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Subramanian B, Kumar M, Sen P, Raman R. Optical Coherence Tomography Characteristics for Differentiating Scars in Type 1 (Polypoidal Choroidal Vasculopathy (PCV)) and Type 2 (Classical) Macular Neovascularization (MNV) in Age-Related Macular Degeneration (AMD). Cureus 2024; 16:e62593. [PMID: 39027747 PMCID: PMC11257609 DOI: 10.7759/cureus.62593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE This study aimed to assess the optical coherence tomography (OCT) characteristics for differentiating scars in the scarred stages of macular neovascularization (MNV) in age-related macular degeneration (AMD). METHODS Medical records of 20 patients, 10 in each group with type 1 and type 2 MNV, were selected for the study. Participants chosen were above 50 years of age and underwent comprehensive eye examination alongside indocyanine green angiography (ICGA), fundus fluorescence angiography (FFA), and Spectralis optical coherence tomography (SOCT) (Heidelberg Engineering, Germany), respectively. The qualitative and quantitative OCT measurements, such as the frequency of outer retinal tubulations, presence of cystoid spaces, scar area, choroid thickness, retinal thickness, presence of disorganization in retinal layers (DRIL), foveal contour, and involvement of retinal layers in the scar, were meticulously evaluated and compared between the two groups. RESULTS Significant disparities between type 1 MNV and type 2 MNV in choroidal thickness were identified in the nasal and superior quadrants within 1 mm, in the superior quadrant within 3 mm, and in all quadrants except the inferior quadrant within 6 mm. Overall, type 2 MNV showed thinner choroid than type 1 MNV. CONCLUSION Although there are several overlapping features noticed between the groups, the OCT was able to pick up characteristic features that aid in differentiating type 1 (polypoidal choroidal vasculopathy (PCV)) and type 2 (classic) MNV in AMD. This precise differentiation has the potential to assist ophthalmologists in making well-informed decisions, thereby enhancing patient care.
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Affiliation(s)
- Brughanya Subramanian
- Department of Ophthalmology, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, IND
| | - Meenakshi Kumar
- Department of Ophthalmology, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, IND
| | - Parveen Sen
- Department of Ophthalmology, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, IND
| | - Rajiv Raman
- Department of Ophthalmology, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, IND
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Marolo P, Borrelli E, Caselgrandi P, Parisi G, Gelormini F, Ricardi F, Ceroni L, Fallico M, Toro MD, Ventre L, Reibaldi M. Comparison of Functional, Structural, and Microvascular Features in Different Stages of Idiopathic Epiretinal Membrane. J Clin Med 2024; 13:3188. [PMID: 38892898 PMCID: PMC11172683 DOI: 10.3390/jcm13113188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Idiopathic epiretinal membrane (ERM) often leads to visual symptoms such as metamorphopsia and decreased central vision. This study aimed to evaluate functional, structural, and microvascular characteristics in patients with different stages of idiopathic ERM who were candidates for surgery, with a focus on identifying potential indicators for surgical timing. Methods: A retrospective cohort study was conducted on consecutive patients with unilateral idiopathic ERM who were candidates for surgery. Patients underwent comprehensive ophthalmological assessments, including OCT grading, reading performance evaluation, and OCT angiography. Data analysis included comparisons between different ERM stages for functional, structural, and microvascular parameters. Results: A total of 44 eyes were included, classified into four ERM stages according to the Govetto grading system. Functional parameters, including distance and near visual acuity, worsened significantly with higher ERM stages, particularly in the transition from Stage 3 to Stage 4. Structural assessments revealed significant increases in central macular thickness (CMT) from Stage 3 to Stage 4. No significant differences were observed in microvascular features across different ERM stages. Conclusions: This study highlights the significant functional and anatomical impact of OCT staging in idiopathic ERM, particularly during the transition from Stage 3 to Stage 4, characterized by notable reductions in visual acuity and increases in CMT. These findings underscore the importance of considering both functional and structural parameters in surgical decision-making for ERM management. However, further research with larger cohorts is needed to confirm these observations and inform clinical practice.
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Affiliation(s)
- Paola Marolo
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Enrico Borrelli
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Paolo Caselgrandi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Guglielmo Parisi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Francesco Gelormini
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Federico Ricardi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
| | - Luca Ceroni
- Department of Psychology, University of Turin, 10124 Turin, Italy;
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy;
| | - Mario Damiano Toro
- Department of General Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland;
- Eye Clinic, Public Health Department, Federico II University, 80131 Naples, Italy
| | - Luca Ventre
- Department of Ophthalmology, Beauregard Hospital, 11100 Aosta, Italy;
| | - Michele Reibaldi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy; (E.B.); (P.C.); (G.P.); (F.G.); (F.R.); (M.R.)
