuncu D, Omay AE, Yilmazbas P. Clinical significance of ectopic inner foveal layers in patients with idiopathic epiretinal membranes. Eye (Lond) 2018; 32:1652-1660. [PMID: 29934636 DOI: 10.1038/s41433-018-0153-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/06/2018] [Accepted: 05/12/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/OBJECTIVES To evaluate the relationship between the presence of ectopic inner foveal layers (EIFL), choroidal thickness, and visual acuity (VA) in patients with epiretinal membranes (ERM) staged by spectral-domain optical coherence tomography (SD-OCT). SUBJECTS/METHODS A total of 242 eyes of 121 patients with unilateral idiopathic ERM were prospectively evaluated. ERM stages were defined based on the SD-OCT staging system as stage 1: negligible morphological or anatomical disruption, retinal layers, and foveal pit are identified; stage 2: characteristic stretching of the outer nuclear layer, absence of foveal depression, retinal layers are identified; stage 3: continuous EIFL crossing the central foveal area, absence of foveal depression, retinal layers are identified; and stage 4: anatomical disruption of the fovea, continuous EIFL crossing the entire foveal area, retinal layers are distorted. RESULTS Of 121 eyes with ERM, 23.1% had stage 1, 26.5% had stage 2, 39.7% had stage 3, and 10.7% had stage 4 disease. VA was better in eyes with stage 1 or 2 ERM than stage 3 or 4 ERM (p < 0.001). VA in logMAR was positively correlated with central foveal thickness (r = 0.557, p < 0.001) and EIFL thickness (r = 0.526, p < 0.001), but not with an outer nuclear layer thickness (r = 0.233, p = 0.123). In multivariate analysis, the presence of EIFL was an independent predictor of VA in eyes with ERM (p < 0.001). The presence and stage of ERM did not have a significant effect on choroidal thickness (p > 0.05). CONCLUSIONS The SD-OCT staging system according to the presence of EIFL is effective for grading retinal damage and visual loss in eyes with ERM.
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Affiliation(s)
- Sibel Doguizi
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.
| | - Mehmet Ali Sekeroglu
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Dilara Ozkoyuncu
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Aslihan Esra Omay
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pelin Yilmazbas
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Vieira L, Cabugueira A, Borges B, Carvalho V, Noronha M, Abegão Pinto L, Reina M, Dutra Medeiros M. Secondary Epiretinal Membrane After Trabeculectomy. J Glaucoma 2017; 25:e576-80. [PMID: 26398580 DOI: 10.1097/ijg.0000000000000326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the frequency of epiretinal membranes (ERM) in eyes with primary open-angle glaucoma subjected to trabeculectomy. METHODS We conducted a retrospective study on patients subjected to trabeculectomy with at least a 6-month follow-up. Ophthalmologic examination and spectral-domain optical coherence tomography (SD-OCT) were analyzed. Eyes with previous surgical or laser treatments or other pathologies (other than glaucoma and ERM) were excluded. RESULTS A total of 50 eyes (40 patients) were included in this study. The mean follow-up time after surgery was 27.8 months. After surgery, 9 eyes (18%) had preretinal macular fibrosis and 19 eyes (38%) had cellophane macular reflex. Of the 16 eyes with a preoperative macular SD-OCT, 3 (18.8%) developed ERM and 4 (25%) progressed from cellophane macular reflex to preretinal macular fibrosis, after surgery. The ERM frequency did not differ significantly between eyes subjected to trabeculectomy with or without the use of antimetabolites (P=0.08), or between eyes subjected to simple or combined surgery (phacotrabeculectomy) (P=0.09). CONCLUSION Trabeculectomy may predispose one to the appearance and progression of ERM. Further studies are needed to clarify this intriguing relation.
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Affiliation(s)
- Luísa Vieira
- *Department of Ophthalmology, Central Lisbon Hospital Center †Institute of Pharmacology and Neurosciences, Faculty of Medicine, University of Lisbon ‡NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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16
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Wertheimer C, Eibl-Lindner KH, Compera D, Kueres A, Wolf A, Docheva D, Priglinger SG, Priglinger C, Schumann RG. A cell culture technique for human epiretinal membranes to describe cell behavior and membrane contraction in vitro. Graefes Arch Clin Exp Ophthalmol 2017; 255:2147-2155. [DOI: 10.1007/s00417-017-3767-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/08/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022] Open
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Nelis P, Alten F, Clemens CR, Heiduschka P, Eter N. Quantification of changes in foveal capillary architecture caused by idiopathic epiretinal membrane using OCT angiography. Graefes Arch Clin Exp Ophthalmol 2017; 255:1319-1324. [DOI: 10.1007/s00417-017-3640-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 12/20/2022] Open
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18
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Tranos P, Wickham L, Dervenis N, Vakalis A, Asteriades S, Stavrakas P. The role of membrane-inner retina adherence in predicting simultaneous internal limiting membrane peeling during idiopathic epiretinal membrane surgery. Eye (Lond) 2016; 31:636-642. [PMID: 28009345 DOI: 10.1038/eye.2016.285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 11/07/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo correlate the frequency and extent of simultaneous inadvertent internal limiting membrane (ILM) peeling during idiopathic epiretinal membrane (ERM) removal with characteristics of ERM adherence demonstrated on pre-operative spectral domain optical coherence tomography (SD-OCT).Patients and methodsThis is a prospective, observational, case series of patients undergoing pars plana vitrectomy for idiopathic ERM. Inner retina-ERM adhesion was categorized as focal, broad or complete in five anatomic locations at macular area based on preoperative SD-OCT findings. The extent of spontaneous ILM peeling was quantified on a scale 0-100% in each of the aforementioned anatomic locations by the operating surgeons who were masked to the OCT characteristics. All operations were recorded with a high definition recording system and the area of simultaneous ILM peel was quantified by a second masked observer. The final extent of spontaneous ILM peel was calculated as the average of the two scores.ResultsThirty consecutive subjects who underwent surgery for idiopathic ERM were included in the study. Evidence of simultaneous ILM peeling was identified in 80.3% of individuals. With regards to the type of ERM-macula adhesion, inadvertent ILM peel was observed in 70% of the patients who pre-operatively showed complete adhesion, in 43% with broad adhesion and in only 21% with focal adhesion (P<0.001). The extent of the spontaneous ILM peel during removal of ERM was also significantly dependent on the type of ERM-inner retina adhesion. Total simultaneous ILM peel was observed in 59% of locations with complete ERM-macula adhesion but only in 22% and 7% of locations with broad and focal adhesion respectively (P<0.001).ConclusionsSimultaneous ILM peel is a frequent occurrence during ERM surgery, especially when there is complete or broad ERM adherence to the macula. The type of ERM-inner retina adhesion represents a valid predictor of the extent of simultaneous ILM peel during removal of ERM. Thorough evaluation of preoperative OCT may be a useful tool in determining a safer, more simplistic strategy in ERM surgery.
