Diagnosis Of Epiretinal Membrane Research Articles

Epiretinal membrane in uveitis: Rate, visual prognosis, complications and surgical outcomes.

Epiretinal membrane (ERM) is a common finding in patients with uveitis that contributes to visual impairment. We describe the long-term visual acuity (VA) and morphometric progression in patients with uveitis and epiretinal membrane (ERM). Retrospective cohort study of patients with uveitic ERM from a tertiary centre database. Multivariate analysis of risk factors for ERM progression was calculated using a marginal Cox regression model to estimate hazard ratios (HR). Two hundred and sixteen eyes (4%) of a total 5450 eyes with uveitis were identified to have an ERM. The most common diagnosis was idiopathic uveitis in 45 patients (28.7%), followed by sarcoidosis in 21 (13.4%), HLAB27-related uveitis in 15 (9.6%) and toxoplasmosis in 15 (9.6%). Risk factors for ERM development include age (HR 1.03), intermediate uveitis (HR 2.33), posterior uveitis (HR 1.53) and ERM fellow eye (HR 18.28). Anterior uveitis (HR 0.53) and alternating disease (HR 0.53) were protective. Median VA was 20/40 at diagnosis of ERM and 20/40 at final follow up. Progression of ERM grade occurred in 17 eyes (7.9%) during the study period. ERM peel was performed in 44 eyes (20.4%). Median VA was 20/60 and 20/40 at baseline and 12 months after surgery, respectively. Improvement in visual acuity occurred in 23 eyes (60.5%) following surgery. In addition to intermediate and posterior uveitis, fellow eye involvement is a strong risk factor for ERM development. In treated uveitis, the majority maintain their long-term vision and rates of ERM progression are low.

Морфофункциональные результаты хирургического лечения эпиретинального фиброза: сравнительный анализ

Background. In the last decade, there has been a widespread discussion about the need for ILM peeling. The main argument in favor of ILM removal is that ILM can serve as a framework for cell proliferation, and complete removal of ILM for prevention of ERM recurrence in future is required. On the other hand, the removal of ILM causes damage to Muller cells, which leads to complications such as microscotomas, paramacular holes and dissociation of nerve fiber layers. Purpose of the current study is to compare the functional and anatomical results of various methods of ERM removal. Methods. 75 patients with the diagnosis of epiretinal membrane were operated at the Center of Ophthalmology of NMHC named after N.I. Pirogov. All the patients were divided into 3 groups. Patients of the first group were operated on by the standard method of membrane removal and ILM peeling. The 2nd group included patients operated with the use of ERM removal without removal of ILM. The 3rd group included patients operated according to the original technique with the formation of «notches» in the ILM. All the patients in the pre- and postoperative period (1, 3, 6, 12 months after surgical treatment) underwent complete ophthalmological examination. Conclusion. The results of our study have shown that the technique of ERM surgical treatment without ILM peeling gives higher functional results compared to the group where peeling was performed for up to 12 months of follow-up, however, the risk of ERM recurrence remains. Using the technique of «release notches» allows to achieve higher functional results, compared with the group with ILM peeling and reduces the risk of relapse. Key words: vitrectomy; epiretinal fibrosis; peeling

Spontaneous Epiretinal Membrane Resolution and Angiotensin Receptor Blockers: Case Observation, Literature Review and Perspectives.

Epiretinal membrane (ERM) is a relatively common condition affecting the macula. When symptoms become apparent and compromise a patient's quality of vision, the only therapeutic approach available today is surgery with a vitrectomy and peeling of the ERM. Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE-Is) reduce the effect of angiotensin II, limit the amount of fibrosis, and demonstrate consequences on fibrinogenesis in the human body. Case Description and Materials and Methods: A rare case of spontaneous ERM resolution with concomitant administration of ARB is reported. The patient was set on ARB treatment for migraines and arterial hypertension, and a posterior vitreous detachment was already present at the first diagnosis of ERM. The scientific literature addressing the systemic relationship between ARB, ACE-Is, and fibrosis in the past 25 years was searched in the PubMed, Medline, and EMBASE databases. In total, 38 and 16 original articles have been selected for ARBs and ACE-Is, respectively, in regard to fibrosis modulation. ARBs and ACE-Is might have antifibrotic activity on ERM formation and resolution. Further clinical studies are necessary to explore this phenomenon.