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Belkin A, Harel G, Shtayer C, Bercovich O, Rubowitz A. THE EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON THE INNER RETINAL LAYERS IN PATIENTS WITHOUT MACULAR PATHOLOGIC CONDITION. Retina 2024; 44:831-836. [PMID: 38194675 PMCID: PMC11027973 DOI: 10.1097/iae.0000000000004042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND To examine the effect of internal limiting membrane peeling on the inner retinal layers in patients without macular pathological condition. METHODS A prospective nonrandomized trial of patients undergoing pars plana vitrectomy with internal limiting membrane peeling for pathologic condition outside the macula was performed. Optical coherence tomography including macular ganglion cell layer, inner plexiform layer, and peripapillary retinal nerve fiber layer imaging was performed before surgery, 1, 3, and 6 months postoperatively, and at the end of follow-up (ranges between 4 and 17 months). Patients with any macular pathological condition on optical coherence tomography before surgery were excluded. The main outcome measure was change in thickness of the ganglion cell layer and inner plexiform layer. RESULTS Ten patients who underwent pars plana vitrectomy with internal limiting membrane peeling for macula-on retinal detachment were included in the analysis. The mean age was 55 years, and the mean follow up was 10.8 months. All patients completed at least two postoperative follow-up visits that included an optical coherence tomography as per the protocol (range 2-6 months). There was an immediate reduction in the global (G), inferotemporal, superotemporal, and superior (S) ganglion cell layer thickness at the first follow up as compared with the preoperative state ( P = 0.028, P = 0.027, P = 0.026, and P = 0.027 respectively). From the first follow-up visit onward until the final follow-up, the thinning persisted, although there was no further statistically significant thinning. CONCLUSION Peeling of the internal limiting membrane causes significant ganglion cell layer thinning in maculae without pathologic condition before surgery. At up to 17 months of follow-up, this effect seems to be immediate and nonprogressive.
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Affiliation(s)
- Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Gal Harel
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
| | - Chen Shtayer
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
| | - Or Bercovich
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel
| | - Alexander Rubowitz
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and
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Muller YG, Lenoble P. [Clinical and pathophysiological contribution of OCT-angiography to epiretinal membranes]. J Fr Ophtalmol 2023; 46:776-790. [PMID: 37164872 DOI: 10.1016/j.jfo.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/30/2023] [Indexed: 05/12/2023]
Abstract
Epiretinal membranes may lead to centripetal contraction forces on the retina and its vessels. OCT-Angiography (OCT-A) is a recent tool which permits a non-invasive understanding of these vascular changes. This review focuses on the OCT-A findings in idiopathic epiretinal membranes, before and after surgery, and the role of internal limiting membrane peeling. It appears that contraction of the epiretinal membrane is associated with both a reduction in the area and perimeter of the foveal avascular zone and alterations in the superficial and deep capillary plexuses. These changes mainly reflect a vascular shift from the perifoveal to the foveal region, increasing with retinal deformation, but also probable dynamic changes in vascular flow. Membrane peeling allows at least partial improvement of these microvascular parameters. Nevertheless, some limitations of OCT-A, such as segmentation errors on a retina with highly modified architecture, can lead to a selection bias in the studies and should call for caution in the interpretation of the results. Finally, internal limiting membrane peeling contributes to changes in the retinal architecture after surgery, in particular by causing a centripetal movement of the macular capillaries and a displacement of the fovea toward the optic nerve head. This role should be clarified in future studies.
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Affiliation(s)
- Y-G Muller
- Université Louis-Pasteur, 67000 Strasbourg, France.
