Epiretinal Membrane Eyes Research Articles

Visual Outcomes Following Non-Diffractive Extended-Depth-of-Focus Intraocular Lens Implantation in Patients with Epiretinal Membrane in One Eye and Bilateral Cataracts.

This study aimed to characterize the visual performance in patients with bilateral cataracts and a unilateral epiretinal membrane (ERM) undergoing cataract surgery with non-diffractive extended depth of focus (EDoF) intraocular lens (IOL) placement in both eyes and phacovitrectomy in the eye with ERM. This was a prospective, descriptive, single-arm study. Visual outcomes were measured in monocular and binocular conditions in patients with bilateral cataracts and unilateral ERM stages 2 or 3 implanted with an EDoF IOL. At 6 months, visual acuity (uncorrected and corrected at different distances and contrast levels), contrast sensitivity, and visual disturbances assessed using a Light Distortion Analyzer were determined. We included 22 patients (50% females, mean age of 71.4 ± 5.8 years). Mean monocular best-corrected visual acuities at 100% contrast were 0.07 ± 0.09, 0.23 ± 0.10, and 0.48 ± 0.14 logMAR for eyes with ERM, and 0.02 ± 0.08, 0.19 ± 0.11, and 0.41 ± 0.18 logMAR for fellow eyes for far, intermediate, and near distance vision, respectively. No differences were observed in visual outcomes, contrast sensitivity, or visual disturbances between ERM and non-ERM eyes, except for near distance. No unexpected adverse events were observed. Non-diffractive EDoF IOL can be considered in patients with cataracts and stage 2 or 3 ERM pursuing spectacle independence.

Predictive factors for postoperative visual function in eyes with epiretinal membrane

Our current study aimed to investigate the association of preoperative OCT parameters with visual function after vitrectomy surgery in eyes with epiretinal membrane (ERM). This study enrolled 33 eyes with ERM that underwent vitrectomy surgery. In addition to visual acuity (VA), metamorphopsia was measured pre- and postoperatively for each eye. Using the preoperative horizontal and vertical OCT images, SUKIMA (the gap area between the ERM and retinal surface) was measured respectively and the average of horizontal SUKIMA and vertical SUKIMA was used for the analysis. The associations of baseline parameters (age, axial length, preoperative central retinal thickness [CRT], inner nuclear layer [INL] thickness, ectopic inner foveal layer [EIFL] and SUKIMA) with postoperative VA, the change in VA, postoperative metamorphopsia and the improvement in metamorphopsia were investigated using multivariate regression analysis followed by the model selection. The result suggested that age and INL thickness were related to the postoperative VA, whereas age and preoperative CRT were significantly associated with the change in VA. In contrast, only SUKIMA was correlated with the postoperative metamorphopsia, whilst age, EIFL and SUKIMA were associated with the improvement in metamorphopsia. Measuring SUKIMA might be useful for predicting postoperative metamorphopsia and the improvement in metamorphopsia in ERM eyes.

Morphologic analysis of the foveal avascular zone for prediction of postoperative visual acuity in advanced idiopathic epiretinal membrane

To investigate the preoperative morphology of the foveal avascular zone (FAZ) for prediction of the postoperative visual acuity in advanced idiopathic epiretinal membrane (ERM). 28 patients (28 eyes) with unilateral idiopathic ERM who underwent pars plana vitrectomy with internal limiting membrane peeling were included. Superficial FAZ was measured preoperatively in both eyes using optical coherence tomography angiography. Area, perimeter, and circularity of FAZ were achieved, and the differences between the ERM eyes and the contralateral eyes were evaluated to analyze the degree of FAZ distortion in diseased eyes. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured at baseline and more than 6 months after surgery. The correlations of the preoperative FAZ with BCVA and CFT were assessed. The FAZ in the eyes with ERM was significantly reduced, and the BCVA was significantly correlated with the FAZ area (FAZa) (P = 0.001) and the FAZ perimeter (FAZp) (P < 0.001) before surgery. LogMAR BCVA and CFT were significantly improved from 0.550 ± 0.221 to 0.354 ± 0.229 (P = 0.008), and from 524.393 ± 93.575 µm to 400.071 ± 75.979 µm (P < 0.001) after surgery. The preoperative FAZa and FAZp were significantly associated with letter score gain (P < 0.001, P < 0.001) and the postoperative final BCVA (P = 0.026, P = 0.006). The preoperative FAZp had correlation with ratio of postoperative to preoperative CFT (P = 0.016). The preoperative FAZp is a predictor of visual acuity and morphological prognosis after surgery in advanced idiopathic ERM.

