GANGLION CELL LAYER THICKNESS AND VISUAL IMPROVEMENT AFTER EPIRETINAL MEMBRANE SURGERY

Quantitative evaluation of metamorphopsia with M-CHARTS™ and evaluation of retinal morphologic changes by optical coherence tomography before and after pars plana vitrectomy in patients with idiopathic epiretinal membrane

PURPOSE

We aimed to quantitatively evaluate metamorphopsia pre- and postoperatively in patients with idiopathic epiretinal membrane(iERM) using M-CHARTS™ and to evaluate the relationship between morphological changes in retinal layers on optical coherence tomography (OCT) and metamorphopsia scores.

MATERIALS AND METHODS

This prospective study included 42 patients followed in Akdeniz University Hospital Ophthalmology Clinic diagnosed with iERM by fundus examination and OCT between 2020-2022. Detailed ophthalmologic findings, visual acuities, metamorphopsia scores, and OCT parameters of all patients were recorded. The relationship between pre- and postoperative visual acuity, metamorphopsia scores and OCT parameters was investigated. Changes in OCT parameters were compared by evaluating patients with stable or increasing metamorphopsia scores as one group (group1) and patients with decreasing metamorphopsia scores as the other group (group 2).

RESULTS

In "group 2", preoperative Ganglion Cell Layer+Inner Plexiform Layer (Central) (GCL+IPL (C)) was significantly (P: 0.028) higher than in "group 1".

CONCLUSION

A statistically significant preoperative thickness difference in the OCT parameters of the GCL+IPL (C) layer was associated with the quantitative metamorphopsia complaints of the patients. The thickness of the preoperative GCL+IPL (C) layer can be considered an important indicator of symptoms of metamorphopsia determining functional success after surgery.

THREE-DIMENSIONAL RETINAL DISPLACEMENT BEFORE AND AFTER MACULAR PUCKER SURGERY

PURPOSE

To measure the coronal and sagittal retinal displacement before and after surgery for epiretinal membranes in InfraRed horizontal foveal sections and optical coherence tomography scans and describe displacement tridimensionality, vision loss, and metamorphopsia.

METHODS

Retrospective series with greater than 6-month average follow-up before and after surgery. The record included best-corrected visual acuity, optical coherence tomography, M-charts, and InfraRed retinography. Overall, pre- and postoperative coronal and sagittal retinal displacement across the entire field, concentric circles at 0.5-, 1.5-, and 4.5-mm radii, and the central horizontal and vertical meridian were calculated as the optical flow of consecutive images.

RESULTS

This study comprised 10 patients (4 men, 6 women), with 22.7 ± 25.2 months follow-up before surgery and 16.2 ± 7.3 months after. Best-corrected visual acuity reduced before surgery (0.15 ± 0.67 logarithm of minimum angle of resolution to 0.38 ± 0.85 logarithm of minimum angle of resolution; P < 0.05) and increased afterward (0.086 ± 0.61 logarithm of minimum angle of resolution; P = 0.003). Preoperative coronal displacement was 30.1 ± 29.1 µm versus 67.0 ± 23.4 µm after (P = 0.002). Sagittal retinal displacement was 140.9 ± 84.6 µm before surgery, 339.7 ± 172.5 µm after (P = 0.017), and 357.6 ± 320.8 µm across the entire follow-up. Preoperative best-corrected visual acuity decreases correlated with the foveal coronal displacement. Vertical metamorphopsia correlated with the average coronal displacement within a 4.5-mm radius. Pre- and postoperative sagittal displacement correlated with horizontal metamorphopsia (P = 0.006 and P = 0.026). Postoperative sagittal displacement correlated with postoperative best-corrected visual acuity (P = 0.026) and foveal thickness (P = 0.009).

CONCLUSION

This study confirms that postoperative displacement is greater than preoperative and that sagittal displacement is greater than coronal and correlates with best-corrected visual acuity and metamorphopsia changes.

Comparison of Functional, Structural, and Microvascular Features in Different Stages of Idiopathic Epiretinal Membrane

Background: Idiopathic epiretinal membrane (ERM) often leads to visual symptoms such as metamorphopsia and decreased central vision. This study aimed to evaluate functional, structural, and microvascular characteristics in patients with different stages of idiopathic ERM who were candidates for surgery, with a focus on identifying potential indicators for surgical timing. Methods: A retrospective cohort study was conducted on consecutive patients with unilateral idiopathic ERM who were candidates for surgery. Patients underwent comprehensive ophthalmological assessments, including OCT grading, reading performance evaluation, and OCT angiography. Data analysis included comparisons between different ERM stages for functional, structural, and microvascular parameters. Results: A total of 44 eyes were included, classified into four ERM stages according to the Govetto grading system. Functional parameters, including distance and near visual acuity, worsened significantly with higher ERM stages, particularly in the transition from Stage 3 to Stage 4. Structural assessments revealed significant increases in central macular thickness (CMT) from Stage 3 to Stage 4. No significant differences were observed in microvascular features across different ERM stages. Conclusions: This study highlights the significant functional and anatomical impact of OCT staging in idiopathic ERM, particularly during the transition from Stage 3 to Stage 4, characterized by notable reductions in visual acuity and increases in CMT. These findings underscore the importance of considering both functional and structural parameters in surgical decision-making for ERM management. However, further research with larger cohorts is needed to confirm these observations and inform clinical practice.