| | - P Lenoble
- Hôpital Pasteur, 68000 Colmar, France
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EPIRETINAL MEMBRANE WITH FOVEAL HERNIATION: Visual and Surgical Outcomes. Retina 2023; 43:182-190. [PMID: 36695789 DOI: 10.1097/iae.0000000000003669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Foveal herniation occurs when neuroretinal tissue protrudes through and above the level of an epiretinal membrane. This study describes the visual symptoms and spectral domain optical coherence tomography findings associated with foveal herniation and evaluates the postoperative visual, anatomical, and surgical outcomes. METHODS A multicenter retrospective review of patients diagnosed with epiretinal membrane identified 59 patients with preoperative foveal herniation on spectral domain optical coherence tomography. Data regarding visual symptoms, preoperative and postoperative best-corrected visual acuity (BCVA), central retinal thickness, macular volume, and size of foveal herniation were collected, and statistical analysis was performed. RESULTS A total of 58 of the 59 patients with foveal herniation underwent surgical epiretinal membrane peeling, with foveal contour restored in 53.5% of patients after surgery. Average BCVA improved from 20/80 to 20/40 Snellen equivalent at most-recent postoperative visit (P < 0.0001). The average central retinal thickness decreased from 632 µm to 432 µm (P < 0.0001) and the average macular volume decreased from 11.3 mm3 to 9.5 mm3 (P < 0.0001) at 3 months postoperatively. Preoperatively, greater herniation height was associated with worse BCVA (P = 0.008), greater central retinal thickness (P = 0.01), retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone abnormality, and external limiting membrane abnormalities (P < 0.05). Postoperatively, there was a decrease in retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone, and external limiting membrane abnormality (P < 0.05) on spectral domain optical coherence tomography. CONCLUSION Patients with larger foveal herniation height had greater preoperative central retinal thickness, worse preoperative and postoperative BCVA, and more intraretinal abnormalities on spectral domain optical coherence tomography. Surgical epiretinal membrane peeling in patients with foveal herniation resulted in a significant improvement in patients' BCVA and microstructural abnormalities.
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Predictive value of ectopic inner foveal layer without internal limiting membrane peeling for idiopathic epiretinal membrane surgery. Int Ophthalmol 2022; 42:1885-1896. [PMID: 34989953 DOI: 10.1007/s10792-021-02186-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the clinical importance of ectopic inner foveal layer (EIFL) grading (mild to severe) in patients diagnosed with idiopathic epiretinal membrane (iERM) and had pars plana vitrectomy (PPV) with solely ERM peeling. MATERIALS AND METHODS Patients diagnosed with iERMs who had undergone PPV including only ERM peeling were enrolled in the study, and follow-up findings were recorded at baseline, and at 3, 6, 12 months and final examinations. EIFL was categorized into four grades, from mild to severe. Pre- and postoperative anatomical changes were measured using spectral domain optical coherence tomography (SD-OCT) imaging. The association between EIFL and other SD-OCT parameters with best-corrected visual acuity (BCVA) was assessed before and after PPV surgery. RESULTS One-hundred thirty-eight eyes of 106 patients with mild to severe EIFL were included in the study. Higher EIFL thickness was significantly correlated with lower baseline (r = 0.575, p = 0.020) and final BCVA (r = 0.748, p = 0.001). Although EIFLs continued in advanced-stage cases (stage 3 and 4) (64 eyes [82%]) at the final visit, it was observed in 8 eyes (23%) in the early stage (stage 2) of iERMs. A strong positive correlation was found between EIFL thickness and recurrence rate of ERM (r = 0.876, p < 0.001). Recurrence of ERM was detected in 27 eyes; 2 (7%) at stage 1, 3 (9%) at stage 2, 10 (23%) in stage 3, and 12 (33%) in stage 4 (p < 0.001). CONCLUSION A negative association was found between the severity of EIFL and postoperative anatomical and visual recovery. In terms of surgical timing, early stages (stages 1 and 2) may be preferred for providing good anatomical and visual recovery and a low recurrence rate following surgery.