Long-Term Visual Acuity and Optical Coherence Tomography Changes After Vitrectomy for Idiopathic Epiretinal Membranes.

To evaluate the long-term visual acuity and retinal thickness changes after pars plana vitrectomy (PPV) for idiopathic epiretinal membranes (ERM). We performed a retrospective analysis of 72 patients who underwent PPV for idiopathic ERM in a tertiary hospital over 5 consecutive years. The main outcome measurement was change in visual acuity and macular thickness as recorded with optical coherence tomography (OCT). Medical records of 239 patients with a diagnosis of ERM who underwent PPV with or without internal limiting membrane (ILM) peeling were reviewed; of these, 72 patients with idiopathic ERM were included in the final analysis. All patients completed at least one year of follow-up, and 23 patients (30%) had 5 or more years of follow-up. The mean preoperative best corrected visual acuity (BCVA) was 20/65, and mean preoperative central macular thickness (CMT) on OCT was 434 microns (µm). Mean postoperative BCVA and CMT at one year were 20/40 and 303 µm, respectively (p<0.0001). A total of 42 patients (58%) improved by 2 or more lines; BCVA and CMT continued to improve postoperatively for up to 5 years of the follow-up period. There was no significant difference in BCVA or CMT between phakic and pseudophakic patients, and ILM peeling was performed in 67% of patients. Improved BCVA at 1 year was associated with younger age (p<0.0001) and ILM peeling (p=0.020). PPV is an effective treatment for idiopathic ERM, and ILM peel may be of benefit. BCVA continues to improve up to 2 years and beyond after surgery regardless of the duration of symptoms.

Удаление идиопатических эпиретинальных мембран с сохранением фовеальной внутренней пограничной мембраны

Introduction. The epiretinal membrane (ERM) is a connective tissue structure on the surface of the retina, formed as a result of proliferative and dystrophic processes in the inner layers of the retina and the cortical layers of the vitreous body. ERM has contractile properties and could cause tangential tractions, retinal folding and edema. To ensure the maximum preservation of visual functions, a method of ERM removal with the preservation of foveal inner limiting membrane (ILM) is proposed. Purpose. To present results of a new approach for ERM removal with preservation of foveal ILM on a series of clinical cases. Material and methods. The study included 3 patients with a diagnosis of ERM, with the complaints of metamorphopsia of less than 8 months. In addition to the standard ophthalmological examination, patients underwent optical coherence tomography (CirrusHD-OCT 5000; Carl Zeiss Meditec) and microperimetry (MAIA; CenterVue). Surgical intervention consisted in minimally invasive three-port vitrectomy with removal of ERM and ILM with preservation of foveal ILM. In the postoperative period, patients were examined at the time of 1, 3 and 6 months. Results. The analysis of microperimetric data showed that the degree of functional disorders corresponded to morphological changes: ectopia of the inner layers of the retina, deformation of its normal profile, a pronounced decrease in light sensitivity in the projection area of traction macular edema. In the postoperative period, the indicators of central light sensitivity improved gradually throughout the entire follow-up period. Conclusion. Thus, the proposed low-traumatic method of ERM removal with the preservation of foveal ILM, provides a stable anatomical and functional result, the restoration of both morphological and functional parameters. The data presented in this paper require confirmation in further comparative clinical trials. Key words: epiretinal membrane, surgical treatment, internal limiting membrane

Retinal misregistration and effect of surgery on its improvement in patients with epiretinal membrane

