Quantitative cone contrast threshold testing in patients with differing pathophysiological mechanisms causing retinal diseases

BACKGROUND

Cone contrast threshold testing (CCT) provides quantitative measurements of color and contrast function to reveal changes in vision quality that are not standard endpoints in clinical trials. We utilize CCT to measure visual function in patients with multiple sclerosis (MS), age-related macular degeneration (AMD), epiretinal membrane (ERM), and retinal vein occlusion (RVO).

METHODS

Retrospective data was gathered from 237 patients of the Gavin Herbert Eye Institute. Subjects included 17 patients with MS, 45 patients with AMD, 41 patients with ERM, 11 patients with RVO, and 123 healthy controls. Patients underwent the primary measurement outcome, CCT testing, as well as Sloan visual acuity test and spectral domain optical coherence tomography during normal care.

RESULTS

Color and contrast deficits were present in MS patients regardless of history of optic neuritis. AMD with intermediate or worse disease demonstrated reduced CCT scores. All 3 stages of ERM demonstrated cone contrast deficits. Despite restoration of visual acuity, RVO-affected eyes demonstrated poorer CCT performance than unaffected fellow eyes.

CONCLUSIONS

CCT demonstrates color and contrast deficits for multiple retinal diseases with differing pathophysiology. Further prospective studies of CCT in other disease states and with larger samples sizes is warranted.

Effect of Internal Limiting Membrane Peeling or Not on Blood Flow Signal in Macular Area of Diabetic Patients with Preretinal Membrane

PURPOSE

To study the effect of intraoperative internal limiting membrane (ILM) peeling on the macular vascular structure in patients with diabetic epiretinal membrane (ERM).

METHODS

Patients with diabetic ERM were divided into an ERM + ILM peeling group (18 eyes) and an ERM peeling group (19 eyes), all of whom underwent standard vitrectomy and were followed up until 6 months postoperatively. Best-corrected visual acuity (BCVA), Central macular thickness (CMT), Vessel density (VD) and vessel length density (VLD) of the superficial as well as deep retinal capillary plexus were compared between the two groups.

RESULTS

There was no significant difference in BCVA (p = .188, .410, .901, .916) and CMT (p = .164, .128, .110, .105) between the two groups at the week 1, month 1, month 3 and month 6 after operation. In the superficial capillary plexus (SCP), the change in VD (p = .106) and VLD (p = .438) was not affected by ILM peeling, and there was no significant difference in VD (p = .154, .063, .100, .162) and VLD (p = .386, .263, .431, .391) between the two groups during the four follow-up after operation. For the deep capillary plexus (DCP), there was an effect of ILM peeling on the changes in VD (p = .024) and VLD (p = .012), ILM peeling delayed the recovery time of the VD and VLD; The VD (p = .026, .000, .003) and VLD (p = .005, .000, .000) of ERM + ILM peeling group were lower than those of ERM peeling group from the month 1 to the month 6 after operation.

CONCLUSION

Intraoperative peeling of the ILM in patients with diabetic ERM delayed the improvement of blood flow signal in the DCP but did not affect the recovery of postoperative BCVA and CMT.

Assessment of histological and immunohistochemical features of retinal tissues using a novel tissue submission procedure

We introduce a novel tissue submission procedure without additional equipment or storage facilities for assessing the histological and immunohistochemical features of retinal tissues. In total, 150 specimens were collected from patients who underwent vitrectomy or macular surgery from January to December 2020. Ninety-eight specimens were submitted using the new procedure, and 58 specimens were submitted as flat-mount slides to compare specimen adequacy. The tissues submitted using the new procedure were subjected to paraffin-embedding and sectioning for hematoxylin & eosin staining. Additional immunohistochemical analysis was performed to assess the cellular composition in retinal tissues with diverse etiologies. The new submission procedure had an adequacy ratio of 75.51%, which was comparable to that of the flat-mount method (p = 0.1397). The new method could produce high-quality images of histological features of tissues and facilitated immunohistochemical analysis to demonstrate cell origins. More glial cells (p = 0.000) and myofibroblasts (p = 0.012) were detected in the epiretinal membranes (ERMs) than in the internal limiting membranes (ILMs). Subgroup analysis revealed that secondary ERMs contained more macrophage-like cells (p = 0.001) and retinal pigment epithelial cells (p = 0.000) than did idiopathic ERMs. Our novel tissue submission procedure can be applied to routine clinical practice. Our study provides additional histological and immunohistochemical evidence of cellular components in retinal tissues based on a large number of human tissue samples. Moreover, tissues submitted using the new method can be permanently preserved, enabling future investigation for potential prognostic or therapeutic targets.