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Affiliation(s)
- P Tranos
- Ophthalmica Eye Institute, Thessaloniki, Greece
| | | | - N Dervenis
- Ophthalmica Eye Institute, Thessaloniki, Greece
| | - A Vakalis
- Ophthalmica Eye Institute, Thessaloniki, Greece
| | | | - P Stavrakas
- Attikon University Hospital, 2nd Department of Ophthalmology, University of Athens Medical School, Athens, Greece
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Pomytkina NV, Sorokin EL. [Study of vitreomacular interface in patients with pseudophakia by means of spectral optical coherence tomography]. Vestn Oftalmol 2016; 132:43-47. [PMID: 27600894 DOI: 10.17116/oftalma2016132443-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM to investigate the state of vitreomacular interface in pseudophakic patients by means of spectral optical coherence tomography (OCT). MATERIAL AND METHODS Spectral OCT of the macular region was performed in 58 pseudophakic eyes that underwent laser treatment for secondary cataract, 28 newly pseudophakic eyes (day 1 after cataract phacoemulsification with IOL implantation), and 40 eyes with early senile cataract. RESULTS A higher incidence of subclinical fibrosis of the internal limiting membrane was noted in pseudophakic patients after YAG laser surgery for secondary cataract as compared to cataract patients and those right after cataract phacoemulsification. CONCLUSION Fibrosis of the internal limiting membrane significantly more often develops in the late period after cataract extraction as compared to patients with early senile cataract and those who have just underwent phacoemulsification surgery. Fibrosis of the internal limiting membrane arising in the late period after cataract extraction cannot be unambiguously attributed to either primary or secondary. The resolution of spectral OCT is high enough to allow detection of preclinical ultrastructural changes in the vitreomacular interface.
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Affiliation(s)
- N V Pomytkina
- Khabarovsk branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 211 Tikhookeanskaya St., Khabarovsk, Russian Federation, 680033
| | - E L Sorokin
- Khabarovsk branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 211 Tikhookeanskaya St., Khabarovsk, Russian Federation, 680033; Far Eastern State Medical University, 35 Muravyeva-Amurskogo St., Khabarovsk, Russian Federation, 680000
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20
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Stevenson W, Prospero Ponce CM, Agarwal DR, Gelman R, Christoforidis JB. Epiretinal membrane: optical coherence tomography-based diagnosis and classification. Clin Ophthalmol 2016; 10:527-34. [PMID: 27099458 PMCID: PMC4820189 DOI: 10.2147/opth.s97722] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Epiretinal membrane (ERM) is a disorder of the vitreomacular interface characterized by symptoms of decreased visual acuity and metamorphopsia. The diagnosis and classification of ERM has traditionally been based on clinical examination findings. However, modern optical coherence tomography (OCT) has proven to be more sensitive than clinical examination for the diagnosis of ERM. Furthermore, OCT-derived findings, such as central foveal thickness and inner segment ellipsoid band integrity, have shown clinical relevance in the setting of ERM. To date, no OCT-based ERM classification scheme has been widely accepted for use in clinical practice and investigation. Herein, we review the pathogenesis, diagnosis, and classification of ERMs and propose an OCT-based ERM classification system.
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Affiliation(s)
- William Stevenson
- Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | | | - Daniel R Agarwal
- Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
| | - Rachel Gelman
- Department of Ophthalmology, University of Arizona Medical Center, Tucson, AZ, USA
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21
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Ponomareva EN, Kazaryan AA. [Idiopathic epiretinal membranes: visual function impairment, morphological and functional features of retinal involvement]. Vestn Oftalmol 2016. [PMID: 28635827 DOI: 10.17116/oftalma2016132390-95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
By affecting different retinal layers, an idiopathic epiretinal membrane (iERM) produces changes in macular architectonics and functioning. Morphological and functional assessment of these patients using modern visualization methods and electroretinography contributes to a better understanding of pathogenetic mechanisms of iERM.
