Epiretinal Membrane Research Articles

Epidemiology of epiretinal membranes using spectral-domain optical coherence tomography in an Iranian elderly population.

Epidemiological information about the epiretinal membrane is important for better clinical management and understanding of the nature and burden of this disease. There are some gaps in our understanding of the epidemiology of epiretinal membranes, particularly in Africa and the Middle East. This study aimed to determine the prevalence and risk factors of epiretinal membrane using spectral-domain optical coherence tomography (OCT) in an Iranian elderly population. This report is a part of a population-based study conducted on the elderly population 60 years and older from Tehran, the capital of Iran, using multistage stratified random cluster sampling. Study participants underwent measurement of visual acuity, autorefraction, subjective refraction, and slit-lamp biomicroscopy. The epiretinal membranes were diagnosed by a retinal specialist from OCT images (Spectralis OCT). A total of 1298 individuals were analyzed for this report. Of these, 58.9% were female, and the mean age of the participants was 67.4 ± 6.4 years. The prevalence rates of all epiretinal membranes, primary epiretinal membrane, and secondary epiretinal membrane were 6.0% (95% confidence interval [CI], 4.6 to 7.5%), 4.7% (95% CI, 3.0 to 6.3%), and 10.1% (95% CI, 6.6 to 13.6%), respectively. According to the multiple logistic regression model, the interaction between age and diabetes (odds ratio [OR], 1.09; 95% CI, 1.01 to 1.18, p=0.048) and the presence of posterior vitreous detachment (OR, 2.89; 95% CI, 1.45 to 5.78, p=0.003) were significantly linked to a higher prevalence of primary epiretinal membrane. Additionally, a significant inverse relationship was found between the prevalence of primary epiretinal membrane and the number of years of education (OR, 0.91; 95% CI, 0.85 to 0.97; p=0.002). The prevalence of primary epiretinal membrane in Tehran, Iran, was found to be lower than that reported in the majority of earlier studies. Posterior vitreous detachment, interaction between age and diabetes, and lower education level were risk factors of primary epiretinal membrane in this study.

Visual Performance and Predictive OCT Biomarkers in Epiretinal Membrane Assessment: Beyond Distance Visual Acuity.

This study aimed to comprehensively assess visual performance in eyes with idiopathic epiretinal membrane (iERM). Additionally, it sought to explore the associations between optical coherence tomography (OCT) imaging biomarkers and visual performance in patients with iERM. In this prospective, non-interventional study, 57 participants with treatment-naïve iERM from the University of Turin, between September 2023 and March 2024 were enrolled. Visual performance was measured using distance best-corrected visual acuity (BCVA), near BCVA, and maximum reading speed (MaxRS). Structural retinal imaging biomarkers were obtained from OCT, focusing on retinal layer thicknesses and epiretinal membrane characteristics. Statistical analyses, including linear regression and multivariate analysis, were used to determine relationships between visual function and imaging metrics. Monocular distance BCVA (0.37 ± 0.23 LogMAR), near BCVA (0.59 ± 0.18 LogMAR), and MaxRS (108.88 [68.38] words perminute [wpm]) in patients with iERM were significantly reduced compared with reference values. Both near BCVA and reading speed exhibited a greater percentage reduction than distance visual acuity. Patients with phakic showed worse visual acuity than patients with pseudophakia, although their reading performance was similar. Higher outer plexiform layers thickness and inner retinal thickness were associated with decreased distance and near visual acuity and reduced reading speed (beta, P value). The iERM predominantly impacts near visual performance, with near visual acuity and reading speed being more affected than distance visual acuity. Structural OCT biomarkers, particularly retinal thickness in specific regions, correlate with worse functional impairments. This highlights the importance of near vision assessments and imaging biomarkers for a comprehensive evaluation of visual impairment in iERM.