Assessment of Risk Factors Affecting Refractive Outcomes after Phacovitrectomy for Epiretinal Membrane

PURPOSE

To investigate factors associated with refractive outcomes after phacovitrectomy for epiretinal membrane (ERM).

METHODS

Retrospective review of patients undergoing phacovitrectomy for ERM was done. The main outcome measure was predictive refraction error (PE), defined as observed refraction error - target refraction error, calculated by the SRK/T, Haigis, and SRK II formulae. PE was measured at postoperative 1, 3, and 6 months. Simple and multiple linear regression analysis were used to evaluate factors associated with PE.

RESULTS

A total of 53 eyes of 53 patients were included. The mean PEs at postoperative 1, 3, and 6 months were all negative, implying myopic shift in all patients regardless of the intraocular lens formula used. Haigis formula showed the least myopic shift among the three formulae (p = 0.001, Friedman test). There was no significant difference in PE depending on preoperative central macular thickness (CMT) in subgroup analysis. On stepwise multiple linear regression analysis, ERM etiology (β = 0.759, p = 0.004, SRK/T formula; β = 0.733, p = 0.008, Haigis formula; β = 0.933, p < 0.001, SRK II formula), preoperative anterior chamber depth (β = -0.662, p = 0.013, Haigis formula; β = -0.747, p = 0.003, SRK II formula), and decrease of CMT (β = -0.003, p = 0.025, SRK/T formula) were significantly associated with PE at postoperative 6 months.

CONCLUSIONS

Myopic shift in PE was observed after combined phacovitrectomy for epiretinal membrane. ERM etiology, preoperative anterior chamber depth, and decrease of CMT were significantly associated with PE at postoperative 6 months. There was no difference in PE after surgery between the two groups defined by CMT (≥500 and <500 μm).

Risk of Tertiary, Quaternary, and Quinary Proliferative Vitreoretinopathy: Analysis of a Nationwide Database (2010-2017)

OBJECTIVE

Primary proliferative vitreoretinopathy (PVR) is established as an important cause of the failed repair of a fresh retinal detachment (RD) and the consequent need for secondary repair. However, the burden of multiple repairs beyond the initial failure has not been studied in detail. We aimed to determine the association between primary PVR and the occurrence of tertiary, quaternary, and quinary RD repairs, using a nationwide database.

DESIGN

Retrospective cohort study of insurance claims.

SUBJECTS

Cases of rhegmatogenous RD that underwent primary surgical repair.

METHODS

Cases of primary RD repair from 2010 to 2017 were categorized based on the absence (P0 group) or presence (P1 group) of primary PVR. In each group, we analyzed the frequency of subsequent RD repair procedures with concurrent PVR.

MAIN OUTCOME MEASURE

The risk of secondary and higher multiples of PVR-associated RD repair.

RESULTS

A total of 27 137 cases were included, with 24 500 (90.3%) in the P0 group and 2637 (9.7%) in the P1 group. The frequency (%) of cases ultimately requiring secondary, tertiary, quaternary, and quinary repair in P0 versus P1 was 1.88 versus 10.24 (P < 0.001), 0.26 versus 2.50 (P < 0.001), 0.07 versus 0.64 (P < 0.001), and 0.03 versus 0.08 (P = 0.272), respectively. The risk of undergoing secondary repair was higher in the P1 than in the P0 group (hazard ratio [HR], 6.02; 95% confidence interval [CI], 5.24-6.92; P < 0.001). The risk of undergoing tertiary repair was also higher in the P1 than in the P0 group (HR, 1.67; CI, 1.23-2.28; P = 0.001). There was no difference in the risk of undergoing quaternary repair between the groups (HR, 0.76; CI, 0.41-1.40; P = 0.37). Senary repairs were not detected in this dataset.

CONCLUSIONS

Primary PVR may increase the risk of requiring multiple sequential retinal reattachment surgeries beyond the initial repair failure. Retinal detachment cases with primary PVR at the initial presentation of RD were more likely to undergo secondary and tertiary repairs than cases without primary PVR. Health care claims analysis may be a useful tool to study population-based estimates for multiple recurrences of RD in cases with PVR.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Reproducibility of each retinal layer thickness measurement in epiretinal membrane patients with ectopic inner foveal layers

BACKGROUND

To identify the reliability of each retinal layer thickness measurement in epiretinal membrane (ERM) patients with ectopic inner foveal layers (EIFLs).

METHODS

Subjects were divided into two groups: ERM patients with EIFLs (Group 1) and without EIFLs (Group 2). The retinal layer thickness was measured twice, and intraclass correlation coefficient (ICC) and coefficient of variation (CV) values were calculated.