Effect of idiopathic epiretinal membrane on the macular ganglion cell complex measurement in eyes with glaucoma

AbstractPurpose: This study investigated the effect of idiopathic epiretinal membrane (ERM) and associated SUKIMA on ganglion cell complex (GCC) thickness measurements in eyes with glaucoma.Methods: We retrospectively recruited 41 eyes of 34 patients with glaucoma with idiopathic ERM and 41 eyes of 41 patients with glaucoma without ERM as controls (matched with age, axial length, and mean visual field deviation). The thicknesses of GCC layers (retinal nerve fibre layer [RNFL], ganglion cell layer + inner plexiform layer [GCIPL] and GCC [RNFL + GCIPL]) were measured with swept source optical coherence tomography. We investigated the presence of SUKIMA (the gap between the ERM and retinal surface) and its effect on GCC measurements.Results: RNFL, GCIPL, and GCC were thicker in ERM (+) eyes than in control (31.0 ± 12.3 μm vs. 22.7 ± 10.8 μm, 62.6 ± 12.2 μm vs. 53.8 ± 5.9 μm, and 91.8 ± 16.6 μm vs. 76.8 ± 13.3 μm, respectively; p &lt; 0.01). Eyes with ERM‐associated SUKIMA (+) had thicker GCIPL and GCC compared with those with ERM but no SUKIMA (−) and controls (p &lt; 0.01).Conclusions: ERM‐associated SUKIMA influences GCC thickness and can result in underestimations of glaucoma severity. We should check the presence of ERM using B mode scan and also check the SKIMA sign.

Effect of idiopathic epiretinal membrane on macular ganglion cell complex measurement in eyes with glaucoma.

Co-existing idiopathic epiretinal membrane (ERM) and glaucoma complicate the estimation of glaucoma severity via optical coherence tomography (OCT). We investigated the effect of ERM and a new associated parameter, SUKIMA (space between the ERM and retinal surface), on ganglion cell complex (GCC) thickness in eyes with glaucoma, based on a matched comparison of visual field defects. We retrospectively recruited 41 eyes from 34 glaucoma patients with idiopathic ERM and 41 eyes from 41 glaucoma patients without ERM as controls (matched by age, axial length, and mean visual field deviation). The thicknesses of GCC layers [retinal nerve fiber layer (RNFL), ganglion cell layer + inner plexiform layer (GCIPL), and GCC (RNFL + GCIPL)] were measured with swept-source OCT. We investigated the presence of SUKIMA and its effect on GCC measurements. RNFL, GCIPL, and GCC were thicker in ERM (+) eyes than in control eyes (31.0 ± 12.3 μm vs. 22.7 ± 10.8 μm, 62.6 ± 12.2 μm vs. 53.8 ± 5.9 μm, and 91.8 ± 16.6 μm vs. 76.8 ± 13.3 μm, respectively; P < 0.01). Eyes in the ERM-associated SUKIMA (+) group had thicker GCIPL and GCC than those in the ERM-associated SUKIMA (-) and control groups (P < 0.01). ERM-associated SUKIMA affects GCC thickness and can result in underestimations of glaucoma severity. We should check for the presence of ERM using a B mode scan as well as check for the SKIMA sign.