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Affiliation(s)
- E N Ponomareva
- Federal Research and Clinical Center, Federal Medical and Biological Agency of Russia, 28 Orehovyy bul'var, Moscow, Russian Federation, 115682
| | - A A Kazaryan
- Federal Research and Clinical Center, Federal Medical and Biological Agency of Russia, 28 Orehovyy bul'var, Moscow, Russian Federation, 115682
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Romano MR, Comune C, Ferrara M, Cennamo G, De Cillà S, Toto L, Cennamo G. Retinal Changes Induced by Epiretinal Tangential Forces. J Ophthalmol 2015; 2015:372564. [PMID: 26421183 PMCID: PMC4573429 DOI: 10.1155/2015/372564] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 12/05/2022] Open
Abstract
Two kinds of forces are active in vitreoretinal traction diseases: tangential and anterior-posterior forces. However, tangential forces are less characterized and classified in literature compared to the anterior-posterior ones. Tangential epiretinal forces are mainly due to anomalous posterior vitreous detachment (PVD), vitreoschisis, vitreopapillary adhesion (VPA), and epiretinal membranes (ERMs). Anomalous PVD plays a key role in the formation of the tangential vectorial forces on the retinal surface as consequence of gel liquefaction (synchysis) without sufficient and fast vitreous dehiscence at the vitreoretinal interface. The anomalous and persistent adherence of the posterior hyaloid to the retina can lead to vitreomacular/vitreopapillary adhesion or to a formation of avascular fibrocellular tissue (ERM) resulting from the proliferation and transdifferentiation of hyalocytes resident in the cortical vitreous remnants after vitreoschisis. The right interpretation of the forces involved in the epiretinal tangential tractions helps in a better definition of diagnosis, progression, prognosis, and surgical outcomes of vitreomacular interfaces.
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Affiliation(s)
- Mario R. Romano
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, University Federico II, Napoli, Italy
| | - Chiara Comune
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, University Federico II, Napoli, Italy
| | - Mariantonia Ferrara
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, University Federico II, Napoli, Italy
| | - Gilda Cennamo
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, University Federico II, Napoli, Italy
| | - Stefano De Cillà
- Azienda Ospedaliero-Universitaria “Maggiore della Carità” di Novara, 28100 Novara, Italy
| | - Lisa Toto
- Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Giovanni Cennamo
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, University Federico II, Napoli, Italy
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Byon IS, Pak GY, Kwon HJ, Kim KH, Park SW, Lee JE. Natural History of Idiopathic Epiretinal Membrane in Eyes with Good Vision Assessed by Spectral-Domain Optical Coherence Tomography. Ophthalmologica 2015; 234:91-100. [DOI: 10.1159/000437058] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/18/2015] [Indexed: 11/19/2022]
Abstract
Purpose: To investigate the natural history of idiopathic epiretinal membrane (ERM) in eyes with good visual function using optical coherence tomography (OCT). Methods: Sixty-two eyes of 58 patients with idiopathic ERM, visual acuity of 20/40 or better, and no significant metamorphopsia were included. The best corrected visual acuity (BCVA), central macular thickness (CMT), membrane configuration, and ellipsoid zone signal data over 24 months were retrospectively analyzed. Based on OCT findings, ERM configurations were categorized as global attachment (GA), partial attachment (PA), pseudohole, and vitreomacular traction (VMT). Results: The mean BCVA and CMT did not change significantly between baseline and 24 months. GA, PA, pseudohole, and VMT types were observed in 33, 19, 9, and 1 eye at baseline, and in 20, 22, 10, and 1 eye at 24 months, respectively. A membrane configuration change was noted in 24 eyes (38.7%) during follow-up, and the distribution shifted from GA to the other types (p < 0.001). Six eyes had visual loss due to membrane progression, and 4 eyes had spontaneous membrane separation. Of the 10 eyes with progression or separation, 6 were of the PA type. Conclusions: Although the BCVA remains stable over 2 years in most idiopathic ERM eyes with good visual function at baseline, the membrane configuration may change, affecting visual acuity. The GA type would be an early stage, and the PA type is prone to changes in visual acuity.
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Fang IM, Hsu CC, Chen LL. Correlation between visual acuity changes and optical coherence tomography morphological findings in idiopathic epiretinal membranes. Graefes Arch Clin Exp Ophthalmol 2015; 254:437-44. [DOI: 10.1007/s00417-015-3069-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/05/2015] [Accepted: 05/15/2015] [Indexed: 11/28/2022] Open
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Comparison of morphologic features of macular proliferative vitreoretinopathy and idiopathic epimacular membrane. Retina 2014; 34:1651-7. [PMID: 24736464 DOI: 10.1097/iae.0000000000000138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND To compare the spectral-domain optical coherence tomography morphologic features and visual characteristics of a series of patients with epimacular membrane with and without a history of retinal breaks. METHODS Prospective, comparative case series of patients with epimacular membrane. All patients were evaluated with spectral-domain optical coherence tomography and detailed peripheral retinal examination. Symptomatic patients were treated with pars plana vitrectomy and epimacular membrane removal based on standard visual criteria. RESULTS Macular proliferative vitreoretinopathy was present in 21 of 50 patients (42%). Approximately 18 of 21 patients had a previous retinal break, 5 of which were untreated before the initial examination. No retinal breaks were observed in the idiopathic group. Macular proliferative vitreoretinopathy was highly associated with a history of retinal breaks (P < 0.001). Presenting visual acuity was significantly worse (mean, 0.86 ± 0.44) for macular proliferative vitreoretinopathy than for the idiopathic group (mean, 0.44 ± 0.36). CONCLUSION Epimacular membrane occurring in the context of previous retinal breaks or macular proliferative vitreoretinopathy has a characteristic morphologic feature in spectral-domain optical coherence tomography. Surgical removal typically results in significant visual improvement.
