Negative correlation between retinal displacement and ganglion cell layer thickness changes in eyes with epiretinal membrane

PURPOSE

To examine retinal displacement after vitrectomy with internal limiting membrane peeling for epiretinal membrane treatment, and to determine the correlation between the extent of displacement and the ganglion cell layer thickness changes.

METHODS

Thirty-nine consecutive patients were evaluated. Optical coherence tomography was performed preoperatively, and 2 and 6 months postoperatively. The distance between the fovea, the vessel intersection in the superior nasal, superior temporal, inferior nasal, and inferior temporal macular regions, and the optic disk were measured. Ganglion cell layer thickness was recorded.

RESULTS

The distance from the optic disk to the fovea and the superior nasal and inferior nasal vessel intersections significantly reduced at 2 and 6 months. Ganglion cell layer thickness significantly decreased in all the subfields (except nasal) at 6 months. A significant negative correlation was found between the change in the ganglion cell layer thickness and the movement of the fovea toward the optic disk. The ganglion cell layer thickness changes significantly correlated with retinal displacement.

CONCLUSION

Retinal displacement toward the optic disk was detected after vitrectomy with internal limiting membrane peeling in eyes with epiretinal membrane. Ganglion cell layer thickness significantly reduced in all the subfields (except nasal). The extent of the displacement and the ganglion cell layer thickness changes showed significant negative correlation.

Intraoperative Dexamethasone Intravitreal Implant (Ozurdex) in Vitrectomy Surgery for Epiretinal Membrane

Objective: To study the effectiveness and safety of the intravitreal dexamethasone implant 0.7 mg (Ozurdex®) in vitrectomy surgery for epiretinal membrane.Methods: This is a prospective, multicenter, pilot study. Inclusion criteria included visually significant (<20/50) idiopathic epiretinal membrane. All patients underwent 23-gauge pars plana vitrectomy with membrane peeling and Ozurdex implant injection. The primary outcome measure was best corrected visual acuity (BCVA) change at 3 months. Secondary outcomes included BCVA at 6 months and changes in central retinal thickness (CRT). Intraocular (IOP) changes were monitored and cataract progression in phakic patients was documented.Results: 15 patients were enrolled in the study, 12 eyes of 12 patients were included in the analysis. Mean preoperative BCVA was 50.67 ETDRS letters and improved significantly to 63.67 (+12.91 letters, p = .008) at 3 months. Mean CRT improved from 548 to 409 microns (p = .002) at 3 months. The IOP showed mild elevation at months 1 and 2 and returned almost to baseline at month six. There were no complications related to the steroid implant injection procedure in an air-filled eye.Conclusions: Intra-operative injection of Ozurdex® at the conclusion of PPV can be done safely. The peak IOP and lowest CRT after 2 months strengthens the findings of prior studies demonstrating Ozurdex activity up to 3 months in vitrectomized eyes.

Effect of Subfoveal and Extrafoveal Hyporeflective Zones due to Iatrogenic Traction during Membrane Peeling for Epiretinal Membranes on Postoperative Outcomes

PURPOSE

The aim of our study using an intraoperative optical coherence tomography (iOCT) device was to assess the rate of neurosensory elevation with resulting subfoveal and extrafoveal hyporeflective zones during membrane peeling and to evaluate a possible influence on postoperative outcomes.

PROCEDURES

This study included patients scheduled for pars plana vitrectomy with membrane peeling due to idiopathic epiretinal membrane. All patients underwent 23-G pars plana vitrectomy with iOCT-guided membrane peeling and were scheduled for follow-up examinations at 1 day, 5 days, and 3 months after surgery.

RESULTS

Among the 171 patients included, subfoveal and extrafoveal hyporeflective zones could be detected in 12 patients (7%). Follow-up at 3 months after surgery was available for 149 patients with a median improvement in best corrected visual acuity of +2 lines (IQR: +1 to +4 lines). There were no significant differences in outcomes between patients with and those without subfoveal/extrafoveal hyporeflective zones concerning visual acuity, macular thickness, occurrence of intraretinal cystoid changes, and postoperative hyporeflective zones.

CONCLUSIONS

No significant differences in postoperative outcomes were observed between patients with and those without subfoveal/extrafoveal hyporeflective zones.