RESULTS

In Group 1, the CVs of the nerve fiber layer (NFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL) were 22.39%, 13.12%, 13.37%, 13.21%, 15.09%, and 11.94%, while the ICCs were 0.431, 0.550, 0.440, 0.286, 0.279, and 0.503, respectively. In Group 2, the CVs were 18.20%, 10.59%, 10.65%, 13.27%, 14.75%, and 10.37%, while the ICCs were 0.788, 0.834, 0.830, 0.715, 0.226, and 0.439, respectively. The average central macular thickness (CMT) was significantly correlated with the CVs of NFL (coefficient = 0.317; P < 0.001), GCL (coefficient = 0.328; P < 0.001), and IPL (coefficient = 0.186; P = 0.042) in Group 1.

CONCLUSIONS

The reproducibility of the inner retinal layer thickness measurements in ERM patients with EIFLs was low compared to those without EIFLs. The reproducibility of the outer retinal layer thickness measurements, including OPL and ONL, was poor regardless of the presence of EIFLs in ERM patients. Additionally, the thicker the CMT in patients with EIFLs, the lower the reproducibility of the inner retinal layer thickness measurements.

Displacement of the retina and changes in the foveal avascular zone area after internal limiting membrane peeling for epiretinal membrane

PURPOSE

We investigated the differences in displacement of the outer and inner macular retina toward the optic disc after vitrectomy with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM). Foveal avascular zone (FAZ) area changes were also investigated.

STUDY DESIGN

Retrospective observational study METHODS: This retrospective observational case series included 45 eyes of 43 patients that underwent vitrectomy with ERM and ILM peeling for ERM and 38 normal eyes. The locations of the centroid of the FAZ (C-FAZ, center of the foveal inner retina) and foveal bulge (center of the foveal outer retina) were determined using 3×3mm superficial optical coherence tomography angiography. C-FAZ and foveal bulge displacements, and the pre- and postoperative FAZ areas and their associated factors, were investigated.

RESULTS

Postoperative C-FAZ dislocated significantly more toward the optic disc than in pre-operative or normal eyes (P<0.001). C-FAZ and foveal bulge displaced toward the optic disc after surgery; C-FAZ showed significantly greater displacement than foveal bulge (P<0.001). The pre- and postoperative FAZ areas were correlated (P=0.01). Preoperative FAZ areas ≧0.10mm² were reduced after surgery, and FAZ areas < 0.10mm² were increased, independent of foveal displacement.

CONCLUSION

ILM peeling during vitrectomy for ERM caused larger displacement of the inner and smaller displacement of the outer retinas, towards the optic disc. Postoperative changes in the FAZ area were dependent on the baseline FAZ area, but not on the foveal displacement. ILM may physiologically exert centrifugal tractional forces on the fovea.

Spontaneous resolution of inflammatory epiretinal membrane: Case series and review of the literature

Epiretinal membrane (ERM) represents a common complication of uveitis that may contribute independently to vision loss in patients with uveitis. Although spontaneous idiopathic ERM separation has been previously reported, to the best of our knowledge there are only two case reports in the scientific literature that depicts spontaneous regression of an inflammation-associated ERM. Spontaneous ERM separation is a rare but possible event, which occurs most often subsequent to posterior vitreous detachment. We present a case series of three patients with uveitis that exhibit the formation and subsequent spontaneous resolution of an inflammatory ERM.

Clinical characteristics of patients with epiretinal membrane-Foveoschisis

PURPOSE

The purpose of this study is to investigate the clinical and morphological characteristics of epiretinal membrane (ERM)-Foveoschisis.

METHODS

Medical charts of 2088 patients diagnosed with idiopathic ERM were screened and eyes with ERM-Foveoschisis were included. All eyes underwent a complete ophthalmological examination including spectral domain optical coherence tomography (SD-OCT). OCT features and best corrected visual acuity (BCVA) were analysed. ERM-Foveoschisis was defined as open, closed, elevated or flat based on the OCT features. Ellipsoidal zone (EZ) abnormality, intraretinal cystoid spaces, central foveal thickness (CFT), posterior vitreous detachment (PVD) and lens status were assessed.

RESULTS

One hundred-sixty-six patients (175 eyes) (72% female, mean age 70.46 years) were included. Incidence of ERM-Foveoschisis was 6.7%. Open type was seen in 86.8% and had a significantly better mean BCVA than closed type (p = 0.01). No statistically significant difference of mean BCVA was noted between the elevated and flat types. Mean BCVA was significantly lower in eyes with EZ abnormality (p = 0.03) and eyes with intraretinal cystoid spaces (p = 0.02). Patients with 'closed' ERM-Foveoschisis showed a significant higher median CFT than 'open' ERM-Foveoschisis (respectively, 364 µm and 176 µm, p < 0.001). A total of 81.9% eyes had PVD.