Anatomical changes in idiopathic epiretinal membrane at 2-year follow-up assessed using spectral domain optical coherence tomography and optical coherence tomographic angiography

PURPOSE

To evaluate anatomical changes in the low-stage partial attachment-type idiopathic epiretinal membrane (iERM) over 2 years.

METHODS

Data from patients with low-stage partial attachment-type iERM (stage 2) were analyzed. The main outcome measures were anatomical changes, including changes in the foveal avascular zone (FAZ) area, vessel density (VD) in the vascular plexus, and thickness of retinal sublayers during the follow-up period.

RESULTS

Thirty patients (mean age: 68±12 years) were included in the study. The FAZ area on the superficial vascular plexus (SVP) significantly decreased from baseline (0.12±0.08 mm2) to month 24 (0.10±0.08 mm2, p=0.024). However, the FAZ area on the deep vascular plexus (DVP) did not significantly decrease from baseline (0.15±0.13 mm2) to month 24 (0.14±0.14 mm2, p=0.099). VDs on both the SVP and DVP did not show significant change from baseline (29.51±8.14% vs. 28.35±5.63%) to month 24 (29.79±9.77%, p=0.564 vs. 28.17±5.75%, p=0.417). Parafoveal ganglion cell and inner plexiform layer (GCIPL) thickness decreased from baseline (108.77±13.61 μm) to month 24 (103.03±15.54 μm, p=0.004). The central total retinal layer thickness did not significantly change from baseline (396.07±64.86 μm) to month 24 (392.04±72.72 μm, p=0.570).

CONCLUSION

Even in low-stage ERM, inner retinal changes, including GCIPL thickness, occurred during follow-up periods, which might be owing to degenerative changes or centrifugal movement.

Retinal Layer Segmentation in OCT Images With Boundary Regression and Feature Polarization

The geometry of retinal layers is an important imaging feature for the diagnosis of some ophthalmic diseases. In recent years, retinal layer segmentation methods for optical coherence tomography (OCT) images have emerged one after another, and huge progress has been achieved. However, challenges due to interference factors such as noise, blurring, fundus effusion, and tissue artifacts remain in existing methods, primarily manifesting as intra-layer false positives and inter-layer boundary deviation. To solve these problems, we propose a method called Tightly combined Cross-Convolution and Transformer with Boundary regression and feature Polarization (TCCT-BP). This method uses a hybrid architecture of CNN and lightweight Transformer to improve the perception of retinal layers. In addition, a feature grouping and sampling method and the corresponding polarization loss function are designed to maximize the differentiation of the feature vectors of different retinal layers, and a boundary regression loss function is devised to constrain the retinal boundary distribution for a better fit to the ground truth. Extensive experiments on four benchmark datasets demonstrate that the proposed method achieves state-of-the-art performance in dealing with problems of false positives and boundary distortion. The proposed method ranked first in the OCT Layer Segmentation task of GOALS challenge held by MICCAI 2022. The source code is available at https://www.github.com/tyb311/TCCT.

Longitudinal changes in the ganglion cell complex thickness in acute central serous chorioretinopathy using spectral-domain optical coherence tomography

In this retrospective longitudinal cohort study, we investigated the temporal changes in the peripapillary retinal nerve fiber layer (pRNFL) and inner retinal thickness in patients with acute central serous chorioretinopathy (CSC) using spectral-domain optical coherence tomography (SD-OCT). We followed up with these patients for 6 months, and during this period, the thickness of the pRNFL and the ganglion cell complex (GCC) in CSC patients were compared with the eyes of normal healthy individuals. The study also examined the correlation between the pRNFL thickness, GCC thickness, and visual acuity. The research sample consisted of 67 patients (43 male and 24 female) with an average age of 49.72 ± 9.87 years. The initial findings showed no significant differences in the pRNFL and GCC thickness between the study and fellow eye, study and normal healthy eyes, and fellow and normal healthy eyes. There was no significant difference in the pRNFL and GCC thickness when comparing the study eye with the fellow eye for 6 months. In the study eye, no significant difference was observed when comparing the initial GCC and pRNFL thickness with those at 1, 3, and 6 months. Visual acuity improved significantly from 0.18 ± 0.23 logMAR to 0.04 ± 0.06 logMAR (p < 0.001). The GCC and pRNFL thickness did not significantly affect visual acuity. In conclusion, acute CSC patients did not show significant changes in the pRNFL and inner retinal thickness, suggesting that the GCC and pRNFL do not substantially influence the short-term visual prognosis in these patients.

Idiopathic epiretinal membranes: postoperative changes in morphology

OBJECTIVE

To describe retinal morphology in idiopathic epiretinal membranes (ERMs) and to evaluate factors influencing function at different postoperative times up to 24 months.

DESIGN

Retrospective study.

PARTICIPANTS

A total of 121 eyes of 117 patients followed with spectral-domain optical coherence tomography for 24 months.