Spectral domain optical coherence tomography findings in myotonic dystrophy

The purpose of the study is to evaluate retinal involvement in a cohort of patients affected by Myotonic Dystrophy type 1 (DM1). Both eyes of 30 patients and one eye of a 31st patient with genetically proven diagnosis of DM1 and both eyes of 20 healthy age- and gender-matched subjects were enrolled. All patients underwent complete ophthalmologic examination including best-corrected visual acuity, intraocular pressure measurement, fundoscopy, fundus autofluorescence, infrared imaging and spectral-domain optical coherence tomography with central macular thickness measurement. DM1 patients showed statistically significant higher central macular thickness values than controls. In the DM1 group, butterfly (14.8%) and reticular (13.1%) pigment abnormalities were found with corresponding drusenoid deposit and focal disruption of photoreceptor and retinal pigment epithelium layers. Compared with the controls, DM1 group had higher prevalence of epiretinal membrane. In the DM1 group, the prevalence of epiretinal membrane and retinal pigment epithelium alterations were directly correlated with age, whereas no correlation was found with disease duration, CTG expansion and MIRS score. In conclusion, in addition to the typical retinal pigment epithelium changes, DM1 is also associated with abnormalities of the vitreoretinal interface, particularly epiretinal membrane, resulting in central macular thickness increase. Both inner and outer retinal alterations were associated with increasing age, suggesting that DM1 may cause a premature aging of the retina.

Postoperative eccentric macular holes after surgery for vitreomacular interface diseases

PURPOSE

To assess the incidence, clinical characteristics, and outcome of postoperative eccentric macular hole (ECMH) after epiretinal membrane (ERM), macular hole (MH), and idiopathic vitreomacular traction (VMT) surgery and discuss the underlying possible mechanisms.

METHODS

A retrospective study was carried out for 711 eyes of 711 consecutive patients who underwent 25-gauge pars plana vitrectomy (PPV) with ERM (396 eyes), MH (268 eyes), and VMT (47 eyes) surgery between 2010 and 2016. Mean follow-up time was 19 months.

RESULTS

Eight patients developed ECMH (1.12%). Four of the patients were ERM, three patients were idiopathic full thickness MH, and one patient was ERM and lamellar pseudohole. There was no ECMH in patients with VMT. The average time of hole formation after vitrectomy was 7.25 weeks with a range from 2 to 15 weeks. Three patients developed 2 ECMH, and others had 1 ECMH. The location of the ECMH was mostly in the temporal of fovea. All patients were asymptomatic. No retinal detachment or choroidal neovascularization occurred in any patient and no additional intervention was attempted in the postoperative period in any case.

CONCLUSION

Postoperative ECMH may be seen after vitreomacular interface surgery. They are mostly asymptomatic, usually do not require additional intervention and often located in the parafoveal area. ILM peeling-induced muller cell damage, residual ILM contraction, and iatrogenic trauma may play a role as the underlying cause in our case series.

[Lamellar macular holes : Morphological characteristics and treatment success]

BACKGROUND

In recent years the high resolution of optical coherence tomography (SD-OCT) has led to a more exact and detailed imaging of different morphological types of lamellar macular holes (LMH). This resulted in new knowledge on the pathogenesis, morphology and progression of the disease; however, this also resulted in a lack of clarity in the terminology and in particular led to uncertainty in the treatment of these patients in clinical practice.

OBJECTIVE

This article gives an overview on the morphological characteristics and treatment indications for LMH with the aim of enabling a clear differentiation compared to other morphological alterations in traction macular pathologies.

MATERIAL AND METHODS

The evaluation is based on the current literature and own study data from the Department of Ophthalmology at the University of Munich, Germany.

RESULTS

In eyes with LMH different morphological forms can be seen in SD-OCT. In addition to the known diagnostic criteria of irregular foveal contour, intraretinal splitting and defect of the inner foveal layers, the occurrence and characteristics of epiretinal tissue as well as the occurrence of photoreceptor layer defects can be evaluated.

CONCLUSION

Further development of imaging techniques, such as SD-OCT led to improved visualization of different types of LMH. Decisions on treatment should be based on subjective complaints, best corrected visual acuity (BCVA), the clinical course, the presence of defects of the ellipsoid zone, occurrence and characteristics of epiretinal tissue. In cases of progression of symptoms and/or traction by the epiretinal tissue, an early surgical procedure has a good prognosis for functional and anatomical rehabilitation.

[Macular pucker surgery with and without delamination of the internal limiting membrane-a prospective randomized study]

BACKGROUND

There is evidence that additional internal limiting membrane (ILM) removal reduces the recurrence rate after pucker surgery with a similar functional outcome. On the other hand, morphological changes of the inner retinal layers after ILM peeling have been described. The aim of this study was to compare the long-term data after vitrectomy with and without ILM delamination in order to uncover possible differences in morphological and functional results.

METHODS

In a prospective study of 32 patients with idiopathic epiretinal membrane, 16 patients were randomized into each of 2 groups. Both groups underwent pars plana vitrectomy (ppV) with peeling of the epiretinal membrane. In group 1 no forced additional peeling of the ILM was performed and in group 2 the ILM or ILM residues were additionally removed after staining. The investigated parameters were visual acuity, central retinal thickness (CRT) in optical coherence tomography (OCT), metamorphopsia and surgical complications. The time points of the examinations were directly preoperative, after 1, 3 and 6 months and partly 8.4 years postoperatively.