CONCLUSION

We differentiated four morphological types of ERM-Foveoschisis based on the OCT examination. Closed ERM-Foveoschisis presented with a higher CFT and lower BCVA than the open type. ERM-Foveoschisis with cystoid intraretinal spaces presented with a lower BCVA. The impact of the morphological types of the ERM-Foveoschisis on the clinical course and for therapy decision requires further long-term studies.

Spontaneous closure of an idiopathic macular hole after epiretinal membrane development

Purpose

To report non-operative closure of an idiopathic full thickness macular hole (FTMH) spontaneous secondary to the development of a macular epiretinal membrane (ERM).

Observations

A 68-year-old woman, with no relevant medical history, and a 6-month history of decreased visual acuity in her right eye was diagnosed to have an idiopathic FTMH. The patient refused surgery and the FTMH was followed-up for seven years. The spectral domain optical coherent tomography follow-up showed the evolution of the FTMH and its spontaneous closure after development of an ERM. In the presence of an ERM with vitreo-papillary detachment, it is possible that the centripetal forces involved helped bring together the edges of the macular hole resulting in a possible spontaneous closure. Additionally and separately, the presence of an ERM may act as scaffolding for Muller cell migration and consequent macular hole closure.

Conclusions and importance

Development of an ERM was followed by non-operative FTMH closure in this specific case. It is important to note, that this is an extraordinary situation in which the patient had a favorable anatomical evolution despite having rejected conventional surgical intervention. Studies aimed at determining the mechanisms and situations in which these cases occur could provide answers that help us make more appropriate decisions. To our knowledge, the present case is the first in the literature to report a spontaneous closure of a FTMH secondary to the appearance and progression of a previously non-existent ERM.

Changes in the Hyperreflective Bands of Outer Retinal Layers after Idiopathic Epiretinal Membrane Surgical Removal

Purpose: The purpose of this study was to describe the relationship between the outer retinal hyperreflective bands and visual acuity recovery after idiopathic epiretinal macular membrane (ERM) surgical removal.Methods: A prospective longitudinal non-comparative study was conducted that included a total of 68 patients with idiopathic ERM, who underwent consecutive 23 G pars plana vitrectomy (PPV) at San Juan University Hospital (Alicante, Spain) from January 2019 to January 2021. All patients underwent a complete preoperative standard ophthalmic examination, including measurement of best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) examination. This protocol was repeated at 1 and 3 months after surgery.Results: Mean preoperative decimal BCVA was 0.30 ± 0.13 and disruption of the first, second, third and fourth outer retinal hyperreflective bands was observed by SD-OCT in 9 (27.9%), 27 (39.7%), 33 (48.5%) and 17 patients (25%), respectively. BCVA improved after ERM peeling at 1 and 3 months in all patients, regardless of the presence of disruption in any hyperreflective band. Significantly larger improvement of BCVA was found at 3 months after surgery in patients not showing disruption of hyperreflective bands 1 and 4 (p = 0.048 and 0.001, respectively).Conclusions: The integrity of the outer retinal hyperreflective bands by SD-OCT in patients with idiopathic ERM is a valuable tool to determine the visual prognosis of the surgical treatment of this condition. A successful recovery of hyperreflective bands 1 and 4 with ERM surgery may be a potential biomarker of the visual improvement achieved due to their important anatomical relation with cone photoreceptors at the foveal level.

Effect of peripheral laser photocoagulation retinopexy on macular morphology and optic nerve fiber layer thickness; a prospective case series

PURPOSE

The goal of the research was to determine the incidence of microstructural alterations in the macula and optic nerve head (ONH) occurred in eyes treated with peripheral laser photocoagulation retinopexy.

METHODS

Patients with retinal breaks, retinal holes, retinal dialysis, and lattice degenerations who required peripheral laser photocoagulation retinopexy were recruited in this prospective case series investigation. We performed preoperative and postoperative evaluations, including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP) measurement, funduscopic examination, and macular and ONH optical coherence tomography (OCT).

RESULTS

Thirty-three eyes of the twenty-three patients enrolled in this study, 14 of which were female. The mean age of the sample was 45.12 ± 9.12 years. The mean refractive error was - 2.45 ± 1.12 Diopters (D). The most prevalent reason for peripheral laser photocoagulation retinopexy was retinal thinning with symptomatic lattice degeneration (90%), followed by retinal hole and break (7%) and retinal dialysis (3%). Between preoperative and postoperative (6-month) evaluation, there was no statistically significant difference in BCVA (P = 0.82), IOP (P = 0.54), central foveal thickness in macular OCT (P = 0.39), or global retinal nerve fiber layer (RNFL) thickness (P = 0.51). There was no association between changes in central foveal thickness and global RNFL thickness and total laser spot numbers (r = - 0.17 P = 0.21, r = 0.06 P = 0.60, respectively). None of patients developed cystoid macular edema (CME) or macular epiretinal membrane (ERM) .