ADAMTS13 Improves Endothelial Function and Reduces Inflammation in Diabetic Retinopathy

The protease, a disintegrin and metalloproteinase with thrombospondin type 1 motif member 13 (ADAMTS13), known to cleave only the von Willebrand factor (VWF), has powerful regulatory effects on microvascular platelet adhesion, thrombosis, inflammation, and endothelial dysfunction. We study the protection against diabetes-induced retinal injury in experimental rats by supplementation with recombinant ADAMTS13. We compare human epiretinal membranes and vitreous samples from nondiabetic subjects and patients with proliferative diabetic retinopathy (PDR) and extend in vitro analyses with the use of various immunodetection and spectrofluorimetric methods on rat retina and human retinal glial and endothelial cell cultures. Functional studies include the assessment of the blood–retinal barrier (BRB), cell adhesion, and in vitro angiogenesis. In epiretinal membranes, endothelial cells and monocytes/macrophages express ADAMTS13. The levels of VWF, the platelet marker CD41, ADAMTS13, and the biomarkers of endothelial cell injury soluble VE-cadherin and soluble syndecan-1 are increased in PDR vitreous. ADAMTS13 is downregulated in diabetic rat retinas. The intravitreal administration of ADAMTS13 attenuates diabetes-induced BRB breakdown, the downregulation of VE-cadherin and β-catenin, and the upregulation of VWF, CD41, phospho-ERK1/2, HMGB1, VCAM-1, and ICAM-1. In Müller cells, ADAMTS13 attenuates MCP-1, MMP-9, and ROS upregulation induced by diabetic mimetic conditions. In HRMECs, ADAMTS13 attenuates the shedding of the soluble VE-cadherin and soluble syndecan-1 and the levels of phospho-ERK1/2, MCP-1, fractalkine, and ROS induced by diabetic mimetic conditions, the upregulation of ICAM-1 and VCAM-1 elicited by TNF-α, the adherence of monocytes induced by TNF-α, and VEGF-induced migration of human retinal microvascular endothelial cells. Our findings suggest that enhancing ADAMTS13 levels in situ ameliorates diabetes-induced retinal inflammation and vascular dysfunction.

Suprachoroidal injection of triamcinolone acetonide as adjuvant to surgical treatment of epiretinal membrane

BackgroundTo analyse the effect of suprachoroidal injection (SChI) of triamcinolone acetonide (TA) on macular thickness (CRT), ectopic inner foveal layer thickness (EIFL-T) and best corrected visual acuity (BCVA) in pseudophakic patients undergoing vitrectomy for epiretinal membrane (iERM) compared to intravitreal injection of TA (IVTA).MethodsProspective matched comparison of patients undergoing vitrectomy for Govetto stage 3 and 4 iERM. 25 eyes receiving IVTA (G-1) were compared to 23 eyes receiving SChI-TA (G-2) during vitrectomy. Primary outcome was change in BCVA, CRT, EIFL-T before surgery and 1, 3 and 6 months after surgery. Secondary outcome was the incidence of cystoid macular edema (CME).ResultsSix months after surgery, G2 had a greater mean reduction in CRT (−222 µm vs −131 µm) and EIFL-T (−200 µm vs −104 µm) than G1. BCVA improved more in G2 than in G1 (p = 0.02). Foveal depression reformed in 43% of cases in G-2 and 16% of cases in G-1. Incidence of postoperative CME was 16% in G-1 and 4.3% in G-2.ConclusionsDuring vitrectomy for iERM, SChI-TA was more effective than IVTA in reducing CRT and EIFL-T and improving BCVA. SChI-TA was effective in preventing postoperative CME. SChI-TA treatment was safe and reproducible and did not affect postoperative IOP.Trial registration NP6289—June 18th, 2024 (retrospectively registered).

Preretinal abnormal tissue before and after pars plana vitrectomy in macula-on rhegmatogenous retinal detachment: a multimodal imaging study

PurposeTo quantitatively explore preretinal abnormal tissue (PAT) in macula-on rhegmatogenous retinal detachment (RRD) before and after surgery.MethodsIn this case-series study, PAT was detected by en-face optical coherence tomography images with...

SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY INSIGHTS INTO IDIOPATHIC EPIRETINAL MEMBRANE SURGERY OUTCOMES.