RESULTS

In group 1 (n = 15) the preoperative mean visual acuity improved from 0.54 logMAR to 0.38 logMAR after 6 months postoperatively (n = 13). Of this group 6 patients could be examined in the long-term course and the visual acuity improved further to 0.32 logMAR after 8 years. The CRT decreased from 473 µm preoperatively to 235 µm in the long-term interval. In group 2 (n = 15) the mean visual acuity preoperatively was 0.47 logMAR and improved 6 months postoperatively (n = 13) to 0.38 logMAR and in the long-term examination (n = 5) to 0.1 logMAR. The CRT in this group decreased from 417 µm preoperatively to 278 µm in the long-term interval. In group 1 one recurrence occurred in the follow-up period, in group 2 none.

CONCLUSION

The study showed that there was no significant difference in visual acuity and CRT between the two groups neither after 6 months nor after 8 years of follow-up. The observed recurrence in the group without ILM delamination underlines the assumption that additional ILM peeling could reduce the recurrence rate.

Choroidal thickness and intraocular pressure after 25-gauge and 23-gauge vitrectomy for idiopathic epiretinal membrane

PURPOSE

To determine the relationship between the subfoveal choroidal thickness (SCT) and intraocular pressure (IOP) following 25-gauge (25G) and 23-gauge (23G) vitrectomy for idiopathic epiretinal membrane (ERM).

STUDY DESIGN

Retrospective, consecutive, interventional case series.

METHODS

Sixty-two patients undergoing 25G vitrectomy and 56 patients undergoing 23G vitrectomy for ERM participated. SCT was measured using enhanced depth imaging optical coherence tomography and IOP were measured both at baseline and postoperatively.

RESULTS

In both groups, the IOPs on day one and one week after surgery were significantly lower than at baseline (P < 0.001 for both). The rates of changes of IOP were significantly greater in 23G compared to 25G on day one (P = 0.026). In 23G the SCTs on day one and one week after surgery were significantly thicker (P < 0.001) than baseline. The rates of changes in SCT between baseline and day one negatively correlated with those of IOP in 23G (r = -0.559, P < 0.001) but no correlation was observed with 25G (r = -0.129, P = 0.316).

CONCLUSION

Choroidal thickness increases soon after 23G vitrectomy for ERM which is probably due to the transient hypotony, however, early SCT change does not appear in 25G vitrectomy. Twenty-five-gauge vitrectomy may have an advantage in minimizing postoperative choroidal changes.

[Correlation of capillary plexus with visual acuity in idiopathic macular epiretinal membrane eyes using optical coherence tomography angiography]

Objective: To observe changes in foveal avascular zone(FAZ) and capillary plexus in idiopathic macular epiretinal membrane (IMEM) in optical coherence tomography angiography (OCTA) and analyze their correlation with the visual acuity. Methods: Cross-sectional study. 42 patients (15 Males and 27 females, age 64.8) from the Eye Hospital of Wenzhou Medical University were included with 51 eyes diagnosed as IMEM (IMEM group), and 23 normal eyes (9 Males and 14 females, control group). All patients received the examination of fissure lamp combined with fundus pre-set lens, best corrected visual acuity (BCVA), OCT angiography (OCTA) and fundus photo. OCTA was performed on 3 mm× 3 mm sections centred on the fovea. The software automatically measured the superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density(VD) and retinal thickness(RT) and FAZ area. The IMEM eyes were compared with the normal eyes and correlation between the parameters of OCTA and BCVA was analyzed in IMEM. Independent-sample t test and MannWhitney test were used for comparison between groups, and Spearman test was used for correlation analysis. Results: LogMAR BCVA in the IMEM group was 0.40(0.15, 0.70), in the control group was 0.10(0.05, 0.22). FAZ area of IMEM group was (0.09±0.05) mm(2), while that of control group was (0.34±0.13)mm(2).Compared with the control group, in IMEM group, the BCVA was worse (Z=-4.443, P<0.001), FAZ area was smaller (t=-9.198, P<0.001), RT was increased (P<0.001), The foveal DCP and SCP vessel density was increased (t=4.280, 9.079, P<0.01), The parafoveal DCP vessel density was decreased (P<0.05), The parafoveal SCP vessel density was decreased in superior, inferior and nasal side (t=-2.759, Z=-3.998, Z=-2.108; P<0.05). The BCVA was negatively correlated with FAZ area (r=-0.337, P=0.017), positively correlated with center macular thickness (r=0.324, P=0.020). The BCVA was no correlated with foveal VD and parafoveal DCP vessel density (P>0.05), but correlated with SCP vessel density(P<0.05). Conclusions: In the IMEM eyes the BCVA was worse, FAZ area was smaller, foveal vessel density was increased and the parafoveal vessel density was decreased compared with the normal eyes. The smaller the FAZ area, the smaller foveal SCP vessel density, the poorer BCVA. There was no correlation between BCVA and DCP vessel density. Changes in VD in IMEM eyes may lead to changes in vision. (Chin J Ophthalmol, 2019, 55:757-762).