CONCLUSION

We found that OCT parameters were not significantly affected by laser retinopexy in patients with high-risk peripheral retinal lesions, also none of our patients had developed ERM, vitromacular traction or CME at 6 months follow up periods.

Natural History and Surgical Timing for Idiopathic Epiretinal Membrane

PURPOSE

This study assessed the prevalence of progression to surgery on idiopathic epiretinal membrane (iERM) and compared the results with those of immediate surgery.

DESIGN

Retrospective study with nested case-control comparison.

SUBJECTS

Patients with mild iERM at initial presentation METHODS: A retrospective study with a nested case-control study was conducted to compare the outcomes of those who later progressed to surgery ("deferred surgery") with those of a control group that underwent surgery within 6 months of initial presentation ("immediate surgery").

MAIN OUTCOME MEASURES

The prevalence of performing vitrectomy with membrane peeling after initial deferral, features associated with deferred surgery, and the visual acuity (VA) outcomes of surgery compared with those with immediate surgery.

RESULTS

A total of 413 patients were included in the base study cohort: 369 did not undergo iERM peeling, whereas 44 (10.7%) underwent deferred surgery at a mean duration of 18.1 months after initial presentation. The factor most associated with later progression to surgery, determined using a multivariate analysis, was symptoms at initial presentation (odds ratio [95% confidence interval], 8.75 [3.80-20.15]; P < 0.0001). The immediate surgical group (controls) had a poorer logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at presentation compared with the deferred surgery group (cases), but this decreased in the latter group to about the same preoperative level immediately before the deferred surgery (typically why they underwent surgery). The final logMAR BCVA was similar in the deferred and immediate surgical groups when only pseudophakic cases were analyzed. An analysis of the change from preoperative BCVA (instead of initial) to final BCVA showed no difference in the magnitude of change between the pseudophakic subgroups of the deferred and immediate surgery groups (median [interquartile range] preoperative VA of 0.52 [0.40-0.60] in the deferred surgery group and 0.44 [0.39-0.60] in the immediate surgery group [P = 0.7256]). Within the deferred and immediate surgery groups, the median change from preoperative BCVA to final BCVA in the pseudophakic subgroups was 0.22 (P = 0.0082) in the former and 0.21 (P = 0.0001) in the latter.

CONCLUSIONS

The vast majority of eyes with iERM remain stable after initial presentation. The deferral of surgery in the minority of patients who progress does not have a disadvantageous final outcome compared with immediate surgery.

LOCTseg: A lightweight fully convolutional network for end-to-end optical coherence tomography segmentation

This article presents a novel end-to-end automatic solution for semantic segmentation of optical coherence tomography (OCT) images. OCT is a non-invasive imaging technology widely used in clinical practice due to its ability to acquire high-resolution cross-sectional images of the ocular fundus. Due to the large variability of the retinal structures, OCT segmentation is usually carried out manually and requires expert knowledge. This study introduces a novel fully convolutional network (FCN) architecture designated by LOCTSeg, for end-to-end automatic segmentation of diagnostic markers in OCT b-scans. LOCTSeg is a lightweight deep FCN optimized for balancing performance and efficiency. Unlike state-of-the-art FCNs used in image segmentation, LOCTSeg achieves competitive inference speed without sacrificing segmentation accuracy. The proposed LOCTSeg is evaluated on two publicly available benchmarking datasets: (1) annotated retinal OCT image database (AROI) comprising 1136 images, and (2) healthy controls and multiple sclerosis lesions (HCMS) consisting of 1715 images. Moreover, we evaluated the proposed LOCTSeg with a private dataset of 250 OCT b-scans acquired from epiretinal membrane (ERM) and healthy patients. Results of the evaluation demonstrate empirically the effectiveness of the proposed algorithm, which improves the state-of-the-art Dice score from 69% to 73% and from 91% to 92% on AROI and HCMS datasets, respectively. Furthermore, LOCTSeg outperforms comparable lightweight FCNs' Dice score by margins between 4% and 15% on ERM segmentation.

Risk of Cystoid Macular Edema after Cataract Surgery in Retinitis Pigmentosa: An Analysis of United States Claims from 2010 to 2018

PURPOSE

Cataract surgery is commonly performed to improve vision in patients with retinitis pigmentosa (RP). However, the risk of postoperative cystoid macular edema (CME) in RP remains unclear. Here, we leveraged a large multiyear claims database to estimate the risk of CME after cataract surgery in patients with and without RP.