The aim of this study is to assess the prognostic value of a classification system that includes the presence of ectopic inner foveal layers and other anatomical variables identified in spectral-domain optical coherence tomography for idiopathic epiretinal membrane (ERM) surgery. A descriptive-analytic, longitudinal, retrospective study was conducted on patients with idiopathic ERMs treated with pars plana vitrectomy from January 2017 to December 2021. Clinical data and spectral-domain optical coherence tomography images were reviewed presurgery and 12 months postsurgery. The primary outcome measured was best-corrected visual acuity (BCVA) before and after surgery, analyzing the impact of anatomical factors on BCVA in patients undergoing ERM surgery. This study included 342 eyes from 323 patients. Postsurgical evaluations showed significant reductions in central foveal thickness across all ERM stages, with most Stage 4 ERMs regressing to Stage 3. The mean improvement in BCVA was significant for all stages, with earlier stages showing better results. The presence of macular edema and ellipsoid zone disruption were significant predictors of postsurgical BCVA, while disorganization of the retinal inner layer showed an association with visual recovery but was not conclusively predictive. This study highlights the importance of spectral-domain optical coherence tomography in assessing retinal changes in idiopathic ERMs, demonstrating the prognostic value of ectopic inner foveal layers stage scheme and other anatomical variables such as ellipsoid zone disruption and macular edema presence on BCVA. These findings offer insights into surgical prognostication and the potential for personalized treatment strategies.

Predicting macular hole surgery outcomes: Integrating preoperative OCT features with supervised machine learning statistical models.

To evaluate various supervised machine learning (ML) statistical models to predict anatomical outcomes after macular hole (MH) surgery using preoperative optical coherence tomography (OCT) features. This retrospective study analyzed OCT data from idiopathic MH eyes at baseline and at 1-month post-surgery. The dataset was split 80:20 between training and testing. XLSTAT® statistical software (Lumivero, USA) was used to train different ML models on 10°CT parameters: prefoveal posterior cortical vitreous status, epiretinal membrane, intraretinal cysts, foveal retinal pigment epithelium hyperreflectivity, MH basal diameter, MH area (MHA), hole-forming factor, MH index, tractional hole index, and diameter hole index. The most effective statistical model was identified and was further assessed for accuracy, sensitivity, and specificity on a separate testing dataset. Six ML statistical models were trained on 33,260°CT data points from 3326°CT images of 308 operated MH (300 patients) eyes. Following training and internal validation, the random forest (RF) model achieved the highest accuracy (0.92), precision (0.94), recall (0.97), and F-score (0.96), and lowest misclassification rate. RF model identified the MHA index as the best predictor of post-surgical anatomical success. Following external testing, the RF model confirmed the highest accuracy and lowest misclassification rate (8.8%). ML-based statistical models can be used to predict MH status after surgery. The RF model was the most accurate ML model, and the MHA index was the best predictor of postoperative hole closure after surgery based on preoperative OCT parameters. These predictions may help with future surgical planning for MH patients.

Clinical features and management of eyes with acute retinal necrosis presenting with rhegmatogenous retinal detachment.

To study clinical features, anatomical and visual outcomes in eyes having rhegmatogenous retinal detachment (RD) as the presenting feature of acute retinal necrosis (ARN). We conducted a retrospective cohort study of patients with ARN (active/healed) and concomitant RD at the presenting visit. The median age of patients was 36 years, with a male preponderance (9:1). Bilateral ARN was observed in 60% of cases, with 50% of patients testing positive for human immunodeficiency virus. The duration between the onset of symptoms and presentation was 3.66 ± 2.26 weeks. At presentation, 53.3% of eyes had active retinitis. Vitreoretinal surgery with silicone oil tamponade was performed for 14 eyes. Visual acuity significantly improved in 3 months (P = 0.0027). Poor visual outcomes were associated with optic nerve involvement. The mean duration of silicone oil tamponade was 7.41 ± 4.48 months. Complications included recurrent RD (14.29%), epiretinal membranes (14.29%), cystoid macular edema (21.4%), and retinal scarring with atrophy. ARN with RD at presentation is a unique medical and surgical challenge, wherein good anatomical and functional outcomes could be achieved. The large size of retinitis and delayed presentation were the risk factors associated with poor visual outcomes.