Tight adherent feature on optical coherence tomography predict postoperative visual outcome in epiretinal membrane eyes

BackgroundTo identify the predictive parameter among preoperative measurements that best predicts postoperative visual outcome in the epiretinal membrane (ERM).MethodsThirty-three consecutive patients with idiopathic unilateral ERM patients between 2015 and 2018 were enrolled. Nineteen healthy normal eyes were selected as an independent age-matched group. Based on preoperative optical coherence tomography (OCT), we further divided the patients with ERM into two groups: type 1, loosely attached ERM, and type 2, tight adherent ERM. We documented the vision and thickness of various retinal layers: nerve fiber layer, ganglion cell layer, inner plexiform layer (GCL + IPL), inner nuclear layer (INL), outer retinal layer (ORL), and retinal pigment epithelium/Bruch complex layer before and after the surgery. The association between postoperative visual acuity and these variables was analyzed using multiple linear regression analysis.ResultsAll retinal layers of ERM eyes were thicker than the normal eyes (P < 0.05). Among ERMs, we identified 11 eyes with type 1 adhesions and 22 eyes with type 2 adhesions. The preoperative GCL + IPL layers were significantly thicker in type 2 patients than in type 1 patients (93.67 ± 33.03 um vs 167.71 ± 13.77 um; P = 0.023). Greater GCL + IPL thickness was correlated with a worse postoperative visual acuity and multiple linear regression analysis showed that GCL + IPL thickness was an independent predictor of postoperative visual acuity (VA) (beta value = 0.689; P = 0.012). A greater thickness of GCL + IPL layers of type 2 patients had worse postoperative best-corrected visual acuity (BCVA) (P = 0.028). Ectopic inner foveal layers with disappearance of fovea pit were persistently presented in OCT profiles of both groups.ConclusionIdiopathic ERM demonstrated significantly thicker inner retinal layers (GCL + IPL and INL). However, the ORL thickness was similar between the normal eyes and ERM eyes. The preoperative GCL + IPL layers were significantly thicker in patients with type 2 ERM than that in patients with type 1 ERM. The increase in GCL + IPL thickness was significantly correlated with worse postoperative visual outcomes.

Choroidal vascularity index changes with phacovitrectomy for vitreoretinal interface disorders.

Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI) changes following internal limiting membrane peeling for epiretinal membrane (ERM) and full thickness macular hole (FTMH). Fifty-nine patients with unilateral ERM and 56 with unilateral FTMH were included in the study. Axial length, pre- and post-surgery intraocular pressure, baseline and post-phacovitrectomy CVI were calculated and compared with the normal fellow eyes. To compare the baseline and the final measurements, Wilcoxon test was used. Mann-Whitney U test was used for independent data comparisons. Median and standard deviations were compared. Axial length, pre- and post-surgery intraocular pressure differences were insignificant between study and fellow eyes within all groups. CVI were significantly lower in post-vitrectomy study eyes of all groups compared with pre-surgery (P < 0.001). There were no significant changes before and after the surgeries in fellow eyes. Baseline CVI of ERM study eyes (median 65.90%) and FTHM study eyes (median 65.59%) did not differ significantly between groups (U = 1336, P = 0.07, r = 0.16). There are conflicting results of vitreoretinal interface disorders CVI in the literature. In this study, both FTMH and ERM eyes showed reduced CVI postoperatively compared with the baseline. Preoperatively, there were no difference between study eyes and the fellow eyes.