METHODS

The following details were analyzed: type of ERM, central retinal thickness, and status of all retina layers in the fovea, especially the outer nuclear layer (ONL) and photoreceptor layer. We evaluated the presence of disorganization of retinal inner layers (DRIL), ectopic inner foveal layer (EIFL), elevation (stretching) of the ONL, cotton ball sign, and type connection between the retina and ERMs (complete adherence or multiple junction spots).

RESULTS

The percentage of DRIL, EIFL, and stretched ONL decreased. Several factors negatively influenced visual acuity during the early postoperative controls: age, interdigitation zone defects; presence of cotton ball sign, DRIL, EIFL, and stretched ONL; and strong adhesion of the ERMs to the retina. Twenty-four months after surgery, only DRIL and strong adhesion between ERMs and the retina remained statistically significant.

CONCLUSIONS

Younger patients (p < 0.001) and patients without DRIL (p < 0.001) experienced a faster recovery of function. The length of follow-up was associated with a decrease of factors influencing the final outcome. After 24 months, only the presence of DRIL and strong adhesion between the ERMs and the retina were significant. Assuming that DRIL appears in more advanced stages when compared with EIFL, this allows us to suggest that earlier surgery might be of more benefit in idiopathic ERMs.

Correlation between Severity of Idiopathic Epiretinal Membrane and Irvine-Gass Syndrome

A higher risk of pseudophakic cystoid macular edema (PCME) has been reported in patients with preoperative idiopathic epiretinal membrane (ERM); however, whether the formation of PCME depends on the grade of ERM has not been well established. We conducted a retrospective case-control study of 87 eyes of 78 patients who were preoperatively diagnosed with idiopathic ERM and had undergone cataract surgery. Patients were divided into two groups: PCME and non-PCME groups. After cataract surgery, the ERM status was graded using the Gass and Govetto classifications. Both the central macular thickness (CMT) and ERM grade increased after surgery, and higher preoperative CMT and ERM grades were found in the PCME group. The association between higher-grade ERM and the development of PCME was significant in the Govetto classification (grade 2, odds ratio (OR): 3.13; grade 3, OR: 3.93; and grade 4, OR: 16.07). The study results indicate that close attention should be given to patients with ERM with the presence of an ectopic inner foveal layer before cataract surgery.

Multimodal Assessment of the Prognostic Role of Ectopic Inner Foveal Layers on Epiretinal Membrane Surgery

BACKGROUND

To perform a multimodal assessment of the ectopic inner foveal layers' (EIFL) prognostic role on idiopathic epiretinal membrane (ERM) surgery.

METHODS

We retrospectively followed-up for 12 months 27 patients who underwent ERM surgery and stratified them based on EIFL presence (group 1) or absence (group 2) at baseline. Central Retinal Thickness (CRT) and best-corrected visual acuity (BCVA) were compared pre- and post-operatively at 1, 4 and 12 months, whereas fixation stability (FS), macular sensitivity (MS) and multifocal electroretinogram (mfERG) responses were confronted at baseline and 12 months.

RESULTS

In group 1, BCVA improved at 4 and 12 months (MD = 0.14 (SE = 0.04); MD = 0.13 (SE = 0.05), respectively) as well as in group 2 (MD = 0.31 (SE = 0.07); MD = 0.41 (SE = 0.08), respectively). CRT did not change in group 1, whereas it decreased in group 2 at 4 and 12 months (MD = -73.13; SE = 23.56; MD = -76.20; SE = 23.56). MS showed no changes in both groups after surgery. FS did not change in group 1, whereas group 2 improved FS 2° (+8.91 ± 13.97) and FS 4° (+4.33 ± 3.84). MfERG P1 wave did not change in group 1, while in group 2 αP1-2, αP1-3 and αP1-4 improved postoperatively (27.97 ± 27.62; 12.51 ± 17.36; 10.49 ± 17.19, respectively).

CONCLUSIONS

Multimodal assessment confirmed that EIFL negatively affected ERM surgery outcomes.

PREDICTING VISUAL OUTCOME AFTER SURGERY IN PATIENTS WITH IDIOPATHIC EPIRETINAL MEMBRANE USING A NOVEL CONVOLUTIONAL NEURAL NETWORK

PURPOSE

To develop a deep convolutional neural network that enables the prediction of postoperative visual outcomes after epiretinal membrane surgery based on preoperative optical coherence tomography images and clinical parameters to refine surgical decision making.

METHODS

A total of 529 patients with idiopathic epiretinal membrane who underwent standard vitrectomy with epiretinal membrane peeling surgery by two surgeons between January 1, 2014, and June 1, 2020, were enrolled. The newly developed Heterogeneous Data Fusion Net was introduced to predict postoperative visual acuity outcomes (improvement ≥2 lines in Snellen chart) 12 months after surgery based on preoperative cross-sectional optical coherence tomography images and clinical factors, including age, sex, and preoperative visual acuity. The predictive accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the convolutional neural network model were evaluated.

RESULTS

The developed model demonstrated an overall accuracy for visual outcome prediction of 88.68% (95% CI, 79.0%-95.7%) with an area under the receiver operating characteristic curve of 97.8% (95% CI, 86.8%-98.0%), sensitivity of 87.0% (95% CI, 67.9%-95.5%), specificity of 92.9% (95% CI, 77.4%-98.0%), precision of 0.909, recall of 0.870, and F1 score of 0.889. The heatmaps identified the critical area for prediction as the ellipsoid zone of photoreceptors and the superficial retina, which was subjected to tangential traction of the proliferative membrane.