DESIGN

Retrospective multicenter cohort.

SUBJECTS

Patients aged 18 to 65 years who underwent single-phase cataract surgery between January 1, 2020, and December 31, 2018. Identified using the IBM MarketScan claims database.

METHODS

We evaluated the baseline characteristics and outcomes and estimated the hazard ratio (HR) using a multivariable mixed-effects approach. The eyes of patients with RP were categorized as group R1, and those without diagnoses of RP by the time of surgery were categorized as group R0.

MAIN OUTCOME MEASURES

Incident postoperative CME in the same eye that underwent cataract extraction within 12 months of the procedure.

RESULTS

We included 468 123 patients and 615 645 eyes. This included 124 eyes with RP (R1) and 615 521 without RP (R0). The mean ages were 50.5 ± 9.8 years in R1 and 57.9 ± 6.1 years in R0. The cumulative incidence of CME at 12 months was 5.8% (95% confidence interval [CI] 1.2%-10.3%) in R1, and it was 1.1% (95% CI 1.1%-1.2%) in R0. On average, CME was reported in R1 subjects 3.9 weeks later than in R0 subjects (95% CI 2.04-6.5 weeks; P <0.001). The subjects in R1 had 4.83 (95% CI 2.13-10.93, P <0.001) times the risk of CME compared to the subjects in R0. A stratified analysis showed that epiretinal membrane (ERM) decreased the risk of CME in R1 (HR 0.12 [95% CI 0.48-0.97; P = 0.004]) but increased it in R0 (HR, 4.32 [95% CI 3.13-5.95; P <0.001]).

CONCLUSIONS

The cataract surgery-related risk of CME among patients with RP may be >4 times that among people without RP. Men and individuals aged 18 to 34 and 55 to 65 years may be at the greatest risk, whereas ERM may lower the risk. Further study is warranted to stratify the risk by RP genotype and phenotype and illuminate the natural history, angiographic features, and functional consequences of postoperative CME.

Risk factors for epiretinal membrane formation and peeling following pars plana vitrectomy for primary rhegmatogenous retinal detachment, an OCT guided analysis

Background

To evaluate the rate and risk factors of epiretinal membrane (ERM) formation and need for ERM peeling after pars plana vitrectomy (PPV) for uncomplicated primary rhegmatogenous retinal detachment (RRD).

Methods

Retrospective, single-center, cohort study of 119 consecutive patients (119 eyes) that underwent RRD repair using PPV. The primary outcomes were ERM formation, classified using an optical coherence tomography grading system, and the rate of ERM peeling. Visual acuity, postoperative complications, and risk factors for ERM formation and peeling were also identified.

Results

Postoperative ERM formation occurred in 69 eyes (58.0%); 56 (47.1%) were stage 1, 9 (7.6%) stage 2, 3 (2.5%) stage 3, and 1 (0.8%) stage 4. Only 6 (5.0%) eyes required secondary PPV for a visually significant ERM, with a mean time to reoperation of 488 ± 351 days. Risk factors for ERM formation included intraoperative cryotherapy, more than 1000 laser shots, 360° laser photocoagulation, and choroidal detachment (p < 0.01). Eyes with more than 3 tears had a trend towards increased ERM surgery (p = 0.10).

Conclusions

Visually significant ERM formation following PPV for primary RRD was uncommon in this cohort (5%). Half of the ERMs were detected after the first post-operative year, indicating that this complication may be underreported in studies with only 1-year follow-up.

Macular toxicity of vital dye after pars plana vitrectomy for idiopathic epiretinal membrane: A case report

Purpose

To describe the first reported case of outer retinal damage following the use of Membrane Blue Dual for epiretinal membrane (ERM) surgery.

Observations

A 74-year-old female underwent pars plana vitrectomy and ERM peeling assisted with Membrane Blue Dual for an idiopathic ERM. Postoperatively, the patient reported a decline in visual acuity with a central scotoma. Fundus examination revealed a well-defined retinal whitening in the peeling area which evolved into pigmentary changes as confirmed by fundus autofluorescence. Optical coherence tomography (OCT) showed loss of outer retinal layers and irregular mottling of the retinal pigment epithelium. Fundus and OCT appearance remained unchanged after 4 months and the central scotoma also persisted.

Conclusions and Importance

ERM surgery assisted with Membrane Blue Dual can induce major changes in retinal pigment epithelium and outer retinal layers. This adverse event which probably results from combined light and dye toxicity should be considered by all surgeons even though its occurrence is rare.

Combined epiretinal and internal limiting membrane retracting door flaps for large macular holes associated with epiretinal membranes

PURPOSE

To assess the closure rate of large full-thickness macular holes (FTMH) associated with epiretinal membrane (ERM) with a combined epiretinal and internal limiting membrane retracting door flap.