Cytokines possibly involved in idiopathic epiretinal membrane progression after uncomplicated cataract surgery

Epiretinal membrane (ERM) is a common retinal fibrotic disorder disease causing visual impairment and metamorphopsia. Recently, increasing attention has been devoted to ERM progression after uncomplicated cataract surgery. Cytokines, which play a role in diverse physiological and pathological activities in eyes, are suggested to be involved in these postoperative changes. However, few studies have investigated the post-cataract surgery cytokine expression changes in ERM eyes and their roles in the postoperative changes. The purpose of this study was to evaluate the aqueous levels of cytokines in eyes with idiopathic epiretinal membrane (iERM) both pre- and post-cataract surgery, and their correlations with postoperative iERM progression. In this study, aqueous humor (AH) samples were collected from iERM eyes (n = 25) and non-iERM eyes (n = 23) from 48 patients (48 eyes) undergoing uncomplicated cataract surgery preoperatively and 20 h postoperatively. Samples were analyzed for 48 cytokines with multiplex bead-based immunoassay. Correlations between cytokine level changes (postoperation vs. preoperation) and three-month postoperative best-corrected visual acuity (BCVA) and optical coherence tomography measure changes were evaluated in iERM eyes. We found that in iERM eyes, the levels of 4 cytokines exhibited significant elevations when compared with those in the controls (all p ≤ 0.0015) preoperatively. Postoperatively, the concentrations of 21 cytokines were higher than the preoperative levels in iERM eyes (all p ≤ 0.0015), among which GRO-α, IL-8, and MCP-3 levels showed more pronounced changes than the controls. Additionally, in iERM eyes, IL-4 level changes showed moderate positive correlations with MV (r = 0.492, p = 0.028) and MT (r = 0.481, p = 0.032) changes. LogMAR changes were positively correlated with IL-1α (r = 0.553, p = 0.011), IL-12(P40) (r = 0.544, p = 0.013), and MCP-3 (r = 0.588, p = 0.006) level changes. No significant cytokine-level-change differences were found between eyes with and without postoperative cystoid macular edema development. In conclusion, cataract surgery will bring great alterations to the specific intraocular cytokine microenvironment inherently in eyes with iERM. Many fibrotic and inflammatory cytokines showing elevated levels or relationships with clinical characteristics are suggested to be involved in the pathogenesis and post-cataract surgery progression of iERM; however, further investigations are needed to discern their real roles.

Association Between Retinal Artery Angle and Visual Function in Eyes With Idiopathic Epiretinal Membrane.

PurposeThis study investigated the relationship between retinal artery angle and visual function in eyes with idiopathic epiretinal membrane (ERM).MethodsUltra-wide field fundus imaging was conducted to analyze ERM and normal contralateral eyes. In addition to the logMAR visual acuity (VA) measurement, the average of the vertical and horizontal metamorphopsia scores (Mave) was measured using m-Charts for each eye. We calculated the retinal artery angle (Yugami correlated angle [YCA]) in all the examined eyes using ImageJ software. The YCAs were then compared between the ERM and normal contralateral eyes. Additionally, the relationship between YCA and visual function was investigated in the ERM eyes.ResultsData from 40 patients with ERM were analyzed. The mean age of the participants was 67.1 ± 8.1 years. The YCA was significantly smaller in the ERM eyes, compared with the contralateral eyes (P < 0.001, respectively; Wilcoxon signed rank test). Among age, axial length, YCAs, central retinal thickness (CRT), and central choroidal thickness (CCT), the optimal model for logMAR VA included age, YCA, and CRT. On the other hand, the optimal model for Mave included YCA and CCT.ConclusionsThe retinal artery angle may be useful for predicting visual function in eyes with ERM.Translational RelevanceOur established quantitative measurements in fundus photography have potential clinical use in predicting visual function in ERM.

Repeatability of Spectral Domain Optical Coherence Tomography Measurements of Bruch's Membrane Opening-Minimum Rim Width in Epiretinal Membrane Patients with Peripapillary Involvement.