Using a deep learning model to predict postoperative visual outcomes of idiopathic epiretinal membrane surgery.

This study assessed the performance of various deep learning models in predicting the postoperative outcomes of idiopathic epiretinal membrane (ERM) surgery based on preoperative optical coherence tomography (OCT) images. Validation of algorithms to predict the outcomes of ERM surgery based on OCT data. Internal training and validation were performed using 1,392 OCT images from 696 eyes. External testing was performed using 152 OCT images from 76 eyes. This study assessed three deep learning models, including Inception-v3, ResNet-101, and VGG-19. Grad-CAM was employed for hotspot analysis. The dataset was split into a training set (80%) and a validation set (20%). Subjects presenting an improvement of ≥2 lines on the Snellen chart at 1-year post-surgery were classified as pronounced visual improvement, whereas those presenting an improvement of <2 lines were classified as limited visual improvement. Using an external test dataset, we compared assessments by seven ophthalmologists with the prediction of deep learning model. The main outcome measures were recall, specificity, precision, F1 score, accuracy, and area under the receiver operating characteristic curve (AUROC). ResNet-101 achieved the best overall performance, as evidenced by the following metrics: recall (0.90), specificity (0.90), precision (0.91), F1-score (0.90), accuracy (0.90), and AUROC (0.97). In Grad-CAM heatmap analysis, the logic of ResNet-101 closely resembled that of clinical physicians. Overall, the performance of this deep learning model was significantly better than that of general ophthalmologists and non-retina specialists and was slightly superior to that of retina specialists. Deep learning based on preoperative OCT images proved highly effective in predicting the outcomes of ERM surgery and elucidating the structural mechanisms underlying the phenomena observed in OCT images.

Topographic changes in macula and its association with visual outcomes in idiopathic epiretinal membrane surgery.

We investigated changes in macular topography and their association with visual acuity and metamorphopsia in the idiopathic epiretinal membrane (iERM). Twenty-four eyes that underwent vitrectomy and ERM removal with internal limiting membrane peeling were included in this study. Best-corrected visual acuity (BCVA) and horizontal/vertical metamorphopsia scores (h and vM-scores in the M-chart) were assessed. The distances of fovea-disc (FD) and fovea-vascular arcade (FV), central subfield macular thickness (CSMT), and foveal location were measured using fundus photography, optical coherence tomography (OCT), and OCT angiography, respectively. The BCVA (logMAR) and vM-scores (P < 0.001, P = 0.014, respectively) improved after surgery. The distance of the FD decreased (P < 0.001) and FVs increased (P < 0.001, both). The fovea moved horizontally toward the disc (P < 0.001). The change in median total FVs (7.114 mm to 7.369 mm, P = 0.001) correlated with the change in BCVA (P = 0.049, Pearson's [r] = -0.404). No topographic parameters were associated with an improvement in the vM score. The macular topography significantly changed after iERM removal; the fovea moved nasally, and the distance between the superior and inferior vascular arcades increased. Such a change was relevant to the improvement in BCVA, but not metamorphopsia.

Application of Multimodal Imaging in the Diagnosis and Treatment of Epiretinal Membrane

Application of Multimodal Imaging in the Diagnosis and Treatment of Epiretinal Membrane

Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Lamellar Macular Hole: Long-Term Follow-Up