PurposeTo evaluate the prevalence of retinal misregistration, that is, misalignment of retinal elements that affect central and peripheral fusion, and the effect of surgery in patients with epiretinal membrane (ERM). MethodsThis prospective interventional case-series was performed on 32 patients with symptomatic ERM with the complaint of binocular diplopia or decreased visual acuity. After the diagnosis of ERM, optotype frame, synoptophore, and lights on-off tests were used to evaluate retinal misregistration. Patients with severe symptoms underwent surgery and were followed for 3 months. ResultsOf the 32 patients, 6 (19%) had preoperative diplopia. Optotype frame, synoptophore, and lights on-off tests had positive results in 20 (63%), 19 (63%), and 11 (34%) cases, respectively. Of the 6 diplopia cases, 5 showed positive results in all 3 tests and 1 was positive on optotype frame and synoptophore testing. Of the 26 cases without diplopia, 15 (58%) showed positive results in at least one test, including 6 (23%) in all three tests, 6 (23%) in two tests, and 3 (12%) in only one test. Ten patients underwent surgery. Postoperatively, all patients had negative lights on-off test, but optotype frame and synoptophore tests were negative in eight patients (80%). Two cases (20%) had postoperative diplopia, including 1 case with postoperative new-onset diplopia. ConclusionsThe prevalence of retinal misregistration was higher than the rate of diplopia. Surgery improved diplopia and results of tests of retinal misregistration.

Clinical and Functional State of the Visual Analyzer after Surgery for the Epiretinal Membrane from the Standpoint of the Relevance of Postoperative Rehabilitation

Purpose: to study the clinical and functional state of the visual analyzer of patients after surgery for the epiretinal membrane (ERM) from the standpoint of the relevance of postoperative rehabilitation.Patients and methods. There were 158 patients under observation (158 eyes, main group, MG), among whom 66 % were men, 34 % were women aged 45–74 years (the average age of patients was 62.4 ± 1.5 years) with a diagnosis of ERM. At the same time, the leading form of ERM was idiopathic (122 patients, 77.2 %). As a control group (CG), were examined 32 patients of equal age and gender, who did not have visual organ pathology. In order to remove ERM, all patients underwent subtotal posterior vitrectomy with intraoperative administration of antioxidants, in particular glutathione contained in a balanced salt solution “BSS-PLUS” (Bausch + Lomb, USA). A comprehensive examination of the clinical and functional state of the visual analyzer was performed one month after surgery.Results. The data obtained indicate that almost all the studied parameters revealed a significant deterioration in the MG compared to the CG with a fairly good anatomical effect (the thickness of the central retinal zone after the operation was 287.1 ± 11.6 μm). In particular, a decrease in the subjective indicator “Quality of life” (by 53.1 %), as well as a deterioration in the objective indicators of the critical frequency of flicker fusion, the magnitude of the electrical lability of the retina and the threshold of electrical sensitivity of the retina (by 36.2; 38.2 and 45, 5 % respectively).Conclusions. A fairly good anatomical effect of vitreoretinal surgical intervention for ERM is accompanied (one month after the operation) by a significant decrease in the functional state of the visual analyzer. In order to restore vision more quickly, it seems advisable to conduct early postoperative rehabilitation (based on the complex use of physiotherapeutic effects and combined drug therapy) aimed at correcting functional disorders of the retina, which will lead to a decrease in the severity of characteristic complaints and an increase in the “Quality of life” of the patient.