Visual Prognostic Factors of Epiretinal Membrane Surgery in Patients with Pseudophakia

PURPOSE

To evaluate the visual prognostic factors in patients with pseudophakic epiretinal membrane (ERM) after vitrectomy using spectral domain optical coherence tomography (SD-OCT).

METHOD

A retrospective review of patients with pseudophakic ERM having undergone vitrectomy was conducted. Best corrected visual acuity (BCVA) and SD-OCT were conducted before and 1, 3, and 6 months after vitrectomy. Known visual prognostic factors, such as inner-retina irregularity index, central foveal thickness (CFT), central inner retinal layer thickness (CIRLT), cone outer segment tip defect length, and photoreceptor outer segment length, were reviewed and their correlation with BCVA was analyzed.

RESULTS

Forty-three patients (mean age: 64.88 ± 10.46 years) with pseudophakic ERM were included. BCVA significantly improved after vitrectomy (logMAR 0.30 ± 0.24 vs. 0.11 ± 0.14, p < 0.001). The preoperative high inner-retina irregularity index significantly correlated with poor postoperative BCVA in patients with pseudophakic ERM (correlation coefficient 0.583, p < 0.001). Postoperative improvements of inner retinal SD-OCT findings, such as inner-retina irregularity index, CFT, and CIRLT, were significantly associated with the amount of BCVA improvement after ERM surgery (correlation coefficients were as follows: inner-retina irregularity index - 0.711, p < 0.001; CFT - 0.462, p = 0.002; CIRLT - 0.596, p < 0.001). However, preoperative outer retinal SD-OCT findings were not associated with postoperative visual prognosis.

CONCLUSION

From this study, we determined the visual prognostic factors of ERM surgery without confounding factors, such as visual acuity improvement following combined cataract surgery, and inner retinal SD-OCT findings more significantly associated with the visual prognosis of ERM surgery compared to outer retinal SD-OCT findings.

Foveal Abnormality associated with epiretinal Tissue of medium reflectivity and Increased blue-light fundus Autofluorescence Signal (FATIAS)

PURPOSE

To describe a distinct vitreomacular interface disorder (VMID) termed Foveal Abnormality associated with epiretinal Tissue of medium reflectivity and Increased blue-light fundus Autofluorescence Signal (FATIAS).

METHODS

A case series including forty-seven eyes of 47 patients. The included eyes must present an irregular foveal contour on optical coherence tomography (OCT) and a pathologically increased autofluorescent signal at the fovea on blue-light fundus autofluorescence (B-FAF). Main outcome measures were morphologic characteristics of the lesions, logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and central foveal thickness (CFT).

RESULTS

The following two types of FATIAS were identified: (1) the step type characterized by an asymmetric contour of the foveal pit and by a tissue of medium reflectivity on the foveal surface and (2) the rail type characterized by a shallow foveal pit and a rail of tissue of medium reflectivity on the foveal surface. The outer retinal bands were continuous in all cases. Both types presented with an area of increased B-FAF signal, usually bilobed in the step type and round and centered on the foveal pit in the rail type. LogMAR BCVA was 0.09 ± 0.1 and 0.1 ± 0.1 (P = 0.91), and CFT was 197.8 ± 9.7 and 202.2 ± 13.2 (P = 0.19) in the step and in the rail group, respectively.

CONCLUSIONS

We describe a distinct VMID named FATIAS. Two types of FATIAS may be appreciated with SD-OCT and B-FAF analyses, the step and the rail type. Both are characterized by abnormal foveal contour and autofluorescence signal.

Prospective study of vitrectomy for epiretinal membranes in patients with good best-corrected visual acuity

Background

To evaluate the efficacy of epiretinal membrane removal in patients with good best-corrected visual acuity (BCVA) for improving visual function and quality of life (QOL).

Methods

This prospective case study compared 37 subjects with preoperative BCVA ≦ 0.046 logMAR (Good group) to 35 patients with 0.10–0.52 logMAR (Moderate group) at 3 and 6 months. Linear mixed-effect models were used for statistical analysis. The primary outcome was the horizontal metamorphopsia score (MH) at 6 months postoperatively (post-6 M), while secondary outcomes were postoperative BCVA, vertical metamorphopsia score (MV), aniseikonia, stereopsis and central foveal thickness. In the Good group, QOL was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) at 6 and 12 months.

Results

MH was significantly improved at post-3 M and post-6 M in the both groups but there were no significant differences between the two groups. MV showed no improvement at the final observation in either group. LogMAR BCVA was significantly improved at post-6 M in the Good group, which had significantly better vision than the Moderate group. Preoperative vertical and horizontal aniseikonia scores remained unchanged in the Good group at post-6 M but worsened in the Moderate group. The NEI VFQ-25 score improved in the Good group, reflecting improved general health, general vision, and mental health.