CONCLUSION

The novel Heterogeneous Data Fusion Net demonstrated high accuracy in the automated prediction of visual outcomes after weighing and leveraging multiple clinical parameters, including optical coherence tomography images. This approach may be helpful in establishing personalized therapeutic strategies for epiretinal membrane management.

Tight adherent feature on optical coherence tomography predict postoperative visual outcome in epiretinal membrane eyes

Background

To identify the predictive parameter among preoperative measurements that best predicts postoperative visual outcome in the epiretinal membrane (ERM).

Methods

Thirty-three consecutive patients with idiopathic unilateral ERM patients between 2015 and 2018 were enrolled. Nineteen healthy normal eyes were selected as an independent age-matched group. Based on preoperative optical coherence tomography (OCT), we further divided the patients with ERM into two groups: type 1, loosely attached ERM, and type 2, tight adherent ERM. We documented the vision and thickness of various retinal layers: nerve fiber layer, ganglion cell layer, inner plexiform layer (GCL + IPL), inner nuclear layer (INL), outer retinal layer (ORL), and retinal pigment epithelium/Bruch complex layer before and after the surgery. The association between postoperative visual acuity and these variables was analyzed using multiple linear regression analysis.

Results

All retinal layers of ERM eyes were thicker than the normal eyes (P < 0.05). Among ERMs, we identified 11 eyes with type 1 adhesions and 22 eyes with type 2 adhesions. The preoperative GCL + IPL layers were significantly thicker in type 2 patients than in type 1 patients (93.67 ± 33.03 um vs 167.71 ± 13.77 um; P = 0.023). Greater GCL + IPL thickness was correlated with a worse postoperative visual acuity and multiple linear regression analysis showed that GCL + IPL thickness was an independent predictor of postoperative visual acuity (VA) (beta value = 0.689; P = 0.012). A greater thickness of GCL + IPL layers of type 2 patients had worse postoperative best-corrected visual acuity (BCVA) (P = 0.028). Ectopic inner foveal layers with disappearance of fovea pit were persistently presented in OCT profiles of both groups.

Conclusion

Idiopathic ERM demonstrated significantly thicker inner retinal layers (GCL + IPL and INL). However, the ORL thickness was similar between the normal eyes and ERM eyes. The preoperative GCL + IPL layers were significantly thicker in patients with type 2 ERM than that in patients with type 1 ERM. The increase in GCL + IPL thickness was significantly correlated with worse postoperative visual outcomes.

Optical coherence tomography biomarkers for visual acuity in patients with idiopathic epiretinal membrane

PURPOSE

To investigate the correlation between outer and inner retina optical coherence tomography (OCT) biomarkers and visual acuity in patients with idiopathic epiretinal membrane (iERM) and identify which of them may be predictive of visual function.

METHODS

A retrospective cross-sectional single-center study was conducted that included patients diagnosed with iERM. Spectral domain OCT images were obtained and assessed qualitatively and quantitatively. The association of OCT parameters with best corrected visual acuity was analyzed.

RESULTS

Charts of 97 eyes of 97 patients were reviewed. Central foveal thickness, maximal retinal thickness (MRT), photoreceptor outer segment length, outer foveal thickness, ganglion cell-inner plexiform layer complex thickening, inner retinal thickness and inner retinal layer irregularity index were among the major outcome measures. OCT scans were also assessed for the presence of cotton ball sign, ellipsoid zone disruption, ectopic inner foveal layer, disorganization of retinal inner layers (DRIL), intraretinal fluid, subretinal fluid (SRF) and epimacular membrane rip. Univariate analysis showed statistically significant association between all the aforementioned parameters with worse vision, except for cotton ball sign and SRF. Multivariate analysis found that MRT and severe DRIL were strongly correlated with worse vision (p < 0.001).

CONCLUSION

MRT and severe DRIL should be considered as negative prognostic factors for visual acuity.

Evaluation of postoperative visual function based on the preoperative inner layer structure in the epiretinal membrane

PURPOSE

To evaluate the postoperative visual function using a preoperative epiretinal membrane (ERM) classification based on the status of the inner layer structure.

METHODS

We assessed 62 eyes, one from each patient undergoing vitrectomy with internal limiting membrane (ILM) peeling for unilateral ERM. The inclusion criteria were as follows: (1) the presence of idiopathic ERM based on optical coherence tomography and a healthy contralateral eye, (2) successful surgery after 25- or 27-gauge transconjunctival 3-port pars plana vitrectomy with ILM peeling, and (3) a minimum follow-up period of 12 months. We included patients with preoperative ERM morphology with no disruption of the inner retinal layer in group A (37 eyes) and those with disruption in group B (25 eyes) and compared the visual acuity, central visual-field sensitivity (CVFS) measured using the Humphrey field analyzer 10-2 program, and detection rate of micro-scotoma (< 10 dB) at baseline and 12 months postoperatively between the groups.