Epiretinal Membrane Detection at the Ophthalmologist Level using Deep Learning of Optical Coherence Tomography

Purpose: Previous deep learning studies on optical coherence tomography (OCT) mainly focused on diabetic retinopathy and age-related macular degeneration. We proposed a deep learning model that can identify epiretinal membrane (ERM) in OCT with ophthalmologist-level performance. Design: Cross-sectional study. Participants: A total of 3,618 central fovea cross section OCT images from 1,475 eyes of 964 patients. Methods: We retrospectively collected 7,652 OCT images from 1,197 patients. From these images, 2,171 were normal and 1,447 were ERM OCT. A total of 3,141 OCT images was used as training dataset and 477 images as testing dataset. DL algorithm was used to train the interpretation model. Diagnostic results by four board-certified non-retinal specialized ophthalmologists on the testing dataset were compared with those generated by the DL model. Main Outcome Measures: We calculated for the derived DL model the following characteristics: sensitivity, specificity, F1 score and area under curve (AUC) of the receiver operating characteristic (ROC) curve. These were calculated according to the gold standard results which were parallel diagnoses of the retinal specialist. Performance of the DL model was finally compared with that of non-retinal specialized ophthalmologists. Results: Regarding the diagnosis of ERM in OCT images, the trained DL model had the following characteristics in performance: sensitivity: 98.7%, specificity: 98.0%, and F1 score: 0.945. The accuracy on the training dataset was 99.7% (95% CI: 99.4 - 99.9%), and for the testing dataset, diagnostic accuracy was 98.1% (95% CI: 96.5 - 99.1%). AUC of the ROC curve was 0.999. The DL model slightly outperformed the average non-retinal specialized ophthalmologists. Conclusions: An ophthalmologist-level DL model was built here to accurately identify ERM in OCT images. The performance of the model was slightly better than the average non-retinal specialized ophthalmologists. The derived model may play a role to assist clinicians to promote the efficiency and safety of healthcare in the future.

Diagnostic and postoperative evaluation: application of new imaging modalities

AbstractThe diagnosis of epiretinal membranes is clinical following a thorough history and fundus assessment. This lecture focuses however on additional imaging modalities currently available to facilitate the diagnostic and postoperative evaluation. Multicolour fundus imaging or confocal infrared imaging have provided superior ERM detection in comparison to fundus photography in mild cases. Diagnostic evaluation with OCT allows the estimation of retinal deformity due to the membrane, determines the involvement of the fovea and, with en‐face OCT, allows for the estimation of the membrane extent and dynamic development. High resolution OCT allows for the classification of epiretinal membranes to conventional or atypical. Specific retinal features have been identified in symptomatic eyes (macropsia). OCT imaging has allowed the determination of the ERM profile for specific categories of patients as patients with uveitis or concurrent diabetic macular oedema. Imaging following ERM peeling allows the estimation of anatomic and functional outcomes. OCT allows the qualitative and quantitative assessment of central macular thickness or individual retinal layers. Additional retinal features, some of which could have prognostic implications such as features of retrograde maculopathy, can be identified. Pre‐ and postoperative macular vascular circulation can be evaluated with the use of OCT‐A and evaluation of retinal oxygen saturation can be evaluated with the use of retinal oximeter. The features of the FAZ postoperatively have been investigated and have been associated with the degree of visual recovery. The impact of artefacts in this modality need to be taken into account.

The 1-year incidence of rhegmatogenous retinal detachment post 23-gauge pars plana vitrectomy

ObjectiveThe purpose of this study was to evaluate the 1-year incidence of retinal tear or retinal detachment following 23-gauge pars plana vitrectomy (PPV) for epiretinal membrane (ERM), macular hole (MH), or vitreomacular traction (VMT). MethodsA retrospective chart review of all patients who underwent 23-gauge PPV for ERM, MH, or VMT between January 1, 2007, and December 31, 2007, was performed. Inclusion criteria included age greater than 50 years and absence of other significant ocular pathology. Exclusion criteria included confounding retinal pathology, laser treatment at the time of surgery, previous laser treatment of the retina, or previous PPV. ResultsA total of 272 eyes of 268 patients were eligible for inclusion: 159 eyes (58%) had the diagnosis of ERM; 108 (40%) had MH; and 5 (2%) had VMT. The average patient age was 70 years. Of the patients, 15 required additional surgery related to persistent macular pathology within 1 year (5 with ERM, 10 with MH). The incidence of retinal detachment after surgery was 1.1% (3 eyes of 3 patients). The mean time duration prior to development of retinal detachment was 159 days (range, 19 to 333 days). ConclusionsThe 1-year incidence of rhegmatogenous retinal detachment post 23-gauge vitrectomy for repair of macular pathology without prophylactic laser of sclerotomy sites is approximately 1%.