Conclusions

Early epiretinal surgery for patients with BCVA ≦ 0.046 logMAR was effective for improvement of HM, BCVA, and QOL and prevented worsening of aniseikonia.

Trial registration

UMIN000021220. Registered 10 September 2015.

UMIN Clinical Trials Registry.

[Morphology of the vitreoretinal interface in fellow eyes of patients with full thickness macular holes]

PURPOSE

We performed a retrospective, observational clinical study to evaluate the vitreoretinal interface (VRI) in fellow eyes of patients with full thickness macular holes (FTMH) based on spectral domain optical coherence tomography (SD-OCT) examinations.

METHODS

The VRI in fellow eyes of 38 patients with idiopathic FTMH, 6 of which had concomitant vitreomacular traction (VMT) and the VRI of 32 patients with FTMH with complete resolution of VMT were examined by SD-OCT for the presence of vitreomacular adhesion (VMA), VMT and the formation of FTMH, lamellar macular holes (LMH), macular pseudoholes (MPH) or epiretinal membranes (ERM). Patients underwent complete ophthalmic evaluation, including SD-OCT at baseline and follow-up visits. To classify the morphology of the VRI, we used the international vitreomacular traction study classification system by Duker et al. (Ophthalmology 2013), evaluating the baseline SD-OCT data for significant classification parameters, including size of VMA, macular thickness and volume and structural changes of retinal layers.

RESULTS

Of the 38 eyes with FTMH, 2 (5.3%) fellow eyes also showed evidence of FTMH, 5 (13.2%) had isolated VMT while 5 (13.2%) showed formation of ERM, of which 2 demonstrated MPH. In 5 patients (13.2%) showing evidence of VMA and 17 patients (44.7%) with an unremarkable VRI, 22 fellow eyes (57.9%) showed no pathological morphology. Altogether, 16 fellow eyes (42.1%) of patients with FTMH showed pathological changes of the vitreoretinal interface.

CONCLUSION

This high-resolution SD-OCT-based retrospective study showed that fellow eyes of patients with VMT or FTMH were at increased risk of demonstrating pathological changes in the morphology of the VRI.

[Lamellar macular holes with hyporeflective epiretinal proliferation : OCT diagnostics and clinical course]

BACKGROUND

High-resolution spectral domain optical coherence tomography (SD-OCT) is the standard examination for assessment of lamellar macular holes (LMH). According to the current SD-OCT classification of LMHs, they are characterized by (1) an irregular foveal contour, (2) a defect in the inner fovea, and (3) a separation of inner retinal layers from outer retinal layers of the fovea leading to an intraretinal splitting with loss of retinal tissue.

OBJECTIVE

The article aims to give an overview on the current knowledge of retinal imaging in LMH diagnostics and clinical course of disease.

MATERIALS AND METHODS

This review is based on current literature and analyses of data from different case series from the Department of Ophthalmology, Ludwig-Maximilian University Munich, Germany.

RESULTS

In eyes with LMH, a homogenous atypical, hyporeflective epiretinal tissue has been described in addition to conventional tractional epiretinal membranes (ERM). By SD-OCT, this named lamellar hole-associated epiretinal proliferation (LHEP) does not show common signs of traction and is characterized as a thick homogenous layer of moderately reflective material. LHEP has been demonstrated to be related to the occurrence of photoreceptor layer defects, enlargement of LMH diameter and poor visual acuity.

CONCLUSION

The correlation of SD-OCT and en-face OCT can help to identify LMH subgroups and morphology progression early on. FAF enables detection of structural changes at a subclinical stage without visual deterioration. With regard to a high variability of intraretinal changes in LMHs and epimacular fibro-cellular proliferation, the current classification of LMH should be discussed and re-evaluated.

Vitreo-macular interface disorders in retinitis pigmentosa

PURPOSE

To investigate the prevalence and progression of vitreo-macular interface disorders (VMID) phenotypes and their natural history in retinitis pigmentosa (RP).

METHODS

A total of 257 eyes of 145 RP patients with VMID were retrospectively evaluated. Patients were divided according to the VMID subtypes into epiretinal membranes (ERMs), vitreo-macular traction (VMT) group, and macular hole (MH). Serial eye-tracked spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) changes were analyzed for a mean follow-up of 36.95 months. The status of posterior vitreous cortex was also considered. A control group of 65 eyes belonging to 65 RP patients with no macular changes was also recruited.