METHODS

Retrospective chart review of patients treated at a single tertiary retina practice between January 2017 and November 2019. Individuals with FTMH larger than 400 μm and co-diagnosis of ERM who underwent surgical repair with an ERM flap were included. Patients underwent pars plana vitrectomy with peeling of ERM that was positioned as a retracting door flap to cover the FTMH. Primary outcome was closure rate at 6 months following surgery. Final surgical success rate and visual acuity were secondary outcomes.

RESULTS

Among 7 eyes of 7 patients, 6 eyes achieved primary surgical success and final surgical success rate was achieved in all 7 eyes with a large FTMH repaired with ERM flap. The mean minimum linear diameter of the FTMH was 681 μm ± 295. All patients had follow-up greater than 6 months, with a mean duration of 17 months (range 14-23 months). Visual acuity improved from a mean of 0.9 ± 0.3 logMar (20/160) before surgery to 0.3 ± 0.5 logMar (Snellen 20/40), postoperatively.

CONCLUSION

Large FTMH with concurrent ERM that are managed with an ERM flap have high single-surgery success rate.

Clinical outcomes after implantation of extended depth-of-focus AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane

PURPOSE

To evaluate the clinical outcomes of extended depth-of-focus (EDoF) AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane (ERM).

METHODS

Forty-five eyes with low-grade ERM and history of Vivity implantation were compared with 50 age-matched controls with Vivity implantation and no ERM. Eyes with ERM showing widening of the outer nuclear layer and loss of the foveal depression, but no ectopic inner foveal layer or outer retinal defect were eligible. Corrected and uncorrected distant visual acuity (CDVA and UDVA), uncorrected intermediate and near visual acuity (UIVA and UNVA), contrast sensitivity detected by area under the log contrast sensitivity function (AULCSF), Strehl ratio, area ratio, and occurrence of dysphotopsia were compared between groups.

RESULTS

UDVA and CDVA were similar between groups (UDVA: 0.01 ± 0.05 vs 0.03 ± 0.06, P = 0.154; CDVA: 0.00 ± 0.00 vs 0.00 ± 0.02, P = 0.125). UIVA and mesopic AULCSF were significantly worse in eyes with ERM compared to those with no ERM (UIVA: 0.09 ± 0.09 vs 0.14 ± 0.10, P = 0.028; mesopic AULCSF: 1.26 ± 0.15 vs 1.17 ± 0.10, P = 0.013). The occurrence of dysphotopsia was similar in both groups (glare: P = 0.465; halo: P = 0.218; starburst: P = 0.457).

DISCUSSION

Eyes with low-grade ERM showed comparable outcomes to eyes without ERM after Vivity IOL implantation. Implantation of this newly developed EDoF IOL with low addition can be of benefit to eyes with low-grade, reversible ERM that is limited to the inner retina.

Structural and functional outcomes of pars plana vitrectomy in patients with lamellar macular hole

PURPOSE

To investigate the short-term functional and microstructural outcomes of pars plana vitrectomy (PPV) without gas tamponade in lamellar macular holes (LH).

MATERIALS AND METHODS

In this prospective case series, LH cases diagnosed by optical coherence tomography (OCT) underwent PPV with epiretinal membrane (ERM) removal and internal limiting membrane peeling without gas tamponade. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and OCT imaging preoperatively and 3 months after the surgery.

RESULTS

Among 22 eyes, 10 degenerative (Deg) LH, 8 tractional (Trac) LH, and 4 mixed-type LH were assessed. After the surgery, anatomical closure occurred in 20 eyes (91%) without any significant difference between LH subgroups. Comparing preoperative and postoperative values, no significant changes was detected regarding BCVA neither totally (P = 0.5) nor in subgroups (P for Deg = 1.0, Trac = 0.71, Mix = 0.18). The overall central foveal thickness was increased significantly after surgery (P < 0.01), but in subgroup analysis, the increase was significant only for Trac LH (P = 0.02). The tractional LH eyes had less ellipsoid zone (EZ) disruptions compared to Deg or mixed subgroups before surgery. There were no changes in EZ integrity before and after the surgery. In regression analysis, no correlation was found between demographic or clinical characteristics and anatomical closure or BCVA improvement postoperatively.

CONCLUSION

PPV resulted in 91% anatomical closure of all cases of LH but without functional improvement in short-term. Further prospective clinical trials with larger sample size and longer follow-up would be required to confirm the clinical significance of these findings.

Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications

INTRODUCTION

The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options.

MATERIAL AND METHODS

Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant.

RESULTS

33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA.

CONCLUSIONS

The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications.