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Lie S, Falkner-Radler CI, Binder S. The course of lamellar macular holes: assessment by Cirrus and Stratus OCT. SPEKTRUM DER AUGENHEILKUNDE 2014. [DOI: 10.1007/s00717-014-0225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kang HM, Koh HJ, Lee SC. Visual outcome and prognostic factors after surgery for a secondary epiretinal membrane associated with branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2014; 253:543-50. [PMID: 25038909 DOI: 10.1007/s00417-014-2731-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/25/2014] [Accepted: 07/01/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the visual outcome and prognostic factors after surgery for a secondary epiretinal membrane (ERM) due to branch retinal vein occlusion (BRVO). METHODS Medical records of 33 patients (33 eyes) were retrospectively reviewed. All patients underwent vitrectomy and completed at least one year of follow-up. Patients characteristics, including baseline best-corrected visual acuity (BCVA; logMAR, logarithm of the minimum angle resolution), fluorescein angiography and optical coherence tomography findings were analyzed. RESULTS Twenty eyes (60.6%) were non-ischemic and nine eyes (27.3%) had ischemic maculopathy. The mean BCVA was 0.82 ±0.56 logMAR (20/132 Snellen equivalent) at baseline and 0.43 ±0.37 logMAR (20/53 Snellen equivalent) at 1 year (p = 0.001). At 1 year three eyes (9.1%) had visual loss with 0.3 logMAR or more deterioration than baseline whereas 16 eyes (48.5%) gained vision. The mean central macular thickness (CMT) was 407.3 ±138.8 μm at baseline and 274.71 ±40.5 μm at 1 year after surgery (p = 0.001). Photoreceptor integrity was intact in 20 eyes (60.6%). Photoreceptor integrity (B = 0.248, p = 0.001) at baseline was significantly correlated with visual outcome after surgery. CONCLUSION Surgery for a secondary ERM associated with BRVO led to a relatively favorable visual outcome. The integrity of photoreceptors at baseline seems to be useful in predicting visual outcome in these patients.
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Affiliation(s)
- Hae Min Kang
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim YW, Jeoung JW, Yu HG. Vitreopapillary traction in eyes with idiopathic epiretinal membrane: a spectral-domain optical coherence tomography study. Ophthalmology 2014; 121:1976-82. [PMID: 24880904 DOI: 10.1016/j.ophtha.2014.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/10/2014] [Accepted: 04/15/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the prevalence of vitreopapillary traction (VPT) and its effect on peripapillary structure and visual function in eyes with idiopathic epiretinal membrane (ERM). DESIGN Observational, comparative study. PARTICIPANTS Patients with idiopathic ERM (n = 116 eyes) and controls with similar age (n = 62 eyes). METHODS Spectral domain optical coherence tomography (SD-OCT) axial optic disc scans were evaluated to identify VPT in eyes with idiopathic ERM. Based on VPT presence/absence, eyes were categorized as ERM with VPT (ERM+VPT, n = 52 eyes) or ERM without VPT (ERM-VPT, n = 64 eyes). Optic nerve head (ONH) parameters, average and sectoral retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) were compared between groups. Best-corrected visual acuity (BCVA) and visual field (VF) (automated Humphrey central 30-2 perimetry) mean deviation (MD) and pattern standard deviation (PSD) were compared between groups. MAIN OUTCOME MEASURES The ONH parameters, peripapillary RNFL thickness, BCVA, VF MD, and PSD. RESULTS Fifty-two of 116 eyes (44.8%) with idiopathic ERM had VPT. The ERM+VPT group had larger rim area, smaller average and vertical cup-to-disc ratios, and smaller cup volume than ERM-VPT and normal groups (all P < 0.001). Eyes with VPT had greater CMT than eyes without VPT (421.87±97.31 μm vs. 377.08±75.1 μm; P = 0.006). Average and temporal RNFL thickness was higher in ERM+VPT (98.64±9.33 μm and 93.90±23.42 μm) than in normal eyes (94.02±8.45 μm and 66.42±12.71 μm). No significant difference in BCVA was found between ERM-VPT and ERM+VPT eyes, but MD was lower in ERM+VPT than in ERM-VPT (-3.91±3.68 dB vs. -2.18±2.42 dB; P = 0.005). Additionally, PSD was greater in ERM+VPT. Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.190; P = 0.014) and increased CMT (OR, 1.013; P = 0.005) were associated with vision loss, whereas VPT presence was associated with VF defects (OR, 6.290; P = 0.024). CONCLUSIONS Vitreopapillary traction was observed in >40% of eyes with idiopathic ERM, as confirmed by SD-OCT imaging. Vitreopapillary traction with idiopathic ERM was associated with altered optic disc architecture, increased average and temporal RNFL thickness, and VF defects.