RESULTS

VMID and control groups had the same baseline BCVA (0.50 vs 0.44 LogMAR) and did not differ in terms of phakic status. Different VMID groups had similar BCVA at baseline (p = 0.98). ERM represented the most prevalent disorder (207/257 eyes, 80.5%), followed by 35/257 (13.6%) VMT, and 15/257 Lamellar MH (LMH) eyes (5.8%). There were no cases of full thickness MH. Throughout the 36.9 months of follow-up, BCVA decreased an average 0.09 LogMAR from 0.31 to 0.4 in VMID patients and 0.01 in controls. VMID subgroup analysis showed a significant BCVA decrease in ERM patients (- 20.29%, p < 0.001), while VMT and LMH did not change significantly. Foveal thickness also remained stable over time. Complete PVD was present in 11 eyes in ERM, VMT, and LMH.

CONCLUSIONS

Our study confirms the high prevalence of VMID in RP patients; however, only ERMs determined a significant loss of vision over 24 months. The high prevalence of VMID in RP patients suggests that macular alteration other than edema represents part of disease spectrum.

Proteomics reveals a set of highly enriched proteins in epiretinal membrane compared with inner limiting membrane

Few data exist regarding the protein composition of idiopathic epiretinal membrane (iERM). In the present study we compared the proteome of epiretinal membrane of iERM with the proteome of the inner limiting membrane (ILM) of idiopathic macular hole (iMH). Twelve epiretinal membrane samples were obtained from patients with iERM undergoing therapeutic vitrectomy. Twelve ILM samples from patients with iMH were used as controls. Proteomic analysis was conducted with discovery-based label-free quantitative nano-liquid chromatography - tandem mass spectrometry (LFQ nLC-MS/MS). Verification of results was performed with targeted MS using selected reaction monitoring on a different set of samples. Discovery data were searched against the Uniprot Homo sapiens protein database using MaxQuant Software. Identified proteins were filtered with Perseus software. Bioinformatic analysis of the differences in protein expression between epiretinal membrane from iERM and ILM from iMH was performed using STRING. A total of 2,183 different proteins were identified. 357 proteins were found to be present in all samples. The protein profile of iERM was highly different from iMH with 62 proteins found at significantly higher levels in iERM. The proteins upregulated more than 10-fold in iERM were: fibrillin-1, tenascin, prolargin, biglycan, opticin, collagen alpha-1(II) chain, protein-glutamine gamma-glutamyltransferase 2, fibronectin, filamin-A, collagen alpha-2(IX) chain, spectrin alpha chain, transforming growth factor beta induced protein ig-h3, dihydropyrimidinase - related protein 3, endoplasmin and glutamate dehydrogenase 1. Proteins with high level in iERM consisted of proteins that especially localized to the actin cytoskeleton, the extracellular matrix and the mitochondrion. Analysis of all proteins indicated that the disease process in iERM at least in part can be characterized as skin formation with perturbation of nucleotide metabolism. Our study identified proteins that have not earlier been associated with iERM. Fifteen proteins are found at very high concentration, 10-fold or more, and amongst these four proteins, fibrillin-1, tenascin, prolargin and biglycan were found at more than a 100-fold higher content compared to ILM of iMH. These proteins may be potential therapeutic targets. Data are available via ProteomeXchange with identifier PXD014286.

Epiretinal membrane profile on spectral domain optical coherence tomography in patients with uveitis

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.

Anatomical and functional changes in paravascular abnormalities after epiretinal membrane removal

PURPOSE

To investigate the anatomical and functional changes in areas containing paravascular abnormalities (PVA) in eyes with epiretinal membrane (ERM) after surgery.

METHODS

Twenty-eight eyes with concurrent idiopathic ERM and PVA were enrolled in this prospective study. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and areas of PVA in the superficial and deep capillary levels detected on en face optical coherence tomography were measured preoperatively and 1, 3, and 6 months postoperatively. Retinal sensitivity in selected PVA lesions was evaluated by microperimetry preoperatively and 1 and 6 months postoperatively.

RESULTS

The areas of PVA at the superficial capillary level before and 1, 3, and 6 months after surgery measured 1.65 ± 1.27, 0.44 ± 0.62, 0.40 ± 0.64, and 0.38 ± 0.62 mm², respectively, while those at the deep capillary level measured 0.27 ± 0.57, 0.10 ± 0.26, 0.09 ± 0.29, and 0.05 ± 0.15 mm², respectively. The areas of PVA in the superficial and deep capillary levels were significantly smaller postoperatively (all p < 0.001 at the superficial capillary level and p = 0.010 at the deep capillary level). Average retinal sensitivity values in the PVA lesions before and 1 and 6 months after surgery were 11.2 ± 3.5, 12.9 ± 3.2, and 13.2 ± 2.7 dB, respectively; the values at postoperative months 1 and 6 were significantly improved (p = 0.045 and p < 0.001, respectively). BCVA and CMT were significantly improved postoperatively.

CONCLUSION

PVA not only improves anatomically but also functionally after ERM surgery. Vitrectomy can improve not only central vision but also retinal sensitivity in areas of PVA.

