Predictive value of ectopic inner foveal layer without internal limiting membrane peeling for idiopathic epiretinal membrane surgery

Changes in optical coherence tomography biomarkers in eyes with advanced idiopathic epiretinal membrane treated with dexamethasone implantation

PURPOSE

To investigate the effects of vitrectomy and intravitreal dexamethasone (DEX) implantation on retinal biomarkers in patients with advanced idiopathic epiretinal membrane (IERM) and to evaluate this treatment's anatomical and functional outcomes.

METHODS

This retrospective study included 41 patients with advanced IERM who underwent vitrectomy and were divided into a pars plana vitrectomy (PPV) group (20 eyes) and a dexamethasone (DEX) group (21 eyes) based on intravitreal DEX implantation. We collected data on best-corrected visual acuity (BCVA), central macular thickness (CMT), disorganization of the retinal inner layers (DRIL), subretinal fluid, intraretinal cystoid changes (IRC), integrity of the inner-outer segment layer, and intraocular pressure.

RESULTS

BCVA improved significantly in both groups; the DEX group had a higher visual acuity gain at 1 and 6 months (P = 0.002 and 0.023, respectively). Postoperative CMT gradually decreased in both groups, with the DEX group showing a greater decrease at 1 and 6 months (P = 0.009 and 0.033, respectively). Six months after surgery, the DRIL and IRC grades in the DEX group were significantly improved compared to those in the PPV group (P = 0.037 and 0.038, respectively). Multivariate regression analyses revealed that patients with intraoperative DEX implants were more likely to have a significant CMT reduction (≥ 100 μm) from baseline (odds ratio (OR), 9.44; 95% confidence intervals (CI), 1.58-56.56; P = 0.014) at 6 months and less likely to exhibit DRIL at 6 months postoperatively (OR, 0.08; 95% CI, 0.01-0.68; P = 0.021).

CONCLUSION

Vitrectomy combined with intravitreal DEX implantation facilitates the recovery of postoperative visual acuity and improvement of anatomical outcomes in patients with advanced IERM, effectively reducing CMT and improving DRIL.

Impact of intravitreal triamcinolone injection following epiretinal membrane peeling on ectopic inner foveal layer classification

PURPOSE

This study aimed to evaluate the impact of intravitreal triamcinolone acetonide (TA) administration after peeling of idiopathic epiretinal membranes (iERM) on both anatomical and visual outcomes, utilizing the ectopic inner foveal layer (EIFL) staging scheme.

METHODS

In this retrospective case-control study, we analyzed 43 eyes from 43 patients diagnosed with iERM between June 2019 and December 2021. All participants were categorized into the TA or control groups based on administering intravitreal TA injection following ERM peeling. We thoroughly reviewed the clinical data, including the preoperative and postoperative best-corrected visual acuity (BCVA), central foveal thickness (CFT), and macular cube volume (VOL), with ERM stages classified according to the EIFL staging scheme.

RESULTS

The study enrolled 22 eyes in the TA and 21 in the control groups. Following a mean follow-up period of 11.07 ± 2.02 months, noteworthy improvements in EIFL stages were observed in both cohorts (p < 0.01), but without significant distinctions between groups. In the TA group, 63.64% of eyes demonstrated improvements in EIFL stages, while the control group exhibited 76.19% (p = 0.37). At the final visit, both groups experienced a noteworthy reduction in the postoperative CFT and VOL (p < 0.05), coupled with significant improvement in BCVA (p < 0.01). No substantial differences appeared between the two groups concerning BCVA, CFT, and VOL (all p > 0.05).

CONCLUSIONS

Our study suggested that concurrent intravitreal TA injection following ERM removal did not provide additional benefits regarding anatomical and visual improvement in iERM cases classified as Stages 2 and 3.

Influence of Preoperative Foveal Layers’ Thickness on Visual Function and Macular Morphology by Phacovitrectomy for Epiretinal Membrane

Background. The aim of this retrospective study with short, differently dispersed follow-up is to record the relationships between the pathologies of the individual foveal layers, measured by spectral domain optical coherence tomography (SD-OCT), and to investigate their influence on pre- and postoperative best-corrected decimal far visual acuity (BCVA) by phacovitrectomy for epiretinal membrane (ERM) in comorbidity with cataract. Patients and Methods. 208 eyes of 173 patients with symptomatic idiopathic ERM and moderate cataract were included. Results. In all OCT morphological stages of ERM, as well as in their combination with macular lamellar hole (MLH) and vitreomacular traction (VMT), a significant difference in the thickness of the individual fovea layers was found. In addition, the entire fovea thickening led to the proportional thickening of the individual fovea layers ( $p<0.001$ ). The larger the central foveolar (CFT, R2 = −0.238, $p=0.002$ ), maximum foveal (MFT, R2 = −0.267, $p=0.001$ ), and ONL thickness (R2 = −0.16, $p=0.044$ ) were preoperatively, the worse the initial visual acuity was at all OCT stages of ERM. This was even more significant in the presence of a tractive component in the case of MLH or VMT ( $p<0.001$ ). In ERM without a traction component, only ONL thickening led to significant postoperative visual acuity reduction (R2 = −0.163, $p=0.047$ ). The foveolar retinal thickening (CFT and MFT) of the pure ERM is directly associated with distortion of the retinal layers (R2 = 0.292, $p<0.001$ and R2 = 0.287, $p<0.001$ ) as well as with separation of the ERM (R2 = 0.168, $p=0.034$ and R2 = 0.187, $p=0.018$ ). When ERM was combined with tractive component, CFT, ONL, and INL thickness correlated (positively) with the integrity of ellipsoid zone (R2 = 0.342, $p<0.05$ ) and external limiting membrane (R2 = 0.548, $p<0.001$ ). Conclusions. ONL thickening in ERM without a tractive component serves as a limited prognostic factor of postoperative visual acuity decrease. The preoperative BCVA in the groups of ERM with traction component showed significant correlation with CFT as well as with the thickness of individual foveal layers. VMT in ERM correlates with the disintegration of the ellipsoid zone.