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Affiliation(s)
- Yong Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
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Oct-based interpretation of the vitreomacular interface and indications for pharmacologic vitreolysis. Retina 2014; 33:2003-11. [PMID: 23881226 DOI: 10.1097/iae.0b013e3182993ef8] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To review the role of optical coherence tomography (OCT) in diagnosis and management of vitreomacular disease and the impact of OCT on potential uses of ocriplasmin, a new pharmacologic vitreolysis agent recently approved by the U.S. Food and Drug Administration for the treatment of symptomatic vitreomacular adhesion. METHODS Analysis of current literature regarding OCT in diagnosis and management of vitreomacular interface disease. RESULTS Posterior vitreous detachment is typically a nonpathologic age-related event. Anomalous posterior vitreous detachment emerges when the vitreous cortex fails to cleanly detach from the macula, optic nerve, or other adherent sites. Focal vitreomacular adhesion is a nonpathologic anatomical designation associated with perifoveal posterior vitreous detachment but normal retinal morphology on OCT. Vitreomacular traction is a pathologic consequence of persistent vitreous attachment with structural disturbance of the macular retina visible on OCT. Full-thickness macular holes are foveal defects continuous through all retinal layers to the retinal pigment epithelium. Vitreomacular traction and macular hole with focal vitreomacular adhesion are indications for pharmacologic vitreolysis. CONCLUSION Noninvasive high-resolution OCT imaging has transformed the understanding of vitreomacular interface disease. Careful evaluation of the vitreomacular interface with OCT has increased in importance with the introduction of ocriplasmin for vitreomacular adhesion associated with symptomatic anatomical retinal changes.
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Spectral-domain optical coherence tomography evaluation of vitreoretinal adhesions in idiopathic epiretinal membranes. Graefes Arch Clin Exp Ophthalmol 2014; 252:1041-7. [PMID: 24384800 DOI: 10.1007/s00417-013-2546-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 10/14/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Vitreoretinal adhesions play a key role in the vector forces exerted on the vitreoretinal interface, leading to tractional retina deformation and macular hole formation. The aim of this study was to identify the presence of vitreopapillary and vitreofoveal adhesions in idiopathic epiretinal membranes (ERMs) with spectral-domain optical coherence tomography (SD-OCT) and to evaluate their influence on the vitreoretinal interface. METHODS Sixty-five eyes (65 patients) with idiopathic ERM and 64 healthy eyes (64 patients) underwent SD-OCT analysis. We studied vitreopapillary and vitreofoveal adhesion prevalence in eyes with idiopathic ERM using different SD-OCT patterns ("adherent" or "tractional"). We analyzed their influence on central foveal thickness (CFT), on retinal nerve fiber layer (RNFL) thickness, and on morphological modifications (foveal depression profile and inner/outer photoreceptor junction). RESULTS Vitreopapillary adhesion was present in 51.6 % of normal eyes and in 24.6 % of eyes with idiopathic ERM, while vitreofoveal adhesion was found in 14.1 % of normal eyes and in 15.4 % of eyes with ERM. Vitreopapillary adhesion prevalence was significantly higher in the tractional ERM subgroup (p = 0.01), than in the adherent ERM subgroup. Both adhesions had no influence on CFT, RNFL thickness, or inner segment/outer segment junction status. CONCLUSIONS Our study suggests that vitreoretinal adhesions may influence the pathogenesis and course of idiopathic ERM. The absence of vitreopapillary adhesion in the adherent type, and its presence in the tractional type, seems to play a key role in ERM characterization.
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Arevalo JF, Lasave AF, Arias JD, Serrano MA, Arevalo FA. Clinical applications of optical coherence tomography in the posterior pole: the 2011 José Manuel Espino Lecture - Part I. Clin Ophthalmol 2013; 7:2165-79. [PMID: 24235810 PMCID: PMC3825704 DOI: 10.2147/opth.s51098] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Optical coherence tomography (OCT) is now a standard of care in ophthalmology and is considered essential for the diagnosis and monitoring of many retinal diseases. One of the major advances obtained with OCT was the understanding of the pathophysiology of macular holes. Non-full-thickness macular holes have been revisited because high-resolution OCT images can detect a lamellar macular defect that is not always visible clinically, and surgery has been advocated by some authors. OCT can be valuable in determining the need for and/or timing of surgical intervention on epiretinal membranes or vitreomacular traction syndrome. In addition, we can use this technology as a predictive factor in the prognosis and follow-up of the most common posterior pole pathologies.
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Affiliation(s)
- J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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Brunner S, Binder S. Surgery for Proliferative Diabetic Retinopathy. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wickham L, Gregor Z. Epiretinal Membranes. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Seo SJ, Lee SJ, Park JM. Surgical Outcome According to Morphology in Epiretinal Membrane Based on Optical Coherence Tomography (OCT). JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.5.736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Jin Seo
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Soo Jung Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung Min Park
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
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Nazari H, Dustin L, Heussen FM, Sadda S, Rao NA. Morphometric spectral-domain optical coherence tomography features of epiretinal membrane correlate with visual acuity in patients with uveitis. Am J Ophthalmol 2012; 154:78-86.e1. [PMID: 22541930 DOI: 10.1016/j.ajo.2012.01.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify visually significant spectral-domain optical coherence tomography (SD-OCT) features of epiretinal membranes (ERM) in patients with uveitis. DESIGN Retrospective cohort and cross-sectional study. METHODS Eighty consecutive eyes with uveitis and SD-OCT-documented ERM were included. Clinical data were collected at the time of diagnosis of ERM and at the final visit. SD-OCT images at the last visit were evaluated to identify fovea and ERM configuration and structural changes. Changes of 10% and 20% in central subfield thickness between initial and last SD-OCT were calculated and correlated with visual acuity (VA). An ERM thickness map was created using validated SD-OCT grading software. RESULTS VA improved significantly in eyes with more than 12 months of follow-up (P = .03). Although inflammation activity and medical treatment methods were no different in eyes with more or less than 12 months of follow-up, 16 eyes in the subset with longer follow-up underwent cataract extraction and intraocular lens implantation. Kaplan-Meier analysis demonstrated few vision losses during the follow-up period. Change in central subfield thickness did not correlate with VA. Foveal center involvement (P < .001), focal attachment of the ERM (P = .003), and foveal inner segment and outer segment junction disruption (P = .006) were associated independently with lower VA. ERM was thinner in eyes with 20/40 or better VA (4.6 ± 0.6 μm) compared with eyes with VA of less than 20/200 (P = .02). Longer duration of ERM was associated with thicker ERM (P < .05). CONCLUSIONS In most eyes with uveitis and ERM, VA remains stable if ocular inflammation and comorbidities are addressed appropriately.