Mapping diurnal variations in choroidal sublayer perfusion in patients with idiopathic epiretinal membrane: an optical coherence tomography angiography study

Background

Optical coherence tomography angiography (OCTA) is a non-invasive tool for imaging and quantifying the choroidal vasculature and perfusion state. In this index study, OCTA was used to investigate diurnal changes in choroidal sublayer perfusion in eyes with idiopathic epiretinal membrane (ERM) and to identify impacting factors.

Methods

A prospective study was conducted on volunteers with symptomatic ERM, each of whom underwent repeated measurements of subfoveal choroidal thickness (SFCT) using enhanced-depth imaging optical coherence tomography and perfusion of choroidal vascular sublayers using OCTA at 7 a.m., 12 p.m., 4 p.m., and 8 p.m. Possible interactions between diurnal variations and other factors, such as gender and age, were evaluated.

Results

A total of 21 eyes of 21 participants (mean age 72.43 ± 7.06 years) were analysed. A significant pattern of diurnal variation was observed for SFCT (p = 0.008) as well as perfusion of Haller's layer (HLP, p = 0.001). SFCT and HLP both demonstrated a quadratic relation to time of the day, decreasing from morning to afternoon, before increasing again in the evening. No significant differences with regard to gender or age were detectable.

Conclusion

OCTA-based analysis of choroidal sublayer perfusion demonstrated significant diurnal variations in patients with symptomatic ERM, which are quite different from changes reported in healthy eyes. Therefore, it is important to account for time of day, when comparing longitudinal OCTA data.

Comparison of the effect of ranibizumab and dexamethasone implant in diabetic macular edema with concurrent epiretinal membrane

OBJECTIVE

To compare the efficacy and safety of intravitreal ranibizumab (RZB) injections and intravitreal dexamethasone (DEX) implant in diabetic macular edema (DME) with concurrent epiretinal membrane (ERM).

METHODS

This was a retrospective, observational, comparative study. Medical records of DME patients with concurrent ERM were retrospectively reviewed. Seventeen eyes of 16 patients treated with 3 consecutive monthly RZB injections (RZB group) and 22 eyes of 18 patients treated with a DEX implant (DEX group) were included. The groups were compared at baseline, 1st, 2nd, 3rd and 4th months in terms of best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP).

RESULTS

Eighteen of the 39 eyes (46.1%) were phakic at baseline, 9 (52.9%) of which were treated with RZB, whereas 9 (40.9%) were treated with DEX implant (P=0.528). Although CMT improved significantly in both the RZB and DEX groups (P<0.001); the trend was different (P=0.003). The mean change in CMT at 1month in the DEX group was greater (DEX: 188.2±142.7μm; RZB: 95.7±110.7μm; P=0.034); it was in favor of RZB group at the 3rd and 4th months (DEX: -52.7±86.9μm; RZB: 1.4±31.4μm; P=0.012. DEX: -63±67.3μm; RZB: -5.8±43.9μm; P=0.004, respectively). BCVA improved significantly in both groups (P<0.001). There was no statistical difference between the groups with regard to gain in BCVA or IOP change throughout the study period (P=0.572, P=0.064, respectively).

CONCLUSION

Both RZB and DEX are effective in improving anatomical and visual outcomes in DME with concurrent ERM. The DEX group was associated with a prompt anatomic response, but with a gradual decrease from 3rd month.

The Role of Disorganization of Retinal Inner Layers as Predictive Factor of Postoperative Outcome in Patients with Epiretinal Membrane

PURPOSE

The purpose of this retrospective study was to evaluate the disorganization of the retinal inner layers (DRIL) as a potential predictive factor of postoperative visual outcome in patients with idiopathic epiretinal membrane (iERM), treated with pars plana vitrectomy (PPV).

METHODS

Participants in the study were 46 consecutive patients diagnosed with iERM, who underwent PPV. Best corrected visual acuity (BCVA) measurement and spectral-domain optical coherence tomography (SD-OCT) were performed at baseline (preoperatively), and at months 3 and 6 postoperatively. DRIL and additional OCT parameters were assessed at 1-mm-wide foveal centered area.

RESULTS

DRIL was observed in 47.8% of patients at baseline. There was statistically significant improvement in BCVA and central retinal thickness (CRT) between baseline and months 6 and 12 in all patients. There was a statistically significant difference in BCVA and CRT change between patients with and without DRIL at months 6 and 12 compared to baseline, showing that there was a correlation between change in BCVA or CRT and baseline DRIL. Ellipsoid zone and external limiting membrane were intact in 91.3 and 95.7%, respectively, not affecting our results.

CONCLUSIONS

Baseline DRIL has been shown to be predictive of postoperative visual outcome in patients with iERM, treated with PPV.

Outcomes after Epiretinal Membrane Surgery with or Without Internal Limiting Membrane Peeling

INTRODUCTION

The aim of this study was to assess the incidence of persistent postoperative cystoid macular edema (pCME) in patients undergoing pars plana vitrectomy with epiretinal membrane peel (ERM) only versus those with ERM peel combined with internal limiting membrane peel (ILM). Secondary endpoints of the study were to review both the central macular thickness (CMT) and visual acuity.