Background: To investigate functional and anatomical outcomes after pars plana vitrectomy (PPV) for lamellar macular hole (LMH) with a long-term follow-up. Methods: An interventional study on 14 patients (16 eyes) with LMH was conducted. The inclusion criteria included a minimum 36-month follow-up after PPV. The preoperative and postoperative best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography parameters were examined. Results: Preoperatively, the mean BCVA was 0.46 ± 0.22 LogMAR. Epiretinal proliferation (ERP) was visible in 81.25% of eyes. Outer retinal disruption was present in 31.25% of LMH cases. The average central foveal thickness (CFT) measured 183.68 ± 61.73 microns. The mean BCVA improved at each follow-up time point: it was 0.24 ± 0.16 LogMAR at 1 month, 0.18 ± 0.15 LogMAR at 6 months, and 0.09 ± 0.11 LogMAR at the last follow-up. There was a statistically significant improvement between BCVA at 1 month and BCVA at 6 months and between BCVA at 6 months and BCVA at the last follow-up (p &lt; 0.001). BCVA improved in all eyes, with 87.5% achieving at least 0.3 LogMAR improvement. The mean CFT at the 1-month follow-up was 211.45 ± 43.55 microns, increased to 248.81 ± 48.51 microns at 6 months, and further increased to 278.37 ± 45.50 microns at the last follow-up. Foveal contour restoration was achieved in all eyes, and those with preoperative ellipsoid zone alterations demonstrated a complete repair of the external retinal layers. No intra or postoperative complications were recorded. Conclusions: In our series, PPV had a high success rate and was associated with a substantial functional improvement in LMH treatment, and this result was maintained and kept increasing until the last follow-up. Long-term follow-up is crucial for a comprehensive evaluation of the healing process and to assess the benefits of the surgical intervention.

Preclinical study of novel human allogeneic adipose tissue-derived mesenchymal stem cell sheets toward a first-in-human clinical trial for myopic chorioretinal atrophy.

Mesenchymal stem cells may have neuroprotective and tissue regenerative capabilities and the potential to rescue retinal degeneration in chorioretinal diseases including myopic chorioretinal atrophy. Transplantation of human (allogeneic) adipose tissue-derived mesenchymal stem cell (adMSC) suspensions has been clinically conducted to treat retinal degenerative diseases. However, serious side effects including proliferative vitreoretinopathy and epiretinal membrane formation have been reported. PharmaBio Corporation fabricated novel adMSC sheets with a Bruch's membrane-like structure using our original method, potentially overcoming these problems. We evaluated the characteristics of newly developed adMSC sheets named PAL-222 and assessed their safety and efficacy in rats with congenital retinal degeneration (RCS rats) to obtain the proof-of-concept for the first-in-human clinical trial for myopic chorioretinal atrophy. We measured the viability of cells obtained from PAL-222, examined cell surface antigens by flow cytometry, measured the vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) secretory ability, examined the expression of types I and IV collagen and elastin by immunostaining. We performed a transwell in vitro migration assay to evaluate durability and similarity to retinal pigment epithelium (RPE) and checked in vitro tumorigenicity. In an in vivo experiment, we transplanted PAL-222 into the subretinal space of RCS rats and evaluated the safety and efficacy. Viability of cells obtained from PAL-222 was 88.1%. The rate of positive markers such as CD90, CD73, CD105 and CD44 exceeded 90%; that of the negative markers such as CD34, CD11b, CD19, CD45 and HLA-DR was less than 2%. PAL-222 secreted significant amounts of VEGF and PEDF and expressed types I and IV collagen and elastin. The migration assay showed that PAL-222 preserved the sheet structure without cell migration. No chromosomal aberration or colony formation was observed in in vitro tumorigenicity tests. PAL-222 transplantation suppressed the progression of retinal degeneration by preserving the outer nuclear layer without negative changes in RCS rats, suggesting a retinoprotective effect. We confirmed the efficacy and safety of PAL-222 and are currently conducting a clinical trial to treat myopic chorioretinal atrophy. Transplantation of these novel adMSC sheets may be a promising therapy for myopic chorioretinal atrophy. ClinicalTrials.gov, Identifier: NCT05658237. URL: https://classic. gov/ct2/show/NCT05658237 .

Emerging clinical evidence of a dual role for Ang-2 and VEGF-A blockade with faricimab in retinal diseases.