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Kim JS, Chhablani J, Chan CK, Cheng L, Kozak I, Hartmann K, Freeman WR. Retinal adherence and fibrillary surface changes correlate with surgical difficulty of epiretinal membrane removal. Am J Ophthalmol 2012; 153:692-7, 697.e1-2. [PMID: 22137206 DOI: 10.1016/j.ajo.2011.08.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 08/27/2011] [Accepted: 08/29/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To correlate surgical difficulty of epiretinal membrane (ERM) removal with characteristics of ERM adherence seen by spectral-domain optical coherence tomography (SD-OCT). DESIGN Prospective observational case series. METHODS Surgical difficulty was correlated with extent of ERM adherence by SD-OCT using masked observers in consecutive eyes undergoing ERM removal (N=31). Surgical videos were analyzed and difficulty of ERM removal (grade 1-3) was determined in 4 quadrants as well as the fovea by consensus of observers masked to SD-OCT findings. Extent of ERM adhesion was categorized (focal, broad, or complete) by masked observers using SD-OCT. The presence of fibrillary changes between the ERM and retinal nerve fiber layer (RNFL) was also evaluated. Surgical difficulty of ERM removal for each quadrant and fovea was compared to extent of ERM adherence and presence of fibrillary changes. RESULTS Assessment of ERM adherence using SD-OCT between masked observers was highly concordant (kappa=0.9178). Surgical difficulty of ERM removal was strongly associated with more extensive ERM adherence to the retina observed by SD-OCT. Complete ERM adherence correlated with an 8.6-fold increased surgical difficulty of ERM removal compared to focal adherence (P<.0001). The presence of fibrillary changes between the ERM and RNFL also correlated with a 25.5-fold increased difficulty of surgical removal compared to the absence of fibrillary changes (P<.0001). CONCLUSION Extent of ERM-retinal adhesion and presence of fibrillary changes determined by SD-OCT provide reliable preoperative assessment of surgical difficulty. Furthermore, SD-OCT analysis may help localize surgically advantageous coordinates to initiate ERM removal.
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Hajnajeeb B, Georgopoulos M, Sayegh R, Geitzenauer W, Schmidt-Erfurth U. The role of the optical coherence tomography in identifying shape and size of idiopathic epiretinal membranes. Br J Ophthalmol 2012; 96:867-71. [PMID: 22328818 PMCID: PMC3355339 DOI: 10.1136/bjophthalmol-2011-300629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Currently, the border of idiopathic epiretinal membranes (iERM) is outlined intraoperatively using vital dyes. Therefore, the authors set out to investigate the role of the preoperative retinal thickness map (RTM) of the optical coherence tomography (OCT) in identifying the shape and the size of the iERMs. Methods 15 eyes of 15 patients with iERM who underwent vitrectomy with indocyanine green-assisted membrane peeling were included in this study. The authors analysed the intraoperative fundus images and preoperative Cirrus HD-OCT to detect the shape and the size of the iERM as well as the shape and the size of each thickness-indicating colour (white, red, orange and yellow) on the RTM, respectively. The correlation of areas and morphologic characteristics between both groups was explored. Results Analysis of iERM morphologic characteristics (shape) showed a similarity between the iERM contour and the corresponding RTM in 13 cases (86.6%). Furthermore, retinal folds were found in six iERMs and in their corresponding RTMs. Analysis of iERM size (area) revealed a positive correlation between the iERM area and each studied coloured area in RTM. The most significant correlation was between iERM and the red area (440–480 μm; r=0.87, p<0.0001). Conclusion The iERM-related retinal folds are clearly distinguishable on the HD-OCT. The red area in RTM representing the 440–480 μm retinal thickness can be a reliable predictor of the extent and the shape of the iERM.