RESULTS

Visual acuity at 12 months showed greater improvement in group A than in group B (P = .03). There was no significant difference in CVFS at baseline; however, that of the nasal area was substantially lower after surgery in group B than in group A (P = .02). The 12-month postoperative detection rate of micro-scotoma was significantly higher in group B than in group A (P = .002).

CONCLUSION

ERM that has preoperatively disrupted the inner layer poses the risks of CVFS reduction and micro-scotoma formation after vitrectomy. Evaluating the inner layer could be an important prognostic factor in determining retinal function in ERM.

Anatomical and Functional Recovery Kinetics After Epiretinal Membrane Removal

Purpose

To investigate the nature of anatomical and functional recovery kinetics after epiretinal membrane (ERM) removal.

Methods

The records of 42 patients (45 eyes) with idiopathic ERM treated with pars plana vitrectomy and surgical peeling of the ERM performed by a single surgeon at Massachusetts Eye and Ear between 2012 and 2017 were retrospectively reviewed. Outcome measures included spectral domain optical coherence tomography-measured central macular thickness (CMT) pre-operatively and at post-operative day 1, week 1, months 1, 3, 6, 12 and 24 as well as best-corrected visual acuity (BCVA). Correlations between baseline or early values and final anatomical and functional outcomes were investigated.

Results

Improvement in CMT was statistically significant after 1 week, 1, 3, 6, 12 and 24 months (p < 0.01). BCVA improvement was statistically significant after 1, 6, 12 and 24 months follow-up (p<0.01). The improvement of BCVA and CMT with time was found to be logarithmic (R² =0.96, R² =0.84) suggesting that early (<30 days) post-operative functional and anatomical changes may be predictive of long-term outcomes. Preoperative BCVA and CMT revealed a weak positive correlation with the respective BCVA and CMT at 24 months (R²=0.13 and R²=0.16). When plotted as a percentage of the fellow normal eye CMT, first week proportional improvement in CMT from pre-operative baseline was found to be correlated with final CMT proportional decrease (R²=0.72) suggesting that first week postoperative CMT could be predictive of final CMT.

Conclusion

There is a logarithmic improvement in CMT and BCVA after ERM peel with BCVA improvement following the CMT improvement. Early (less than 30 days) post-operative anatomical changes can be predictive of long-term anatomical outcomes.

Epiretinal Membrane Surgery: Structural Retinal Changes Correlate with the Improvement of Visual Function

Several parameters have been studied for identifying the visual outcomes after pars plana vitrectomy (PPV) for epiretinal membrane (ERM) peeling. This retrospective study aimed to analyze structural retinal changes with spectral domain-optical coherence tomography (SD-OCT) and their correlations with visual acuity improvement in patients with ERM undergoing PPV. Twenty-one pseudophakic eyes were enrolled in the study. Ophthalmic evaluations included best corrected visual acuity (BCVA) and retinal layer thickness measurements with SD-OCT. The segmentation of the retina was divided into four parts: the inner retinal layer (IRL), composed of an internal limiting membrane, retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer; inner nuclear layer (INL); outer plexiform layer (OPL); and outer nuclear layer (ONL). Correlations between changes in retinal layer thicknesses and BCVA were explored over a 6 month follow-up period. The postoperative thickness decrease of the INL was significantly correlated with thickness changes in all other measured retinal layers (p < 0.001). Non-parametric linear regression showed that postoperative improvement in BCVA was associated with a postoperatively decreased thickness in the IRL (p = 0.021), INL (p = 0.039), and OPL (p = 0.021). In eyes undergoing PPV, postoperative thickness decreases of the IRL, INL, and OPL were correlated with visual acuity improvements. Re-compaction of these retinal layers after relieving ERM-induced traction may be an important factor in postoperative visual function improvement.

Outer Plexiform Layer Angle: A Prognostic Factor for Idiopathic Macular Pucker Surgery

Purpose. To investigate the efficacy of idiopathic macular pucker (epimacular membrane) surgery and to identify the possible prognostic factor. Methods. This was a retrospective study which enrolled 38 patients with idiopathic macular pucker who underwent 23-gauge pars plana vitrectomy (PPV) with indocyanine green-assisted peeling of epiretinal membrane (ERM) and internal limiting membrane (ILM). Visual outcomes were assessed at the baseline and during the follow-up including best-corrected visual acuity (BCVA) and metamorphopsia score, as well as outer plexiform layer (OPL) angle and central retinal thickness (CRT) using spectral-domain optical coherence tomography (SD-OCT). A comparison was made between patients with the prepeeling CRTs ≥500 μm and those <500 μm. A comparison was also made between patients with the prepeeling OPL angles ≥130° and those <130°. Based on the prepeeling parameters, the correlations between various prepeeling and postpeeling visual functions were analyzed. Results. Mean follow-up was 36.07 ± 4.62 months (range 1.30–96.70 months). BCVA was significantly improved from 0.26 ± 0.03 to 0.67 ± 0.04 $\left(p<0.001\right)$ ; metamorphopsia score was significantly reduced from 1.42 ± 0.16 to 0.61 ± 0.08 $\left(p<0.001\right)$ ; CRT was significantly decreased from 519.62 ± 13.41 μm to 385.37 ± 8.97 μm $\left(p<0.001\right)$ . Greater prepeeling OPL angle (≥130°) was associated with significantly greater BCVA improvement (Snellen E/LogMAR: $p=0.01/0.03$ ) and greater metamorphopsia reduction $\left(p=0.03\right)$ , as compared to smaller OPL angle (<130°) with less BCVA improvement and less metamorphopsia reduction. However, the final BCVA improvement and metamorphopsia reduction relevant to the prepeeling smaller CRT (<500 μm) did not significantly differ from that relevant to the prepeeling greater CRT (≥500 μm; $p>0.05$ ). Endophthalmitis, retinal tear, or retinal detachment was not observed after peeling. Conclusion. Indocyanine green-assisted ERM/ILM peeling combined with small gauge vitrectomy is associated with significant visual acuity improvement and metamorphopsia reduction in patients with idiopathic macular pucker. Greater prepeeling OPL angle rather than CRT might act as a useful prognostic factor in predicting better final visual functional outcomes.