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Tuifua TS, Sood AB, Abraham JR, Srivastava SK, Kaiser PK, Sharma S, Rachitskaya A, Singh RP, Reese J, Ehlers JP. Epiretinal Membrane Surgery Using Intraoperative OCT-Guided Membrane Removal in the DISCOVER Study versus Conventional Membrane Removal. Ophthalmol Retina 2021; 5:1254-1262. [PMID: 33647472 PMCID: PMC8390556 DOI: 10.1016/j.oret.2021.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/09/2021] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE To provide a comparative assessment of clinical outcomes between patients undergoing intraoperative OCT (iOCT) and conventional surgery for pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peel. DESIGN Case-control retrospective, comparative assessment. PARTICIPANTS Patients undergoing PPV with membrane peel for ERM with eyes pooled from the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study and eyes undergoing conventional ERM surgery without iOCT. METHODS Visual acuity and OCT assessment before ERM surgery and at 1-, 3-, 6-, and 12-month follow-up after standard small-gauge PPV with iOCT feedback (iOCT DISCOVER group) or PPV with compulsory internal limiting membrane (ILM) peeling (conventional group). Visual acuity, central subfield thickness (CST), reoperation rate, and ERM recurrence were determined by record review and post hoc assessment of clinical OCTs after ERM peel. MAIN OUTCOME MEASURES Visual acuity and ERM recurrence. RESULTS A total of 262 eyes were included. Visual acuity (VA) improved 11.9 letters in the iOCT group (P < 0.0001) and 12.1 letters in the conventional group (P < 0.0001) at 12 months after ERM surgery. Visual acuity improvement did not differ between the iOCT and conventional groups at 1, 3, 6, or 12 months after surgery (P > 0.05 for each time point). Preoperative mean CST decreased in the iOCT group (P < 0.0001) and conventional group (P < 0.0001) with no difference between groups in CST reduction at 12 months (P = 0.36). No reoperations or visually significant recurrent ERMs occurred in either cohort. CONCLUSIONS Intraoperative OCT-guided ERM removal without mandated ILM peeling provided similar VA and anatomic results to conventional ILM peeling for ERM. Future randomized prospective studies are needed to assess fully the possible role of iOCT in ERM surgery and to evaluate the potential impact of nonfoveal ERM persistence or recurrence in comparison with conventional surgery.
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Affiliation(s)
- Tisileli S Tuifua
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Arjun B Sood
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph R Abraham
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter K Kaiser
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sumit Sharma
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aleksandra Rachitskaya
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P Singh
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamie Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
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Bae BJ, Ryoo NK. Effect of Foveal Pit Restoration in Foveal Avascular Zone After Surgery for idiopathic Epiretinal Membrane. ACTA ACUST UNITED AC 2021; 36:44-53. [PMID: 34743488 PMCID: PMC8849990 DOI: 10.3341/kjo.2021.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022]
Abstract
Purpose To investigate the relationship between ophthalmic parameters—including optical coherence tomography (OCT) and OCT angiography findings—and foveal pit restoration in eyes that had undergone vitrectomy for idiopathic epiretinal membrane (iERM) removal. Methods This study retrospectively analyzed data of patients who underwent pars planar vitrectomy for the removal of epirentinal membrane. Only eyes with iERM above stage 2 with a follow-up over 6 months were included. Baseline data and changes in ophthalmic parameters were analyzed from 3 months before to 12 months after surgery. Additionally, we stratified iERM patients into two groups (foveal pit restoration and no restoration group). Longitudinal comparison analyses between the two groups were done in best-corrected visual acuity (BCVA), central foveal thickness (CFT) and foveal avascular zone (FAZ) areas measurements using swept-source OCT and OCT angiography. Results Forty-three patients with a mean age of 75 ± 5 years were enrolled. After surgery, BCVA, FAZ, and CFT showed improvements over time (all p < 0.002). Thirty-one patients were designated into the foveal pit restoration (R) group and 12 patients into the no restoration (NR) group. Differences in BCVA and FAZ area in both groups existed up to 6 months. However, BCVA improved and FAZ expanded (R, 0.20 ± 0.05 vs. NR, 0.18 ± 0.04) in both groups showing no statistical difference 12 months postsurgery. The CFT decreased in both groups, but the R group was thinner at every point compared to the NR group (all p < 0.05). Conclusions The removal of epirentinal membrane in pars planar vitrectomy significantly improves BCVA, decreases the CFT and expands the FAZ. Foveal pit restoration improves BCVA, CFT, and FAZ area possibly at a faster rate in the early months but long-term improvements could be achieved regardless of the status of foveal pit restoration.