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Affiliation(s)
- Bilal Hajnajeeb
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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Yazici AT, Alagöz N, Celik HU, Bozkurt E, Alagöz C, Cakir M, Cekiç O, Yilmaz OF. Idiopathic and secondary epiretinal membranes: do they differ in terms of morphology? An optical coherence tomography-based study. Retina 2011; 31:779-84. [PMID: 21836405 DOI: 10.1097/iae.0b013e3181ef8786] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to define the morphologic differences in idiopathic and secondary epiretinal membranes (ERMs) using a time domain optical coherence tomography. METHODS The medical records and optical coherence tomography images of 293 eyes of 236 consecutive patients diagnosed to have ERM were evaluated retrospectively. Demographic features, best-corrected visual acuities, central macular thickness, membrane attachment patterns, macular changes, and the presence of posterior retinal detachment at the time of diagnosis were compared between the groups (idiopathic group, n = 125 eyes; secondary group, n = 168 eyes). RESULTS The mean age was higher among idiopathic ERMs (67 ± 9 vs. 62 ± 10 years, P = 0.001). In the secondary group, best-corrected visual acuity was estimated to be worse (P < 0.001) and central macular thickness higher (P = 0.02) than the idiopathic group. In both groups, ERMs were mostly diagnosed at Grade 1 level. Diffuse attachment was more common in both of the groups. Among macular changes, only cystoid macular degeneration differed significantly between the groups (P = 0.0001). CONCLUSION Idiopathic and secondary ERMs were estimated to differ significantly at the time of diagnosis in terms of age, visual acuities, macular thickness, presence of cystoid macular degeneration, and posterior vitreous detachment. These parameters may assist the retinal surgeon in the treatment process of ERM.
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Affiliation(s)
- Ahmet T Yazici
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey.
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Morphologic and functional association of retinal layers beneath the epiretinal membrane with spectral-domain optical coherence tomography in eyes without photoreceptor abnormality. Graefes Arch Clin Exp Ophthalmol 2011; 250:491-8. [DOI: 10.1007/s00417-011-1848-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/21/2011] [Accepted: 10/12/2011] [Indexed: 01/28/2023] Open
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Theodossiadis PG, Theodossiadis GP, Charonis A, Emfietzoglou I, Grigoropoulos VG, Liarakos VS. The photoreceptor layer as a prognostic factor for visual acuity in the secondary epiretinal membrane after retinal detachment surgery: imaging analysis by spectral-domain optical coherence tomography. Am J Ophthalmol 2011; 151:973-80. [PMID: 21457925 DOI: 10.1016/j.ajo.2010.12.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/22/2010] [Accepted: 12/31/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To study the prognostic factors that influence best-corrected visual acuity (BCVA) outcome in patients with secondary epiretinal membrane (ERM) after retinal detachment surgery. DESIGN Retrospective case series. METHODS Forty-two patients with ERM were divided into macula-on and macula-off groups based on the macular status before retinal detachment surgery and were studied using the same spectral-domain optical coherence tomography device. Several variables, including the integrity of the external limiting membrane (ELM), the status of the photoreceptor inner segment/outer segment (IS/OS) junction line, and central foveal thickness were evaluated in 17 treated and 25 untreated patients. Linear regression analysis was used to determine the best combination of all variables affecting BCVA. RESULTS Final BCVA was significantly better in macula-on and macula-off eyes with intact ELMs and IS/OS junction lines (0.35 ± 0.18 logarithm of the minimal angle of resolution [logMAR] and 0.51 ± 0.17 logMAR, respectively) than in macula-off eyes with disrupted or absent ELMs and IS/OS junction lines (0.83 ± 0.17 logMAR and 1.04 ± 0.05 logMAR, respectively; P < .001, analysis of variance). Final BCVA also was better in the treated group than in the controls (0.55 ± 0.31 logMAR and 0.73 ± 0.26 logMAR, respectively; P = .05, t test). ELM and IS/OS junction line integrity were the main variables significantly affecting the final BCVA outcome (β = 0.42; P = .006, linear regression analysis). Disruption of the ELM and IS/OS junction line was observed in 21 of the 42 cases studied. CONCLUSIONS ERM secondary to retinal detachment surgery is accompanied by a high incidence (50%) of IS/OS junction line and ELM disruption. Among the variables studied, the condition of the IS/OS junction layer and the ELM are the main factors that predict final BCVA after ERM peeling.
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Lee P, Lee TG, Kim MS, Kim ES, Yu SY, Kwak HW. Prognostic Factors in Vitrectomy for Macular Epiretinal Membrane. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.11.1302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Pyung Lee
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, College of Medicine, Konyang University, Daejeon, Korea
| | - Moo Sang Kim
- Department of Ophthalmology, Inje University College of Medicine, Busan, Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Young Yu
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyung Woo Kwak
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea
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Errera MH, Cohen SY, Chahed S, Gaudric A. Scattered Lamellar Microholes as a Complication of Epiretinal Membranes. Ophthalmic Surg Lasers Imaging Retina 2010; 41 Online:e1-4. [DOI: 10.3928/15428877-20101124-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 08/03/2010] [Indexed: 11/20/2022]
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Correlation between thickening of the inner and outer retina and visual acuity in patients with epiretinal membrane. Retina 2010; 30:503-8. [PMID: 19952992 DOI: 10.1097/iae.0b013e3181bd2d65] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationship between thickening of the inner and outer retinal layers and visual acuity in patients with idiopathic epiretinal membrane. METHODS We examined 30 eyes of 30 patients and 25 eyes of 25 healthy volunteers as age-matched normal control subjects. The inner (between the vitreoretinal interface and the outer border of inner plexiform layer), outer, and full retinal thickness at the fovea, parafovea, and perifovea were measured using spectral-domain optical coherence tomography. RESULTS Thickening ratios of both the inner and outer retina were greater in the fovea than in the other macular regions (P < 0.0001). Inner foveal retinal thickening was significantly greater than outer foveal retinal thickening (P < 0.0001). However, outer retinal thickening in the fovea (r = 0.644, P < 0.001), parafovea (r = 0.616, P < 0.001), and perifovea (r = 0.410, P = 0.025) was significantly correlated with visual acuity; inner retinal thickening was not. Visual acuity tended to be worse, although not significantly so, in eyes with photoreceptor disruption. CONCLUSION Epiretinal membrane-induced retinal damage associated with visual acuity seems to be located within the outer retina external to the inner plexiform layer.