Association between individual retinal layer thickness and visual acuity in patients with epiretinal membrane: a pilot study

Purpose

We investigated the correlation between visual acuity (VA) and individual retinal layer thickness in the foveal, parafoveal, and perifoveal regions of patients with an idiopathic epiretinal membrane (ERM).

Methods

One hundred and five subjects presenting with unilateral idiopathic ERM were included in this study. We segmented each patient’s optical coherence tomography (OCT) image into seven layers and calculated the mean layer thickness in the foveal, parafoveal, and perifoveal regions using the Iowa Reference Algorithm. In 105 patients with ERM, we detected correlations between their macular regions’ individual retinal layer thickness and their best corrected VA. Thirty-one of the 105 patients with ERM underwent vitrectomy and completed six months of follow-up. We then compared the 31 surgical patients’ preoperative and postoperative individual retinal layer thickness in each macular region. Additionally, the association between preoperative individual retinal layer thickness in each macular region and VA six months post-surgery in patients with ≥ two Snellen lines of visual improvement was determined.

Results

Multiple linear regression analysis showed that the inner nuclear layer (INL) thickness in the foveal, parafoveal, and perifoveal region were all associated with VA in the 105 patients (R² = 0.344, P < 0.001; R² = 0.427, P < 0.001; and R² = 0.340, P < 0.001, respectively). Thirty-one surgical patients 6 months post-surgery showed significantly decreased thicknesses (P ≤ 0.012) of the foveal INL, inner plexiform layer (IPL), and outer nuclear layer (ONL); the parafoveal retina nerve fiber layer (RNFL), IPL, INL, and ONL; and the perifoveal RNFL, IPL, INL, ganglion cell layer (GCL), outer plexiform layer (OPL), and photoreceptor layer (PRL). We found a weak correlation between postoperative VA and preoperative foveal and perifoveal RNFL thickness (r = 0.404 and r = 0.359, respectively), and a moderate correlation between postoperative VA and preoperative foveal and parafoveal INL thickness (r = 0.529 and r = 0.583, respectively) in the 31 surgical patients (P ≤ 0.047). The preoperative INL thickness in the foveal, parafoveal, and perifoveal regions showed a moderate to strong correlation (r = 0.507, 0.644, and 0.548, respectively), with postoperative VA in patients with ≥ 2 lines of visual improvement (P ≤ 0.038).

Conclusion

We detected a correlation between retinal damage and VA in the parafoveal, perifoveal, and foveal regions. Our results suggest that INL thickness in all macular regions may be a prognostic factor for postoperative VA in ERM patients.

Long-Term Outcomes After Idiopathic Epiretinal Membrane Surgery

Purpose

To report anatomic and logMAR best-corrected visual acuity (BCVA) outcomes with long-term follow-up after pars-plana vitrectomy and epiretinal membrane peeling (PPV-MP).

Design

A retrospective case-series.

Participants

Patients with epiretinal membrane (ERM) who underwent PPV-MP performed by one surgeon.

Methods

Best-corrected visual acuity (BCVA) was recorded as a logMAR preoperatively and, when available, at 1, 2, 3, 5, 8, 10 years after surgery. The integrity of outer retinal layers was evaluated using spectral domain optical coherence tomography (SD-OCT).

Main Outcome Measures

Postoperative BCVA at different follow-up visits and its correlation with different OCT parameters.

Results

Fifty-five eyes of 49 patients were followed postoperatively with a mean of 8.6± 2.6 years (median: 9 years, range 5–16 years). The mean BCVA improved from 0.56±0.29 (20/72) preoperatively to 0.33±0.25 (20/42) at 1 year, 0.29±0.27 (20/38) at 2 years, 0.25±0.28 (20/35) at 3 years, 0.29±0.32 (20/38) at 5 years, 0.28±0.31 (20/38) at 8 years, and 0.28±0.25 (20/38) at 10 years (p<0.001). The BCVA improved at each of the first 3 years postoperatively and remained stable at 5, 8, and 10 years. Postoperative improvement in the integrity of ELM, and EZ, on SD-OCT correlated with improved BCVA.

Conclusion

BCVA continues to improve after PPV-MP during the first 3 years postoperatively and remains stable. Improved anatomic integrity of outer retinal layers correlated with improved BCVA.