METHODS

The patients were divided in two groups, one group in which only the ERM was peeled (n = 36 patients) and another group in which both the ERM and the ILM were removed (n = 62 patients). The results were analyzed retrospectively. Each patient received a complete ophthalmological examination, including best-corrected visual acuity (BCVA) using an ETDRS chart and spectral domain optical coherence tomography, at three time points: prior to surgery and 3 weeks and 3 months after surgery.

RESULTS

A total 98 eyes of 98 patients were included in this study. The mean follow-up time was 7.7 months. CMT decreased significantly after surgery in all patients, and none of these changes differed significantly between the two groups. The BCVA increased significantly after surgery across all patients, and there were no significant changes between the two treatment groups. Postoperative pCME occurred in eight patients in each group, representing 22.2% of the 36 patients in the ERM only group and 12.9% of the 62 patients in the ERM/ILM peel group. However, this difference was not statistically significant.

CONCLUSIONS

No difference was found between the two groups in terms of incidence of pCME. Both groups experienced had similar decrease in the CMT and improvement in the BCVA postoperatively.

Treatment of Macular Edema after Pars Plana Vitrectomy for Idiopathic Epiretinal Membrane Using Intravitreal Dexamethasone Implant: Long-Term Outcomes

PURPOSE

The aim of this study was to investigate the efficacy and safety of intravitreal dexamethasone implant for the treatment of macular edema after pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal.

METHODS

This prospective study included 27 patients who were diagnosed with macular edema after PPV for ERM removal and who were treated with either intravitreal dexamethasone implant (n = 15) or were observed without intervention (n = 12). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed 1, 6, and 12 months -after treatment.

RESULTS

Patients treated with intravitreal dexamethasone implant showed significant improvement in BCVA and reduction in CRT at months 1, 6, and 12 after treatment, while patients in the control group showed improvement that did not reach statistical significance. The two groups differed significantly in terms of BCVA and CRT at all time points of the follow-up period, in favor of the dexamethasone implant group. Eighty percent of the patients treated with intravitreal dexamethasone needed only one implant until month 12, while no serious adverse events were noticed in any group.

CONCLUSIONS

Intravitreal dexamethasone implant was found to be effective and safe for the treatment of macular edema after PPV for ERM removal.

A Double Inverted Flap Surgical Technique for the Treatment of Idiopathic Lamellar Macular Hole Associated with Atypical Epiretinal Membrane

OBJECTIVES

To propose a new technique of a double inverted epiretinal membrane (ERM) and internal limiting membrane (ILM) flap (double flap group) for the treatment of idiopathic lamellar macular hole (LMH) with atypical ERM (AERM) and to compare surgical outcomes to those of the standard technique of ERM and ILM peeling of the fovea including LMH (control group).

METHODS

AERM was tomographically defined as a medium reflective thickened membrane above the retinal fiber layers without retinal traction signs. A series of patients affected by LMH with AERM were recruited. Preoperative parameters were: intraretinal cysts (IRC), intraretinal splitting diameter, residual foveal thickness, and ellipsoid zone integrity. Postoperative findings were: full-thickness macular hole (FTMH) development, and persistence or new appearance of IRC. Best-corrected visual acuity (BCVA) at baseline, first, third, and sixth postoperative month was evaluated.

RESULTS

A total of 48 eyes of 48 patients were included in this study. In the double flap group (30 eyes), a clear improvement of BCVA was noted (p = 0.004), and there were no complications. In the control group (18 eyes), BCVA did not improve and 3 patients developed postoperative FTMH.

CONCLUSIONS

The double inverted flap technique is associated with better functional recovery compared to the standard technique and reduces the risk of postoperative FTMH development.

Lamellar Macular Hole: State of the Art

Lamellar macular hole (LMH) is a vitreoretinal disorder characterized by an irregular foveal contour, a break in the inner fovea, dehiscence of the inner foveal retina from the outer retina, and the absence of a full-thickness foveal defect with intact foveal photoreceptors. The pathogenesis is only partially known. The advent of high-resolution optical coherence tomography has allowed distinguishing between two types of epiretinal membrane (ERM) associated with LMH: a conventional ERM (commonly found in macular pucker) and an atypical ERM (known by varied names: dense, epiretinal proliferation, or degenerative). These two types of ERM not only influence LMH morphology but also differ in cell and collagen composition. It remains unclear if these two types are indeed two distinct clinical entities or rather two stages of the same macular disorder. Studies of the natural evolution of LMH have not fully resolved this issue and also offered variable results. Surgical treatment leads to excellent anatomical and functional outcomes, but not without risks. This review provides a critical summary of the available data on LMH including some new insights.