Anti-vascular endothelial growth factor (VEGF) therapies have transformed the treatment of retinal diseases. However, VEGF signaling is only one component of the complex, multifactorial pathophysiology of retinal diseases, and many patients have residual disease activity despite ongoing anti-VEGF treatment. The angiopoietin/tyrosine kinase with immunoglobulin and epidermal growth factor receptor-2 (Ang/Tie2) signaling pathway is critical to endothelial cell homeostasis, survival, integrity, and vascular stability. Ang-2 can interfere with Ang-1/Tie2 signaling and is increased in several retinal diseases. Lack of Tie2 signaling due to elevated Ang-2 levels drives vascular instability through pericyte dropout, neovascularization, vascular leakage, inflammation, and fibrosis. Although Ang-2 and VEGF can synergistically promote vascular instability and neovascularization, Ang-2 may also mediate vascular instability independently of VEGF. Faricimab is a bispecific antibody designed for intraocular use that inhibits two distinct pathways via Ang-2 and VEGF-A blockade. Clinical biomarkers of vascular instability are important for evaluating disease control and subsequent treatment decisions. These biomarkers include measurement/evaluation with optical coherence tomography (OCT) of intraretinal fluid, subretinal fluid, central subfield thickness, and pigment epithelial detachments (PEDs), and fluorescein angiography imaging of macular leakage and PEDs. Hyperreflective foci (HRF), thought to be representative of activated microglia, indicating an inflammatory microenvironment, and epiretinal membranes (ERMs), a marker for retinal fibrotic proliferation in diabetic macular edema (DME), are both also identified using OCT. Here we summarize data (secondary endpoint and prespecified exploratory analyses as well as post hoc analyses) from six Phase III trials suggest that dual therapy Ang-2/VEGF-A inhibition with faricimab (6mg) has a greater effect on reducing/resolving biomarkers of vascular instability than aflibercept (2mg), by both controlling neovascularization and vascular leakage (with resultant resolution of exudation associated with DME, neovascular age-related macular degeneration, and retinal vein occlusion), as well as by targeting inflammation (reduction of HRF in DME) and retinal fibrotic proliferation (reducing the risk of ERMs in eyes with DME). Modulation of both the Ang-2 and VEGF-A pathways with faricimab may therefore provide greater disease control than anti-VEGF monotherapy, potentially leading to extended treatment durability and improved long-term outcomes.

Association of intravitreal and topical anti-inflammatory therapies on short-term anatomical and functional outcomes following epiretinal membrane surgery.

Here we examine the association of anti-inflammatory therapy with anatomical and functional outcomes of epiretinal membrane surgery. The study included consecutive patients having gone through epiretinal membrane surgery at Helsinki University Hospital, Finland, between 2017 and 2021. The association of perioperative intravitreal and postoperative topical anti-inflammatory therapies with surgical outcomes was assessed. In total, 214 eyes of 214 patients with a mean age of 71.2 ± 8.2 years were studied. At 1-month, perioperative intravitreal use of triamcinolone acetonide (n = 27) was associated with a significant proportional and absolute improvement in foveal thickness (-15.9 ± 18.4% vs. -4.2 ± 25.6%, p = 0.003 and -86.2 ± 109.6 μm vs. -33.7 ± 94.3 μm, p = 0.004), and central subfield macular thickness (-14.7 ± 16.5% vs. -6.3 ± 16.9%, p = 0.009 and -80.6 ± 102.8 μm vs. -36.1 ± 75.9 μm, p = 0.004) when compared to those without triamcinolone acetonide. Furthermore, best-corrected visual acuity (BCVA) gain showed a non-significant yet corresponding trend favouring intraoperative intravitreal use of triamcinolone acetonide (0.21 ± 0.27 vs. 0.09 ± 0.28 LogMAR units, p = 0.062). Postoperative use of topical non-steroidal anti-inflammatory drugs (NSAIDs) (n = 36) as adjunct therapy showed no significant advantage in anatomical outcomes or BCVA gain when compared to those without NSAIDs (all p > 0.05). Triamcinolone acetonide remained significant for proportional and absolute improvement in foveal thickness (p = 0.019 and p = 0.006) and in central subfield macular thickness (p = 0.013 and p = 0.006) when controlled for confounding factors patient age and gender and topical NSAID use. Intraoperative intravitreal use of triamcinolone acetonide improved short-term anatomical outcomes in patients who underwent epiretinal membrane surgery.

Idiopathic epiretinal membrane surgery with internal limiting membrane peeling: An optical coherence tomography angiography analysis of macular capillary plexus changes.