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Affiliation(s)
- Byung-Jin Bae
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea
| | - Na-Kyung Ryoo
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea.,Retinal Degeneration Research Lab, Seoul National University Medical Research Center, Seoul, Korea
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Mao J, Xu Z, Lao J, Chen Y, Xu X, Wu S, Zheng Z, Liu B, Shen L. Assessment of macular microvasculature features before and after vitrectomy in the idiopathic macular epiretinal membrane using a grading system: An optical coherence tomography angiography study. Acta Ophthalmol 2021; 99:e1168-e1175. [PMID: 33423352 DOI: 10.1111/aos.14753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate pre- and postoperative microvasculature features in eyes with different idiopathic macular epiretinal membrane (iERM) classifications using optical coherence tomography angiography (OCTA). METHODS In this retrospective study, 100 eyes with iERM were enrolled; 62 eyes underwent pars plana vitrectomy (PPV). All iERM eyes were evaluated and graded using optical coherence tomography (OCT). According to the thickness of the fovea relative to the surrounding macula from OCT radial line scans, we classified iERM into three grades. Optical coherence tomography angiography (OCTA) was used to measure the foveal avascular zone (FAZ)-related parameters and the superficial and deep capillary plexus layers using 3 × 3 mm scans. Measurements were taken at baseline and 3 months postoperatively. Best corrected visual acuity (BCVA), vessel density (VD), FAZ area, FAZ perimeter (PERIM), acircularity index (AI), and foveal vessel density (FD) were evaluated. RESULTS Idiopathic macular epiretinal membrane (iERM) eyes with a higher grade had a lower FAZ area and perimeter (p < 0.0001), higher foveal vessel density (FVD) both in the superficial capillary plexus (SCP) (p < 0.0001) and in the deep capillary plexus (DCP) (p < 0.05), and a lower parafoveal vessel density (PRVD) in the DCP (p < 0.0001). The macular vessel density ratio (MVR = FVD/PRVD) increased with an increase in grade both in the SCP and in the DCP (p < 0.0001). For grade 1 iERM eyes, only PRVD in the DCP significantly changed before versus after the operation (p < 0.05). For grade 2 iERM eyes, the FAZ area and perimeter became larger after the operation (p < 0.05). The MVR of grade 2 iERM eyes decreased postoperatively both in the SCP (p < 0.05) and in the DCP (p < 0.001). For grade 1 and grade 2 iERM eyes, preoperative LogMAR BCVA was negatively correlated with the FAZ area (p < 0.01) and perimeter (p < 0.01), and was positively correlated with the MVR in the SCP (p < 0.05). Postoperative LogMAR BCVA was positively correlated with the FVD in the DCP (p < 0.05). CONCLUSIONS Idiopathic macular epiretinal membrane (iERM) eyes of different grades have significant differences in microvasculature features. According to OCTA, eyes with higher grades have more serious microvascular changes. Grading plays a part in predicting postoperative microvascular characteristics, and grade 1 iERM eyes have a better visual outcome compared with grade 2 iERM eyes.
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Affiliation(s)
- Jianbo Mao
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
| | - Zhaokai Xu
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
| | - Jimeng Lao
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
| | - Yiqi Chen
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
| | - Xiaoqiong Xu
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
| | - Sulan Wu
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
| | - Zicheng Zheng
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
| | - Bowen Liu
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
| | - Lijun Shen
- Department of Retina Center Affiliated Eye Hospital of Wenzhou Medical University Hangzhou China
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Xu Z, Mao J, Lao J, Deng X, Liu C, Xu J, Wu S, Chen Y, Shen L. Macular retinal sensitivity and microvasculature changes before and after vitrectomy in idiopathic macular epiretinal membrane with classification. Ophthalmologica 2021; 244:569-580. [PMID: 34348345 DOI: 10.1159/000517523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Zhaokai Xu
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Jianbo Mao
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Jimeng Lao
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Xinyi Deng
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Chenyi Liu
- Chicago College of Optometry, Midwestern University, Downers Grove, Illinois, USA
| | - Jiahao Xu
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Sulan Wu
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Yiqi Chen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China
| | - Lijun Shen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, China
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Yang HJ, Kim KS. Analyses of Tangential Retinal Displacement and Metamorphopsia after Idiopathic Epiretinal Membrane Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.5.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Okada M, Chiu D, Yeoh J. Vitreomacular disorders: a review of the classification, pathogenesis and treatment paradigms including new surgical techniques. Clin Exp Optom 2021; 104:672-683. [PMID: 33899681 DOI: 10.1080/08164622.2021.1896946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This review explores how optical coherence tomography has guided our assessment of vitreomacular disorders. Vitreomacular disorders (VMD), such as macular holes and epiretinal membranes are common and potentially sight threatening. The introduction and widespread use of optical coherence tomography (OCT) imaging technology has transformed our ability to visualise the vitreoretinal interface. This review discusses the pathogenesis and updated classification scheme for VMD in the OCT era. Imaging biomarkers and the treatment algorithm, including the role of novel therapeutics, for managing patients with VMD are presented.