The Bruch’s membrane opening-minimum rim width (BMO-MRW) is a recently introduced parameter of the neuroretinal rim. We analyzed the repeatability of spectral-domain optical coherence tomography (SD-OCT) measurements of BMO-MRW in epiretinal membrane (ERM) patients with peripapillary involvement, since the surface around the optic disc is distorted in such patients. BMO-MRW and retinal nerve fiber layer (RNFL) thickness measurements were performed using SD-OCT in prospectively enrolled ERM patients and age-matched healthy control individuals. After two consecutive measurements with a 5 min interval, repeatability was analyzed using the intraclass correlation coefficient (ICC), repeatability coefficient (RC), and coefficient of variation (CV). Fifty-two eyes of 52 ERM patients and 62 eyes of 62 healthy controls were included in the study. The ICCs of the mean BMO-MRW/RNFL thickness measurements were 0.999/0.985 in ERM eyes and 0.999/0.999 in normal eyes, respectively. The RC values of mean BMO-MRW/RNFL thickness measurements were 9.0/6.25 μm in ERM eyes and 4.61/0.92 μm in normal eyes, respectively. The CV values were 0.91% and 1.45% for BMO-MRW and RNFL thickness in ERM eyes, and 0.63% and 0.33% in normal eyes, respectively. In ERM eyes, the RC, CV of average BMO-MRW were 1.9 and 1.4 times greater than those of normal eyes, but 6.8 and 4.4 times greater for average RNFL thickness. BMO-MRW and RNFL thickness showed good repeatability in the diseased eyes with peripapillary involvement and healthy control eyes. Based on the ICC, RC, and CV values, the repeatability of BMO-MRW measurements in peripapillary membrane patients was better than that of RNFL thickness.

Biomarkers in the pathogenesis of epiretinal membrane and myopic traction maculopathy: Effects of internal limiting membrane incompliance and posterior staphyloma.

This study compared the structural and vascular intraretinal changes between epiretinal membrane and myopic traction maculopathy eyes. An observational retrospective study of treatment-naïve epiretinal membrane and myopic traction maculopathy eyes was conducted to identify biomarkers of a 3 × 3 mm macular region centered on the fovea, using optical coherence tomography angiography. The myopic traction maculopathy and epiretinal membrane groups comprised 27 and 32 eyes, respectively. In the myopic traction maculopathy group, the spherical equivalent was more myopic and the axial length was longer than in the epiretinal membrane group. Myopic traction maculopathy eyes had larger outer and smaller inner retinal volumes, larger area and perimeter of foveal avascular zones, greater circularity of foveal avascular zones, and smaller foveal vessel density in the superficial layer than epiretinal membrane eyes. Internal limiting membrane incompliance and staphyloma were significantly more in the myopic traction maculopathy group than in the epiretinal membrane group. The intraretinal changes in myopic traction maculopathy eyes compared with epiretinal membrane eyes showed larger avascular zones, which may have been caused by tangential internal limiting membrane incompliance. Anteroposterior traction forces from staphyloma in myopic traction maculopathy eyes may lead to larger outer retinal volumes. In epiretinal membrane eyes, traction forces confined to the superficial retina caused large inner retinal volumes and foveal acircularity.

Effect of internal limiting membrane peeling on visual field sensitivity in eyes with epiretinal membrane accompanied by glaucoma with hemifield defect and myopia.

To investigate the effects of internal limiting membrane (ILM) peeling on visual field sensitivities in eyes with epiretinal membrane (ERM) accompanied by glaucoma with hemifield defect and myopia. Retrospective clinical study METHODS: We reviewed clinical records of patients with ERM who underwent vitrectomy and ERM/ILM peeling. We first collected clinical data of eyes with ERM and glaucoma with hemifield defect. We recorded visual field sensitivities at 52 points and analyzed differences between before and after surgery. We then compared the changes in visual field sensitivity between glaucomatous and normal hemifields. Next, we collected ERM eyes without glaucoma and stratified them into two groups based on axial length (threshold = 26.0mm). In these eyes, we also recorded visual field sensitivities at 52 points and analyzed differences between before and after surgery. The study included 18 eyes with ERM and glaucoma with hemifield defect (11 men; mean age, 68.3 ± 7.2years). These eyes showed significant sensitivity reductions at 5/26 points, mainly in the nasal area of the glaucomatous hemifield, whereas only 1/26 points exhibited significant sensitivity reduction in the normal hemifield. In eyes with axial length <26.0mm and axial length ≥26.0mm, 29 peripheral and seven superior peripheral points showed significant improvements in visual field sensitivities, respectively. Visual field sensitivity reduction occurred mainly in the nasal region of the glaucomatous hemifield. Differences in axial length alone were not a prominent risk factor for reduced visual field sensitivity after ILM peeling in eyes with ERM.