This study aims to assess retinal vascular changes following internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM) treatment using optical coherence tomography angiography (OCT-A). A retrospective study was conducted. A cohort of thirty-nine patients was enlisted for this study. Each participant underwent comprehensive ophthalmological evaluation and OCT-A imaging at baseline, as well as at 1-month and 6-month intervals post-pars plana vitrectomy with ERM and ILM peeling. Post-surgery, remarkable improvements were observed in best-corrected visual acuity (BCVA) (from 0.335 ± 0.173 to 0.096 ± 0.126 at 6 months), coupled with a notable reduction in central retinal thickness (CRT) (from 460 ± 87 µm to 395 ± 53 µm at 6 months). Additionally, there was a noticeable expansion in the foveal avascular zone (FAZ) perimeter (from 0.099 ± 0.060 mm² to 0.125 ± 0.056 mm² at 6 months). However, there was a decline in vessel density (VD) in the superficial capillary plexus (SCP) (from 46.7 ± 4.4 to 43.8 ± 3.5% at 6 months), contrasted by an elevation in the deep capillary plexus (DCP) (from 45.2 ± 5.5% to 43.6 ± 5.3% at 6 months. Noteworthy correlations were detected between CRT and BCVA, as well as CRT and vascular parameters. ERM instigates a milieu of changes including SCP crowding and elevation, potentially leading to a falsely augmented density at OCT-A in affected patients. Subsequent surgery results in a release of ERM-induced forces, elucidating the observed decrease in SCP density. Conversely, the DCP appears to be less distorted by the ERM, facilitating gradual vessel reopening after its removal. OCTA provides valuable insights into optimal surgical timing.

Epiretinal Membrane and Senile Cataract: Combined vs Sequential Surgery.

To evaluate the outcomes of combined phacovitrectomy versus sequential phacoemulsification and vitrectomy in patients with both senile cataract and epiretinal membrane (ERM). A retrospective multicenter study was conducted between 2014 and 2022 at two hospitals in Italy. Patients with idiopathic ERM and senile cataract in the same eye were enrolled and underwent either combined (n=38) or sequential surgery (n=38), performed by a single surgeon. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at 1, 3, and 6 months after surgery. Both surgical approaches significantly improved BCVA and reduced CMT after 6 months. However, sequential surgery showed faster visual recovery, with significant improvements in BCVA (P=0.008) and CMT (P<0.0001) observed as early as 1-month post-surgery, compared to the combined group. Although both surgical approaches yielded significant improvements in visual acuity and central macular thickness at 6 months, the sequential approach offered a faster recovery in the early postoperative period. According to the literature, the sequential approach also allows some patients to be satisfied after cataract surgery alone, potentially avoiding unnecessary vitrectomy and reducing the risk of overtreatment.

Vasoproliferative Retinal Tumors: Manifestations, Management, and Outcomes in a Case Series

Introduction: Vasoproliferative retinal tumors (VPRTs) are rare, benign retinal lesions characterized by abnormal vascular proliferation. They may appear sporadically or with systemic conditions like von Hippel-Lindau disease, often resembling other retinal lesions and posing diagnostic challenges. VPRTs can lead to vision loss if not adequately managed. Current management ranges from observation to different treatment strategies, from laser photocoagulation, photodynamic therapy, cryotherapy to intravitreal injections and vitrectomy. However, optimal approach is still debated due to VPRTs’ rarity and varied presentations. Case Presentations: This series presents three VPRT cases. The first, a 73-year-old man who presented with sudden vision loss due to a VPRT-related vitreous hemorrhage, required multiple interventions, including vitrectomies and anti-VEGF injections, but suffered recurrent macular edema and glaucoma, requiring ongoing management. The second, a 42-year-old asymptomatic man, showed lipid exudation and peripheral retinal detachment, needing photodynamic therapy, laser, and cryotherapy. The third, a 56-year-old woman with decreased visual acuity and epiretinal membrane, achieved stability and good visual outcomes after vitrectomy with cryotherapy. Conclusions: VPRTs pose diagnostic and therapeutic challenges given their heterogeneous presentations and potential for complications. Our cases illustrate that a multimodal management strategy – incorporating tailored combinations of therapies such as laser photocoagulation, cryotherapy, anti-VEGF injections, and surgery – is essential to address individual characteristics of each patient’s disease. Personalized treatment approaches allow for precise targeting of the lesions while minimizing risk of complications, contributing to better disease stabilization and visual outcomes. Early detection and tailored management are essential, though further research is needed to establish standardized treatment protocols.