Preoperative ocular coherence tomographic prognosticators of visual acuity after idiopathic epiretinal membrane surgery

PURPOSE

To provide a current review of the evidence for the utility of preoperative ocular coherence tomography (OCT) parameters in prognosticating postoperative visual acuity and visual improvement after idiopathic epiretinal membrane surgery. To determine which OCT bio-markers are most useful in this regard and where future studies may apply more emphasis.

METHODS

An extensive search of the PubMed database was performed for studies investigating this relationship. Key search terms included: idiopathic, epiretinal membrane, surgery, peel, vitrectomy, vision, outcomes, visual acuity, ocular coherence tomography, central foveal thickness, foveal contour, foveal morphology, ectopic inner foveal layers, inner retinal layers, inner retinal irregularity index, outer retinal layers, ellipsoid zone, interdigitation zone, photoreceptor outer segment length, central bouquet abnormality, staging, choroidoscleral irregularity, ganglion cell and nerve fibre layers, inner and outer plexiform layers, inner and outer nuclear layers. Forty-nine peer-reviewed articles were included in this review. These consisted of 28 retrospective studies [1-3,13,16-18,20,23-29,32-36,38,40,42-47], 17 prospective studies[6-12,14,19,21,22,30,31,37,41,48,49], 2 reviews [4,39] and 2 systematic reviews [5,15].

CONCLUSION

The weight of literary evidence seems to support photoreceptor integrity as the most consistent OCT marker of better postoperative visual acuity. This includes analysis of ellipsoid and interdigitation zones as well as photoreceptor outer segment length. However, the newer OCT staging system proposed by Govetto et al. (2017) fulfils a need for a clinically useful and evidence-based OCT classification. It may be the way forward in prognosticating ERM surgical outcomes by preoperative stratification. There is insufficient evidence to suggest the other discussed parameters in this review as useful prognosticators of postoperative visual acuity.

Vascular tortuosity analysis in eyes with epiretinal membrane imaged by optical coherence tomography angiography

Background

This study aimed to evaluate macular vessel tortuosity using optical coherence tomography angiography (OCTA) and its association with visual outcomes in eyes undergoing surgery for epiretinal membrane (ERM).

Methods

The study included 22 consecutive patients who underwent vitrectomy for ERM between May 2019 and July 2020 and OCTA at Osaka University Hospital. All patients underwent ophthalmologic examinations, including swept-source OCTA. Standard vitrectomy was performed, and the patients were followed up for 6 months postoperatively. Distortion of retinal vessels was calculated using two parameters: the actual vessel length in the vessel section (VL) and the direct vessel branching point distance (BD) in the three quadrants (nasal, temporal, and superior-inferior) of the macula. We analyzed the correlation between these parameters and visual outcomes.

Results

Significantly longer VL was found at 1, 3, and 6 months postoperatively (p = 0.006, 0.008, and 0.022, respectively) in the temporal quadrant compared to baseline temporal VL. Significantly shorter VL was found in nasal quadrants at 1 and 3 months (p = 0.046 and p = 0.018) in the comparison of nasal baseline VL. VL/BDs were correlated with the same postoperative best-corrected visual acuity (BCVA) at 1, 3, and 6 months (p = 0.035, 0.035, and 0.042, respectively) in the superior-inferior quadrant. A significant association of changes in VL and BCVA was found at 3 and 6 months postoperatively in the nasal quadrant (p = 0.018 and 0.0455, respectively).

Conclusions

Changes in vascular distortion after ERM surgery can be measured using OCTA. The change in vessels around the macula became more linear; this was associated with visual outcomes after surgery.

Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study

BACKGROUND

Diffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling.

METHODS

This is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE).

RESULTS

Mean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 μm with the ERM to 313.70 ± 36.98 μm after PPV. Mean SE after lensectomy was - 0.18 ± 0.38 D, which minimally changed to - 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV.

CONCLUSION

PPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.

[Regression of idiopathic epiretinal membrane-Case report and consideration of the possible mechanism]

In the presence of a symptomatic epiretinal gliosis, pars plana vitrectomy with membrane peeling to remove the membrane is usually indicated in clinical practice. According to common clinical experience, almost no independent regression of such an epiretinal membrane and thus healing of the pathology alone exists. Therefore, the unusual case of bilateral independent regression of idiopathic epiretinal gliosis and formation of a lamellar macular hole in a 73-year-old male patient is described. Considerations of the possible mechanism are presented based on the existing literature. These include separation of inflammatory versus noninflammatory membranes, possible separation of individual layers depending on the status of the posterior vitreous limiting membrane and also the possible action of proteolytic systems in the posterior vitreous region. Finally, the question arises, whether patients have to be informed about this fact before possible surgery.