Relationship between morphological changes in the foveal avascular zone of the epiretinal membrane and postoperative visual function

ObjectiveTo investigate the relationship between the preoperative morphology of the foveal avascular zone (FAZ) and postoperative visual function in patients with idiopathic epiretinal membrane (ERM).Methods and analysisThis retrospective study enrolled...

Evaluation of retinal vascular structure after epiretinal membrane surgery by optical coherence tomography angiography.

To evaluate the retinal vascular structure before and after the epiretinal membrane (ERM) surgery by optical coherence tomography angiography (OCTA). Twenty-two eyes with ERM (study eyes) had been evaluated by OCTA for superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density (VD) at foveal and parafoveal regions and foveal avascular zone (FAZ) before and after ERM removal surgery. Twenty-two fellow eyes were selected as control group. Preoperative VD of SCP and DCP were significantly lower in ERM eyes than in controls in both foveal and parafoveal areas (p < 0.05, for all). The difference regressed in SCP (fovea: 18.04 ± 3.1 vs 19.98 ± 18 p = 0.002 and parafovea: 47.33 ± 3.54 vs 49.71 ± 28 p = 0.001), but persisted in DCP (fovea: 17.25 ± 3.52 vs 17.57 ± 4.01 p = 0.856 and parafovea: 50.12 ± 4.35 vs 50.93 ± 3.24 p = 0.791) in study eyes, postoperatively. Superficial and deep FAZ areas were significantly smaller in study eyes than controls. Postoperatively, superficial FAZ area enlarged (0.288 ± 0.10 vs 0.307 ± 0.08 p = 0.012), whereas deep FAZ area did not (0.324 ± 0.09 vs 0.338 ± 0.07 p = 0.435). FAZ area was correlated with the best-corrected visual acuity in ERM eyes. Vascular damage in SCP and DCP was demonstrated by OCTA in eyes with ERM. ERM removal surgery mainly improves superficial changes caused by ERM. Changes in deep retinal flow may be associated with visual outcomes after ERM removal surgery.

Association of macular choroidal thickness with optical coherent tomography morphology in patients with idiopathic epiretinal membrane.

To compare macular choroidal thickness of idiopathic epiretinal membrane (ERM) and fellow eyes, and before and after vitrectomy in terms of the morphological features on spectral-domain optical coherent tomography (SD-OCT). Eighty-four patients with unilateral idiopathic ERM were involved. Patients were categorized into: Group 1, ERM without membrane contraction; Group 2, ERM with membrane contraction and retinal folding; and Group 3, ERM with membrane contraction and macular edema. Twenty-two patients received surgical removal of ERM. Choroidal thickness was compared between ERM and fellow eyes, and before and after treatment. Mean choroidal thickness was significantly greater in ERM eyes than in fellow eyes (234.4 ± 22.5 vs 220.6 ± 20.8 μm; P<0.01). Group 1 (n = 20) showed no significant difference in choroidal thickness between ERM and fellow eyes. Eyes in Group 2 (n = 27) and Group 3 (n = 37) showed statistically significant differences in mean choroidal thickness between ERM and fellow eyes (229.6 ± 23.8 vs 220.8 ± 19.6 μm; 242.6 ± 27.8 vs 221.0 ± 21.8 μm, respectively; P<0.05). In Group 2 (n = 8) and Group 3 (n = 16), choroidal thickness in ERM eyes decreased significantly at 1 month and 6 months after surgery, compared with that before surgery (P<0.05 for all comparisons). Membrane contraction contributed to the increase in choroidal thickness in idiopathic ERM patients. This finding may help to elucidate the pathophysiologic features of idiopathic ERM as well as the response to treatment in these patients.