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Affiliation(s)
- Mali Okada
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Daniel Chiu
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jonathan Yeoh
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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PREOPERATIVE DOMED MACULAR CONTOUR CORRELATES WITH POSTOPERATIVE VISUAL GAIN AFTER VITRECTOMY FOR SYMPTOMATIC EPIRETINAL MEMBRANE. Retina 2021; 41:505-509. [PMID: 32568987 DOI: 10.1097/iae.0000000000002869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Evaluate macular features on preoperative ocular coherence tomography as indicators of postoperative visual gain following vitrectomy for epiretinal membrane (ERM). METHODS A retrospective chart review of 66 eyes that underwent vitrectomy with membrane and internal limiting membrane peeling for symptomatic ERM. Inclusion criteria required a pre-op visual acuity of at least 20/200 and minimum follow-up of 1 year. In addition, 31 of these eyes with complete 5-line raster pre-op ocular coherence tomography had segmentation analysis which included noncentral ERM to inner nuclear layer and ERM to outer plexiform layer measurements. RESULTS Eyes with "domed" pre-op macular contour had a mean preoperative acuity of 20/70 and gained a mean 2.4 lines at one year, compared with those with "flat" or "depressed" macular contour, having a 20/60 mean preoperative acuity and 0.6 lines gained (P = 0.02). Changes for other ocular coherence tomography features examined were not statistically significant. Paracentral ERM to inner nuclear layer measurements had moderate correlation, whereas paracentral ERM to outer plexiform layer measurements had weak correlation with gain in visual acuity. CONCLUSION An inner macular-domed contour in eyes with ERM predicted better visual gain after vitrectomy with ERM and internal limiting membrane peeling compared with a flat or depressed contour.
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Ozturk M, Guven D, Kacar H, Karapapak M, Demir M. Functional and Morphological Results of Epiretinal Membrane Surgery in Idiopathic versus Diabetic Epiretinal Membranes. Semin Ophthalmol 2021; 36:366-372. [PMID: 33617394 DOI: 10.1080/08820538.2021.1890143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Idiopathic and diabetic epiretinal membranes (ERM) are different in terms of pathophysiology, etiology, and macular morphology, and thus might respond to surgical treatment differently. We aimed to compare the surgical results of two groups. METHODS Retrospective case series study of 71 eyes of 66 patients who underwent pars plana vitrectomy (PPV) due to idiopathic or diabetic ERM with at least 1-year follow-up. Examinations were performed before, and 1, 3, 6, and 12 months after surgery. The average macular thicknesses in nine sectors described by the Early Treatment Diabetic Retinopathy Study (ETDRS) were measured with spectral-domain optical coherence tomography (OCT), and BCVA was evaluated. ERM recurrence rates were investigated. RESULTS In both idiopathic and diabetic groups, retinal thickness (RT) changes occurred as long as 12 months after vitrectomy surgery for ERM. However, in the idiopathic group, significant changes were mainly seen in the first 6 months, while in the diabetic group changes slowed considerably between the third and sixth months, but again accelerated (becoming significant) during the last 6 months. CONCLUSIONS According to the findings of this study, as compared to those with idiopathic ERM, diabetic patients would likely see continuing benefits from ERM surgery 6 to 12 months post surgery. The BCVA changes of the two groups were similar. ILM peeling decreased ERM recurrence in the idiopathic group but not in the diabetic group.
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Affiliation(s)
- Mine Ozturk
- Haseki Training and Research Hospital, Clinic of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Dilek Guven
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Hakan Kacar
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Murat Karapapak
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Demir
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, University of Health Sciences, Istanbul, Turkey
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Cacciamani A, Cosimi P, Ripandelli G, Di Nicola M, Scarinci F. Epiretinal Membrane Surgery: Structural Retinal Changes Correlate with the Improvement of Visual Function. J Clin Med 2020; 10:E90. [PMID: 33383922 PMCID: PMC7795238 DOI: 10.3390/jcm10010090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 12/02/2022] Open
Abstract
Several parameters have been studied for identifying the visual outcomes after pars plana vitrectomy (PPV) for epiretinal membrane (ERM) peeling. This retrospective study aimed to analyze structural retinal changes with spectral domain-optical coherence tomography (SD-OCT) and their correlations with visual acuity improvement in patients with ERM undergoing PPV. Twenty-one pseudophakic eyes were enrolled in the study. Ophthalmic evaluations included best corrected visual acuity (BCVA) and retinal layer thickness measurements with SD-OCT. The segmentation of the retina was divided into four parts: the inner retinal layer (IRL), composed of an internal limiting membrane, retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer; inner nuclear layer (INL); outer plexiform layer (OPL); and outer nuclear layer (ONL). Correlations between changes in retinal layer thicknesses and BCVA were explored over a 6 month follow-up period. The postoperative thickness decrease of the INL was significantly correlated with thickness changes in all other measured retinal layers (p < 0.001). Non-parametric linear regression showed that postoperative improvement in BCVA was associated with a postoperatively decreased thickness in the IRL (p = 0.021), INL (p = 0.039), and OPL (p = 0.021). In eyes undergoing PPV, postoperative thickness decreases of the IRL, INL, and OPL were correlated with visual acuity improvements. Re-compaction of these retinal layers after relieving ERM-induced traction may be an important factor in postoperative visual function improvement.