Correspondence between OCT Characteristics and Biochemical Parameters in Diabetic Macular Edema

Objective: The purpose of this study is to evaluate the potential association between peripheral blood parameters and the morphological characteristics of retinal imaging obtained via spectral-domain optical coherence tomography (SD-OCT) in patients with treatment-naïve diabetic macular edema (DME). Materials and Methods: This cross-sectional study included 100 patients with treatment-naïve DME. All participants underwent spectral-domain optical coherence tomography (Optovue) and fundus photography. Peripheral blood samples were collected to assess complete blood count (CBC), glycated hemoglobin (HbA1c), blood glucose, serum urea, serum creatinine, and lipid profile. Results: Central subfield thickness (CST) was significantly associated with serum HDL (P= 0.003). Intraretinal fluid (IRF) was linked to serum triglycerides (P=0.006), serum VLDL (P=0.001), and cholesterol- to-HDL ratio (P= 0.001). Subretinal fluid (SRF) showed an association with blood glucose (P= 0.028). Hyperreflective foci (HF) were related to total blood count (P= 0.001), monocyte count (P= 0.001), cholesterol-to-HDL ratio (P= 0.045), LDL-to-HDL ratio (P= 0.003), and serum urea (P= 0.051). Disorganization of the retinal inner layers (DRIL) correlated with total blood count (P=0.047), lymphocyte count (P= 0.008), blood glucose (P= 0.007), and LDL-to-HDL ratio (P= 0.046). Epiretinal membrane (ERM) was associated with blood glucose (P= 0.001), total cholesterol (P= 0.022), serum LDL (P= 0.025), cholesterol-to-HDL ratio (P= 0.013), and LDL-to-HDL ratio (P= 0.008). Ellipsoid zone (EZ) and external limiting membrane (ELM) disruptions were linked to blood glucose, serum LDL, and VLDL. Hard exudates correlated with blood cell counts, glucose, HbA1c, urea, and creatinine (P&lt; 0.05). CONCLUSION: Systemic factors are significantly associated with retinal morphological patterns in DME, highlighting the potential for modifying these factors to influence disease progression and treatment response.

The alternative approach to epiretinal fibrosis surgery

Purpose. To evaluate the possibility of removal of epiretinal fibrosis (ERF) with complete saving of the internal limiting membrane (ILM) to reduce the risk of iatrogenic intraoperative trauma associated with the procedure of ILM removing, and postoperative complications associated with retinal nerve fiber layer damage developing as a result of ILM removing.Material and methods. The study included 54 patients with ERF, whose average age was 69.5 years. In the course of surgical treatment, it was planned to remove the epiretinal membrane (ERM) with an attempt to completely ILM saving. In all cases, after removal of the vitreous, epiretinal structures were stained with MembranBlue Dual and ERM was removed, trying to completely ILM saving. The anatomical result was evaluated according to optical coherence tomography. The functional result was evaluated according to the indicators of best corrected visual acuity (BCVA). The maximum follow-up period was 12 months.Results. It was possible to remove the ERM with complete ILM saving in 26 (48.14 %) patients, in 28 (51.86 %) the ERM was removed in a single unit with the ILM. In all cases, the postoperative period proceeded without peculiarities and complications. At a follow-up examination after 3 months, all 54 patients showed an increase of BCVA compared to preoperative value. There was no BCVA decrease in any case during this follow-up period. In cases of the ERM removal with the ILM saving in the long-term postoperative period (12 months), no recurrence of ERF was recorded, as in cases where the ILM was removed.Conclusions. It was possible to reduce intraoperative retinal injury due to the ILM saving during the ERM removal in 48.14 % of cases, using standard vitreoretinal instruments and techniques. According to the study, the ILM saving does not lead to a recurrence of ERF in the long-term postoperative period.