Elevated M2 Macrophage Markers in Epiretinal Membranes With Ectopic Inner Foveal Layers

Purpose

To analyze the differences in the vitreous cytokine profiles in epiretinal membrane eyes with and without an ectopic inner foveal layer (EIFL).

Methods

Sixty eyes with epiretinal membrane (32 eyes without EIFL and 28 eyes with EIFL) were included. The vitreous samples were collected during surgery for epiretinal membrane. The cytokine levels of the vitreous were measured using a multiplex bead analysis.

Results

The mean logMAR visual acuity was worse (0.42 vs. 0.37; P = 0.331) and the central foveal thickness was higher in the EIFL group (496.9 µm vs. 434.2 µm; P = 0.007) than they were in the group without EIFL. The mean EIFL thickness was 164.1 ± 67.7 µm in the EIFL group. On multiplex analysis of the vitreous cytokines, the levels of CD163 (21529 pg/dL vs. 10877 pg/dL; P = 0.002) and macrophage colony-stimulating factor (206 pg/dL vs. 159 pg/dL, P = 0.004) were significantly higher in the EIFL group than they were in the group without EIFL.

Conclusions

Eyes with EIFL had increased vitreous levels of M2 macrophage markers. The activation of glial cell proliferation by M2 macrophages may contribute to EIFL formation.

Efficacy and Safety of Combined Vitrectomy with Intravitreal Dexamethasone Implant for Advanced Stage Epiretinal Membrane

Purpose

To evaluate the efficacy and safety of combined 25-gauge (G) pars plana vitrectomy (PPV) with intravitreal dexamethasone implant (DXI) for the treatment of advanced stage epiretinal membrane (ERM).

Methods

Forty consecutive pseudophakic eyes with idiopathic stage 3-4 ERM and intraretinal cysts were randomly assigned to two treatment groups. Twenty eyes underwent combined 25-G PPV, ERM peeling and slow-release DXI (DEX group), whereas 20 eyes underwent standard 25-G PPV with ERM peeling only (control group). Differences in postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT) were evaluated.

Results

In all patients, BCVA significantly increased at 1, 3 and 6 months after surgery compared to baseline (all p < 0.05), but at 3 and 6 months, the visual gain was higher in the DEX group (respectively, p = 0.036, p = 0.006). CMT was significantly lower in DEX group compared to control group at 3 and 6 months after surgery (respectively, p = 0.042, p = 0.003). There was no statistically significant difference in IOP change over the course of the follow-up between groups (p > 0.05).

Conclusion

Combined 25-G PPV with DXI is associated with better anatomical and functional outcomes in patients with advanced stage ERM.

Changes in Metamorphopsia, Visual Acuity, and Central Macular Thickness after Epiretinal Membrane Surgery in Four Preoperative Stages Classified with OCT B-Scan Images

Purpose

To observe the changes in metamorphopsia, visual acuity, and central macular thickness (CMT) in patients undergoing vitrectomy for idiopathic epiretinal membranes (iERM); all of which were preoperatively stratified into 4 stages according to the anatomical structure of the macula seen on the optical coherence tomography (OCT) b-scan images.

Methods

A total of 108 eyes of 106 patients were included. We evaluated and classified the severity of each preoperative ERM based on OCT. Changes in the best-corrected visual acuity (BCVA), metamorphopsia, and CMT were studied by comparing the pre- and postoperative measurements. The follow-up time was at least 6 months.

Results

There were 41 eyes at stage 2, 35 at stage 3, 32 at stage 4, and none at stage 1. BCVA and metamorphopsia significantly improved at the final visit in all patients (P < 0.01). However, comparing the pre- and postoperative measurements at each stage, only the BCVA and CMT improved significantly for all stages (P < 0.001). For stages 2 and 3 ERMs, the horizontal (MH) and vertical (MV) metamorphopsia scores decreased significantly after surgery (P < 0.05). No significant difference was found in either MH or MV for stage 4 ERMs (P both >0.05). The preoperative BCVA, MH, and CMT had significant difference among the three stages (P < 0.05). Similarly, the postoperative values in the three variables mentioned above also had significant difference among the three stages (P < 0.05). For stage 2 ERMs, the baseline MH and MV were positively correlated with the baseline CMT. The MH and MV at the final follow-up also presented a significant positive correlation with the baseline CMT. For stage 3 ERMs, only the baseline MV showed significant correlation with the CMT.

Conclusion

Categorization of the preoperative ERMs is a useful method to predict the postoperative improvement in metamorphopsia, which would aid in surgical decisions for patients with ERMs.

Serous Retinal Detachment Causes a Transient Reduction on Spectral Domain OCT Estimates of Ganglion Cell Layer Thickness

SIGNIFICANCE

During the acute stage of central serous chorioretinopathy (CSC) with retinal elevation, the spectral domain optical coherence tomography (SD-OCT) estimate of ganglion cell layer complex thickness is reduced. Thickness returns to normal after resolution of the event. Measurement error is at least partially responsible for this effect. The reduction in ganglion cell layer complex thickness does not represent atrophy and is not predictive of a poor outcome.