Pitfalls and Complications of Epiretinal Membrane Peeling in Eyes with Comorbid Subretinal Drusenoid Deposits: A Report of Five Cases

Background: Idiopathic epiretinal membranes (ERM) are common with potential for severe visual loss. Surgical outcomes are excellent but predominantly reported from healthy eye studies rather than those with co-morbidities. We report a series of patients with subretinal drusenoid deposits (SRDD) and comorbid ERM with post-operative complications or poor outcomes, describing potential pitfalls to avoid. Case Presentation: This is a case series illustrating the poor functional and morphological outcomes following ERM surgery in five eyes with SRDD. These eyes appear at risk of geographic atrophy (GA), choroidal neovascular membrane (CNVM) formation (pre-and post-operatively) and outer retinal atrophy (ORA), all of which can limit outcomes. Conclusion: ERM surgery in eyes with SRDD presents specific challenges. Assessment of outer retinal changes can be challenging pre-operatively, particularly with significant oedema. Identification of patients with SRDD in ERM eyes often relies on examination of the contralateral eye. Appropriate listing is paramount, with care taken to rule out pre-existing GA or CNVM through use of fundus fluorescein angiography. Patients should be given a guarded prognosis during the consenting process if the outer retina is poorly visualized.

Elevated M2 Macrophage Markers in Epiretinal Membranes With Ectopic Inner Foveal Layers

PurposeTo analyze the differences in the vitreous cytokine profiles in epiretinal membrane eyes with and without an ectopic inner foveal layer (EIFL).MethodsSixty eyes with epiretinal membrane (32 eyes without EIFL and 28 eyes with EIFL) were included. The vitreous samples were collected during surgery for epiretinal membrane. The cytokine levels of the vitreous were measured using a multiplex bead analysis.ResultsThe mean logMAR visual acuity was worse (0.42 vs. 0.37; P = 0.331) and the central foveal thickness was higher in the EIFL group (496.9 µm vs. 434.2 µm; P = 0.007) than they were in the group without EIFL. The mean EIFL thickness was 164.1 ± 67.7 µm in the EIFL group. On multiplex analysis of the vitreous cytokines, the levels of CD163 (21529 pg/dL vs. 10877 pg/dL; P = 0.002) and macrophage colony-stimulating factor (206 pg/dL vs. 159 pg/dL, P = 0.004) were significantly higher in the EIFL group than they were in the group without EIFL.ConclusionsEyes with EIFL had increased vitreous levels of M2 macrophage markers. The activation of glial cell proliferation by M2 macrophages may contribute to EIFL formation.

Macular Choroidal Thickness Changes in Development, Progression, and Spontaneous Resolution of Epiretinal Membrane

To evaluate the association between macular choroidal thickness and the development, progression, and resolution of epiretinal membrane (ERM). The patients (n = 38) with unilateral ERM eyes with definitive changes on optical coherence tomography (OCT) and healthy fellow eyes were observed retrospectively. ERM eyes were divided into three groups: Development/new-onset group (n = 14), progression group (n = 13), and resolution group (n = 11). In each group, the average changes of macular choroidal thickness over time in ERM eyes were compared with those in the fellow eyes RESULTS: Choroidal thickness significantly decreased from 174.0 μm at baseline to 132.3 μm at event time (P = .001) in the development group, and from 140.0 μm ± 30.0 μm to 120.5 μm (P = .002) in the progression group. Conversely, a significant increase in choroidal thickness was observed in the resolution group (from 205.2 μm to 222.6 μm; P = .004). The fellow eyes showed no significant changes in choroidal thickness in all three groups. Choroidal thinning in newly developed or significantly progressed ERM eyes and choroidal thickening in spontaneously resolved ERM eyes suggest a clinical implication of choroidal changes in ERM. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:627-634.].