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Affiliation(s)
- Andrea Cacciamani
- IRCCS Fondazione Bietti, Via Livenza 3/5, 00198 Rome, Italy; (A.C.); (P.C.); (G.R.)
| | - Pamela Cosimi
- IRCCS Fondazione Bietti, Via Livenza 3/5, 00198 Rome, Italy; (A.C.); (P.C.); (G.R.)
| | - Guido Ripandelli
- IRCCS Fondazione Bietti, Via Livenza 3/5, 00198 Rome, Italy; (A.C.); (P.C.); (G.R.)
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy;
| | - Fabio Scarinci
- IRCCS Fondazione Bietti, Via Livenza 3/5, 00198 Rome, Italy; (A.C.); (P.C.); (G.R.)
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Ozdek S, Ozdemir Zeydanli E, Karabas L, Teke MY, Yilmaz G, Citirik M, Kocak N, Durukan H. Relation of anatomy with function following the surgical treatment of idiopathic epiretinal membrane: a multicenter retrospective study. Graefes Arch Clin Exp Ophthalmol 2020; 259:891-904. [PMID: 33185727 DOI: 10.1007/s00417-020-05002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the prognostic factors associated with functional and anatomical outcomes and to assess the longitudinal course of visual acuity and retinal morphology after vitreoretinal surgery for idiopathic epiretinal membrane (ERM). METHODS This multicenter, retrospective study included a total of 634 eyes who underwent surgery for idiopathic ERM in 22 academic centers nationwide in Turkey. Data on best-corrected visual acuity (BCVA) and optical coherence tomography features (central foveal thickness (CFT), ERM and foveal contour morphology, ellipsoid zone (EZ) integrity) were collected and compared at baseline, 6-month, 12-month, and 24-month follow-ups. Prognostic factors for functional (having ≥ 20/25 Snellen BCVA) and anatomical (having normal/shallow foveal contour) recoveries after surgery were investigated by means of multivariate regression analyses. A cutoff value of preoperative BCVA optimizing functional recovery was calculated using receiver operating characteristic curve analysis. RESULTS At a median follow-up of 24 months, 37.4% of the eyes achieved ≥ 20/25 BCVA and 54% regained normal or shallow foveal contour. Functional recovery was more likely in eyes with better baseline BCVA and intact EZ (R2 = 0.356, p < 0.001). The cutoff baseline BCVA value for good visual prognosis was 0.35 logarithm of the minimum angle of resolution (Snellen 20/44) (sensitivity 60%, specificity 85%, p < 0.001). Anatomical recovery was negatively associated with advanced age, higher baseline CFT, foveal herniation-type ERM morphology, and internal limiting membrane (ILM) peeling (R2 = 0.225, p < 0.001). The negative effect of ILM peeling on anatomical recovery was not significant after the first postoperative year (p = 0.05). Mean BCVA values and foveal morphology progressively improved at each visit. Cases with convex baseline foveal contour continued to change towards normal foveal depression over 24 months of follow-up, which took longer than the eyes with shallow/flat contoured cases. One-third of eyes with severe baseline EZ defects showed recovery at follow-up and achieved significantly greater visual acuity gains than the remaining eyes with persistent defects (p < 0.001). CONCLUSIONS Functional and anatomical restoration of the eyes appears to be a slow process after ERM surgery. This process may take much longer in eyes with worse foveal morphology at baseline. Although photoreceptor disruption may be reversible in some eyes, full functional recovery is unlikely when it persists.