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Elbendary AM. Three-dimensional characterization of epiretinal membrane using spectral domain optical coherence tomography. Saudi J Ophthalmol 2010; 24:37-43. [PMID: 23960873 DOI: 10.1016/j.sjopt.2009.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 12/12/2009] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To describe epiretinal membrane (ERM) features using spectral domain optical coherence tomography "SD OCT" and to delineate the three-dimensional (3D) relationship in eyes with epiretinal membrane. METHODS Fifty-two eyes of 44 patients with ERM were classified into two groups: idiopathic ERM and secondary ERM. Posterior vitreous face was evaluated. Pattern of ERM attachment was divided into: focal and global. A 3D SD OCT system (5 μm resolution) was used for scanning. Surface maps were used to study retinal topography. RESULTS Surface maps revealed manner and direction of epiretinal traction, pattern of attachment and blood vessel involvement. In 55.8% of eyes the membrane was globally adherent to the retina. There was a significant association (p = 0.02%) between pattern of membrane attachment and etiological classification of eyes. Posterior vitreous detachment (PVD) was associated with both groups, but no significant difference in between. CONCLUSION SPECTRAL DOMAIN OCT ALLOWED BETTER CHARACTERIZATION OF ERM INCLUDING: visualization, extension, cleavage plane and zones with free edges. Surface maps revealed the topography of ERM and retina pathology. Idiopathic ERM are significantly associated with global pattern. PVD plays an important role in the pathogenesis of primary as well as secondary ERM.
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Affiliation(s)
- Amal M Elbendary
- Mansoura Ophthalmic Center, Mansoura University, Gomhoria Street, Mansoura 35516, Egypt
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SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FOR IMAGING ERM, RETINAL EDEMA, AND VITREOMACULAR INTERFACE. Retina 2010; 30:246-53. [DOI: 10.1097/iae.0b013e3181baf6dc] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Falkner-Radler CI, Glittenberg C, Hagen S, Benesch T, Binder S. Spectral-domain optical coherence tomography for monitoring epiretinal membrane surgery. Ophthalmology 2010; 117:798-805. [PMID: 20045567 DOI: 10.1016/j.ophtha.2009.08.034] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 08/21/2009] [Accepted: 08/25/2009] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To assess prognostic factors in epiretinal membrane (ERM) surgery using spectral-domain (SD) optical coherence tomography (OCT). DESIGN Prospective, interventional case series. PARTICIPANTS Forty-one patients. METHODS Patients with a diagnosis of ERM were examined with spectral-domain and time-domain (TD) OCT before and after surgery. MAIN OUTCOME MEASURES Main outcome measures were functional results and predefined OCT patterns. Cofactors analyzed were the type of ERM, the duration and grading of subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, and age. A multivariate regression analysis was performed. RESULTS Thirty-nine patients (95%) showed an improved or stable best-corrected distance visual acuity (DVA) at 3 months, whereas 36 patients (88%) showed an improved or stable best-corrected near visual acuity (NVA) at 3 months. Significant correlations (P>0.4) were found between the course of central retinal thickness (CRT) assessed using SD OCT and TD OCT (P<0.02). No clinically relevant correlations (P<0.3) were seen between CRT and VA (P>0.1). Baseline DVA and NVA were found to be significant prognostic values for the postoperative decrease in CRT in both OCT systems (P<0.04) as well as for the visual outcomes (P<0.007) at 3 months. In addition, the integrity of the junction between the photoreceptor inner segment and outer segment (IS/OS) significantly influenced the visual outcomes at 3 months (P<0.038). The baseline profile of the internal limiting membrane (ILM) significantly influenced the NVA at 3 months (P<0.009), whereas the postoperative foveal contour significantly influenced the DVA at 3 months (P<0.025). The type of ERM, subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, or age had no significant influence on patient outcome (P>0.05). Compared with TD OCT, SD OCT allowed for a more precise differentiation between the ERM and the retinal surface and for a better evaluation of the IS/OS line. CONCLUSIONS Besides the baseline VA, the integrity of the IS/OS line, better visualized by SD OCT, can be used to predict the functional outcomes after surgery. Additionally, analyzing the ILM profile and the foveal contour may help to understand limited visual outcomes after surgery. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Christiane I Falkner-Radler
- The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria.
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Watanabe A, Arimoto S, Nishi O. Correlation between Metamorphopsia and Epiretinal Membrane Optical Coherence Tomography Findings. Ophthalmology 2009; 116:1788-93. [PMID: 19643494 DOI: 10.1016/j.ophtha.2009.04.046] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 04/25/2009] [Accepted: 04/28/2009] [Indexed: 11/25/2022] Open
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Single Fiber Optical Coherence Tomography Microsurgical Instruments for Computer and Robot-Assisted Retinal Surgery. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION – MICCAI 2009 2009; 12:108-15. [DOI: 10.1007/978-3-642-04268-3_14] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Mark Johnson T, Johnson MW. Epiretinal Membrane. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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