PURPOSE

We investigated the effects of serous retinal detachment on the ganglion cell layer complex analysis (GCA) by SD-OCT in CSC patients during the acute episodes and after resolution of fluid.

METHODS

We retrospectively reviewed medical records of 30 patients who visited the hospital with a first episode of CSC. We analyzed GCA maps using SD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) at the initial visit with serous retinal elevation and after the absorption of subretinal fluid. For repeatability analysis, we used the intraclass correlation and repeatability coefficient from two consecutive measurements 5 minutes apart in 12 patients.

RESULTS

At the initial visit, an average thickness of ganglion cell layer complex was thinner than that measured in the fellow eye (67.4 ± 27.4 μm), but after the absorption of subretinal fluid, it normalized to 87.0 ± 6.7 μm; the difference was statistically significant. The intraclass correlation and repeatability coefficient were low during the period of serous elevation but normalized after fluid resorption. Abnormalities of GCA resulted from the segmentation error of ganglion cell layer and inner plexiform layer during the acute phase of CSC.

CONCLUSIONS

Serous retinal detachment can affect the GCA and repeatability measurements of the GCA. Clinicians should consider this finding when using the GCA measurement in the diagnosis and management of the patients with retinal contour changes such as retinal elevation including CSC.

Disorganization of Retinal Inner Layers as a Biomarker for Idiopathic Epiretinal Membrane After Macular Surgery-The DREAM Study

PURPOSE

Epiretinal membrane (ERM) can cause distortion and disorganization of all inner retinal layers. The purpose of our study was to evaluate the extent of disorganization of the retinal inner layers (DRIL) and to investigate its predictive value for visual outcome in cases of idiopathic ERM that were treated by pars plana vitrectomy (PPV) and ERM peeling.

DESIGN

Multicenter international retrospective case series.

METHODS

In 90 eyes from 90 patients with idiopathic ERM treated by PPV and membrane peeling with 12-month follow-up, optical coherence tomography (OCT) scans previous to surgery were evaluated for presence and severity of DRIL, central foveal subfield thickness (CST), maximal retinal thickness (MRT), presence of intraretinal cystoid changes and subretinal fluid, and integrity of the inner/outer segment layer and of the interdigitation zone. Best-corrected visual acuity (BCVA), CST, and MRT were recorded at baseline and at 3, 6, and 12 months after surgery. Correlations between baseline OCT measures (DRIL) and functional and visual outcome were analyzed. Main outcome measures are presence and severity of DRIL at baseline; anatomic and functional outcomes after 3, 6, and 12 months; and the correlation between DRIL and baseline characteristics and outcome measures.

RESULTS

Patients without and with mild DRIL had a significantly better baseline BCVA compared with patients with severe DRIL (0.61 ± 0.13, 0.56 ± 0.23, 0.73 ± 0.20 [logMAR], respectively). BCVA, CST, and MRT at baseline were statistically significantly correlated with DRIL severity (P = .003, P < .001, and P < .001, respectively). DRIL status before surgery showed a statistically significant interaction with change in BCVA, CST, and MRT over 12 months (P < .001 for all). Patients without and with mild DRIL gained a mean of 3 lines of vision after 12 months, in contrast to 1 line in patients with severe DRIL.

CONCLUSIONS

DRIL grading correlates with functional and anatomic measures in patients with idiopathic ERM and could serve as a biomarker to predict outcome after surgery. Patients with severe DRIL have limited benefits from surgery. This should be considered in the decision process whether to perform ERM peeling in this patient group.

Clinical significance of ectopic inner foveal layers in patients with idiopathic epiretinal membranes

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.

Insights Into Epiretinal Membranes: Presence of Ectopic Inner Foveal Layers and a New Optical Coherence Tomography Staging Scheme

PURPOSE

To describe the presence of continuous ectopic inner foveal layers associated with epiretinal membranes (ERMs) and to present a new optical coherence tomography (OCT) staging system of ERMs.

DESIGN

Retrospective multicenter observational case series.

METHODS

Clinical charts and spectral-domain OCT images of 194 eyes of 172 consecutive patients diagnosed with ERMs were reviewed and analyzed.

RESULTS

The presence of continuous ectopic inner foveal layers was identified in 63 out of 194 eyes (32.5%) and this morphology was significantly associated with lower visual acuity. ERMs were divided into 4 stages. Stage 1 (43 out of 194 eyes, 22.1%) ERMs were mild and thin and a foveal depression was present. Stage 2 (88 out of 194 eyes, 45.4%) ERMs were associated with widening of the outer nuclear layer and loss of the foveal depression. Stage 3 (51 out of 194 eyes, 26.3%) ERMs were associated with continuous ectopic inner foveal layers crossing the entire foveal area. In stages 1, 2, and 3 all retinal layers were clearly defined on OCT. Stage 4 ERMs (12 out of 194 eyes, 6.2%) were thick and associated with continuous ectopic inner foveal layers. In addition, retinal layers were disrupted. Visual acuity progressively declined from stage 1 through stage 4 (P < .001).

CONCLUSIONS

The presence of continuous ectopic inner foveal layers in ERMs is a newly described OCT finding associated with significant vision loss and is an essential element of a novel OCT-based grading scheme of ERMs that may influence visual prognosis.