Foveal Avascular Zone Distortion in Epiretinal Membrane by Optical Coherence Tomography Angiography.

To show the morphologic changes on the foveal avascular zone (FAZ) in patients with epiretinal membrane (ERM) using optical coherence tomography angiography (OCTA) and to demonstrate the correlation between distortion of FAZ and features of the ERM. FAZ eccentricity index (longest diameter of FAZ/shortest diameter of FAZ) was measured in 52 patients with ERM and compared with 27 healthy subjects' values. The density of the ERM was quantified using a grading scale (0-3) on multicolor scanning laser images, and spectral-domain OCT characteristics of the eyes were assessed. Of the 52 eyes with ERM, 31 eyes (59.61%) showed some foveal remodeling, including full (13.46%) or partial (30.76%) apparent vascularization of FAZ, presence of a vessel crossing the fovea (9.61%), and horizontal or vertical elongation of FAZ (5.76%). The mean FAZ eccentricity index was 0.84 ± 0.46 (range: 0.0-1.86) in eyes with ERM and 0.98 ± 0.07 (range: 0.96-1.02) in the control subjects, respectively (P = .02). There was a negative significant correlation between FAZ eccentricity index and central macular thickness (P = .04). Thickening of the central fovea leads to foveal remodeling in ERM eyes, and OCTA enables the visualization of architectural FAZ changes. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:295-301.].

Relationship between the morphology of the foveal avascular zone and the degree of aniseikonia before and after vitrectomy in patients with unilateral epiretinal membrane.

Persistent metamorphopsia, particularly aniseikonia, is a troublesome problem which may occur after epiretinal membrane (ERM) surgery. To clarify if the preoperative foveal avascular zone (FAZ) morphology can be used as a predictor of postoperative residual aniseikonia, the morphological changes in the FAZ and the degree of aniseikonia between before and 12months after vitrectomy for epiretinal membrane (ERM) were measured and analyzed. Thirty patients, each with a unilateral idiopathic ERM, who underwent treatment between September 2016 and March 2017 were enrolled for this prospective case series study. Best-corrected visual acuity (BCVA), the degree of aniseikonia, central foveal thickness (CFT), FAZ area (FAZa), perimeter (FAZp), and circularity in ERM eyes were examined before and 1, 3, 6 and 12months after surgery. The fellow eye without an ERM was also examined and used as the control. The interocular ratios of the CFT, FAZa, and FAZp in ERM eyes with those in control eyes were also calculated. Multiple regression analysis was performed on preoperative parameters that were found to be significantly correlated with the 12-month aniseikonia in univariate analyses. The BCVA in the ERM eyes was significantly improved at 1month after surgery (P < .0001) The degree of aniseikonia was significantly reduced only after 12months (P = .004). The CFT had decreased significantly by 3months after the surgery and continued decreasing thereafter (P < .0001). Both FAZa and FAZp were significantly smaller in the ERM eyes than in the control eyes throughout the study period (P < .0001 and P < .0001, respectively), with no change in either parameter over the study period. Correlation analyses revealed that the degree of aniseikonia was significantly correlated with pre- and postoperative CFT, CFT ratio, FAZa, FAZa ratio, FAZp, and FAZp ratio. Within preoperative OCT parameters, FAZa ratio remained significant after multiple regression analysis was performed (P < .0001). Aniseikonia changed little over the long term following ERM surgery. Preoperative FAZ area ratio was identified as a significant predictor of postoperative aniseikonia.