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Affiliation(s)
- Sengul Ozdek
- Department of Ophthalmology, School of Medicine, Gazi University, 06500, Ankara, Turkey.
| | - Ece Ozdemir Zeydanli
- Department of Ophthalmology, School of Medicine, Gazi University, 06500, Ankara, Turkey.,Department of Ophthalmology, Ardahan State Hospital, 75000, Ardahan, Turkey
| | - Levent Karabas
- Department of Ophthalmology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | | | - Gursel Yilmaz
- Department of Ophthalmology, School of Medicine, Başkent University, Ankara, Turkey
| | - Mehmet Citirik
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Nilufer Kocak
- Department of Ophthalmology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hakan Durukan
- Department of Ophthalmology, Gulhane Education and Research Hospital, Ankara, Turkey
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Changes in Metamorphopsia, Visual Acuity, and Central Macular Thickness after Epiretinal Membrane Surgery in Four Preoperative Stages Classified with OCT B-Scan Images. J Ophthalmol 2019; 2019:7931654. [PMID: 31316825 PMCID: PMC6604338 DOI: 10.1155/2019/7931654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To observe the changes in metamorphopsia, visual acuity, and central macular thickness (CMT) in patients undergoing vitrectomy for idiopathic epiretinal membranes (iERM); all of which were preoperatively stratified into 4 stages according to the anatomical structure of the macula seen on the optical coherence tomography (OCT) b-scan images. Methods A total of 108 eyes of 106 patients were included. We evaluated and classified the severity of each preoperative ERM based on OCT. Changes in the best-corrected visual acuity (BCVA), metamorphopsia, and CMT were studied by comparing the pre- and postoperative measurements. The follow-up time was at least 6 months. Results There were 41 eyes at stage 2, 35 at stage 3, 32 at stage 4, and none at stage 1. BCVA and metamorphopsia significantly improved at the final visit in all patients (P < 0.01). However, comparing the pre- and postoperative measurements at each stage, only the BCVA and CMT improved significantly for all stages (P < 0.001). For stages 2 and 3 ERMs, the horizontal (MH) and vertical (MV) metamorphopsia scores decreased significantly after surgery (P < 0.05). No significant difference was found in either MH or MV for stage 4 ERMs (P both >0.05). The preoperative BCVA, MH, and CMT had significant difference among the three stages (P < 0.05). Similarly, the postoperative values in the three variables mentioned above also had significant difference among the three stages (P < 0.05). For stage 2 ERMs, the baseline MH and MV were positively correlated with the baseline CMT. The MH and MV at the final follow-up also presented a significant positive correlation with the baseline CMT. For stage 3 ERMs, only the baseline MV showed significant correlation with the CMT. Conclusion Categorization of the preoperative ERMs is a useful method to predict the postoperative improvement in metamorphopsia, which would aid in surgical decisions for patients with ERMs.
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FUNCTIONAL AND ANATOMICAL SIGNIFICANCE OF THE ECTOPIC INNER FOVEAL LAYERS IN EYES WITH IDIOPATHIC EPIRETINAL MEMBRANES. Retina 2019; 39:347-357. [DOI: 10.1097/iae.0000000000001940] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Retinal layers thickness changes following epiretinal membrane surgery. Eye (Lond) 2017; 32:555-562. [PMID: 29125147 DOI: 10.1038/eye.2017.233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/15/2017] [Indexed: 01/22/2023] Open
Abstract
PurposeTo evaluate the time course of changes in the thickness of retinal layers after epiretinal membrane (ERM) removal surgery.MethodsA retrospective cohort study of patients following surgery for idiopathic ERM. We used new specialized image analysis software to create a thickness map of each retinal layer and analyzed changes during one year follow-up. Healthy fellow eyes were used as negative controls and the retina prior to surgery as positive control.ResultsTwenty-one patients were included with a mean age of 68±13 years. Central macular thickness decreased steadily until 6 months after surgery (25% decrease, 516±76 to 386±73 μm, P<0.001) with no further decrease between 6 and 12 months (386±73 to 390±73 μm, P=0.291). The retinal nerve fiber layer (RNFL), and the ganglion cell and inner plexiform layer (GCIPL) were most affected (57%, P<0.001 and 27%, P=0.010, respectively). The thickest region showed a more abrupt decrease of 21% at first follow-up (504±61 to 399±58 μm, P=0.001) with subsequent decrements of about 3%. Prior to surgery all retinal layers were thicker in study eyes compared with healthy control eyes (6-63%, all P<0.05).ConclusionsFollowing ERM surgery, in the course of 6 months, the macula gradually becomes thinner after which a stable state is reached. All layers appear to be affected, with the RNFL and GCIPL impacted the most. Our results provide a unique view on how the thickness of different retinal layers changes following ERM surgery.
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Haritoglou C, Schoenfeld CL, Mayer WJ, Wolf A. Surgery for epimacular membrane and vitreomacular traction syndrome. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1251314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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