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

Andrea Cacciamani,Marta Di Nicola,Fabio Scarinci,Guido Ripandelli,Pamela Cosimi

doi:10.3390/jcm10010090

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.

Highlights

Idiopathic epiretinal membrane (ERM) is a common macular disease characterized by an avascular fibrotic membrane that develops between the vitreous and the internal limiting membrane (ILM) in healthy eyes of the elderly [1]
This study aimed to correlate morphological retinal changes using spectral domain-optical coherence tomography (SD-OCT) with visual function in pseudophakic patients affected by ERM after pars plana vitrectomy (PPV) for ERM peeling over a six month follow-up period
The segmentation of the retina was divided into four parts: the inner retinal layer (IRL), composed of an ILM, retinal nerve fiber layer, ganglion cell layer, inner plexiform layer; inner nuclear layer (INL); outer plexiform layer (OPL); and outer nuclear layer (ONL) (Figure 1)

Summary

Introduction

Idiopathic epiretinal membrane (ERM) is a common macular disease characterized by an avascular fibrotic membrane that develops between the vitreous and the internal limiting membrane (ILM) in healthy eyes of the elderly [1]. The pathogenetic mechanism is still unclear, it has been suggested that a posterior vitreous detachment (PVD) can produce microbreaks in the retina, resulting in migration and proliferation of fibroblasts and glial cells on the inner retina surface [2]. Another theory proposed that an abnormal dehiscence during the PVD may result in vitreoschisis, leaving some part of the vitreous body connected to the macula area [3]. A previous study showed that the levels of TGFβ2 and nerve growth factor in vitreous samples of patients with ERM were increased [4]. The authors suggested that TGFβ2 might stimulate the differentiation of a specific type of glial cells into myofibroblasts, by inducing their contraction in the ERM, while nerve growth factor might be involved in the activation of intra- and intercellular signals related to the progression of ERM pathology [4].

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