Spectral-Domain Optical Coherence Tomography for Monitoring Epiretinal Membrane Surgery

To assess prognostic factors in epiretinal membrane (ERM) surgery using spectral-domain (SD) optical coherence tomography (OCT). Prospective, interventional case series. Forty-one patients. Patients with a diagnosis of ERM were examined with spectral-domain and time-domain (TD) OCT before and after surgery. Main outcome measures were functional results and predefined OCT patterns. Cofactors analyzed were the type of ERM, the duration and grading of subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, and age. A multivariate regression analysis was performed. Thirty-nine patients (95%) showed an improved or stable best-corrected distance visual acuity (DVA) at 3 months, whereas 36 patients (88%) showed an improved or stable best-corrected near visual acuity (NVA) at 3 months. Significant correlations (P>0.4) were found between the course of central retinal thickness (CRT) assessed using SD OCT and TD OCT (P<0.02). No clinically relevant correlations (P<0.3) were seen between CRT and VA (P>0.1). Baseline DVA and NVA were found to be significant prognostic values for the postoperative decrease in CRT in both OCT systems (P<0.04) as well as for the visual outcomes (P<0.007) at 3 months. In addition, the integrity of the junction between the photoreceptor inner segment and outer segment (IS/OS) significantly influenced the visual outcomes at 3 months (P<0.038). The baseline profile of the internal limiting membrane (ILM) significantly influenced the NVA at 3 months (P<0.009), whereas the postoperative foveal contour significantly influenced the DVA at 3 months (P<0.025). The type of ERM, subjective metamorphopsia, simultaneous cataract surgery, the type of dyes used, the duration of surgery, gender, or age had no significant influence on patient outcome (P>0.05). Compared with TD OCT, SD OCT allowed for a more precise differentiation between the ERM and the retinal surface and for a better evaluation of the IS/OS line. Besides the baseline VA, the integrity of the IS/OS line, better visualized by SD OCT, can be used to predict the functional outcomes after surgery. Additionally, analyzing the ILM profile and the foveal contour may help to understand limited visual outcomes after surgery. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Characterization of Epiretinal Membranes Using Optical Coherence Tomography

To evaluate optical coherence tomography (OCT), a novel noncontact and noninvasive imaging technique, for the diagnosis and quantitative characterization of epiretinal membranes. Optical coherence tomography is similar to an ultrasound B-scan, except that light rather than sound is used, which enables higher resolution. Over a 2-year period, OCT was used to examine 186 eyes of 160 patients who had a diagnosis of an epiretinal membrane. Optical coherence tomograms were correlated with visual acuity, slit-lamp biomicroscopy, fluorescein angiography, and funds photography. Based on OCT, the epiretinal membrane was clearly separated from the retina with focal points of attachment in 49 eyes and globally adherent (no observed separation) in 125 eyes. Globally adherent membranes were associated with the following features: macular pseudohole (32 eyes), a difference in optical reflectivity between the membrane and retina (65 eyes), and/or a visible membrane tuft or edge (92 eyes). The membrane was undetectable on OCT in 12 eyes. The membrane thickness (mean +/- standard deviation) was 61 +/- 28 microns in the 169 eyes in which the thickness could be measured with OCT. Mean central macular thickness measured with OCT correlated with visual acuity (R2 = 0.73). Optical coherence tomography was able to provide a structural assessment of the macula that was useful in the preoperative and postoperative evaluation of epiretinal membrane surgery. Quantitative measurements and the assessment of membrane adherence with OCT may be useful in characterizing the surgical prognosis of eyes with an epiretinal membrane.