Epiretinal Membrane Research Articles

Contraction of a Giant Epiretinal Human Amniotic Membrane Patch Used to Manage a Highly Myopic Retinal Detachment Associated With Multiple Breaks.

A 64-year-old highly myopic woman with macular hole retinal detachment (MHRD) in her left eye underwent vitrectomy, internal limiting membrane (ILM) peeling, and epiretinal implantation of a 4-mm diameter human amniotic membrane (hAM) patch. One month later, she developed a bullous superior RD in her right eye, associated with a huge MH and multiple posterior breaks. Vitrectomy and ILM peeling were combined with a 15-mm epiretinal hAM patch implantation. One year later, both eyes showed successful MH closure, but the right eye developed an eccentric hAM patch contraction starting 6 months postoperatively, causing a localized stable superonasal RD. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Diabetic Retinopathy: Clinical Features, Risk Factors, and Treatment Options.

Diabetic retinopathy is a common complication of diabetes that affects the eyes and can lead to severe vision loss or blindness if left untreated. Chronic hyperglycemia destroys the blood vessels in the retina, resulting in diabetic retinopathy. The damage can lead to leakage of fluid and blood into the retina, causing edema, hemorrhages, and ischemia. A thorough evaluation by an ophthalmologist is necessary to determine the most appropriate course of treatment for each patient with diabetic retinopathy. The article discusses various surgical treatment options for diabetic retinopathy, including vitrectomy, scleral buckling, epiretinal membrane peeling, retinal detachment repair, and the risk factors of diabetic retinopathy. These surgical techniques can help to address the underlying causes of vision loss and prevent further complications from developing or worsening. To avoid complications and maintain vision, this review emphasizes the significance of early detection and treatment of diabetic retinopathy. Patients with diabetic retinopathy can improve their eyesight and quality of life with the help of some surgical treatments. The article also highlights some case studies in the field of diabetic retinopathy.

Epiretinal membrane formation with a pseudohole appearance ın a case with straatsma syndrome

Epiretinal membrane formation with a pseudohole appearance ın a case with straatsma syndrome

Visual prognostic factors following surgery for stage 3 idiopathic epiretinal membrane by Govetto classification.

To investigate the visual prognosis of metamorphopsia in patients undergoing surgery for stage 3 idiopathic epiretinal membrane (ERM) by Govetto classification using preoperative optical coherence tomography (OCT) parameters. Retrospective clinical study. This study included 45 eyes of 45 patients with a minimum follow-up period of 3 months. The best-corrected visual acuity (BCVA) and metamorphopsia score using the M-CHARTS were recorded. Central foveal thickness (CFT), inner nuclear layer thickness (INL), ectopic inner retinal layer thickness (EIFL), outer retinal layer thickness, disruption of the ellipsoid zone, cotton ball sign, and intraretinal cystoid changes were measured based on spectral domain OCT. Preoperative and postoperative values and conditions were compared, and correlations between the preoperative values or conditions and postoperative metamorphopsia scores or BCVA were analyzed. After surgery, the horizontal, vertical, and mean metamorphopsia scores, as well as BCVA, CFT, INL, and EIFL significantly improved (p < 0.001). Using multivariate analysis, only preoperative CFT was a significant explanatory parameter for both the postoperative horizontal metamorphopsia scores and mean values of the postoperative horizontal and vertical metamorphopsia scores (p = 0.019 and p = 0.011, respectively). Age (p = 0.011) and preoperative CFT (p = 0.026) were significant explanatory parameters of postoperative BCVA. Preoperative CFT significantly correlated with postoperative metamorphopsia in patients undergoing surgery for stage 3 idiopathic ERM. This finding might help surgeons predict postoperative visual outcomes and make timely surgical decisions.

Macular Structure Characteristics in Unilateral Idiopathic Full-Thickness Macular Hole and the Healthy Fellow Eyes

Introduction: This study aimed to investigate the macular structure and foveal pit characteristics in the unilateral full-thickness macular hole (FTMH) patients and healthy fellow eyes. Methods: Our retrospective investigation included patients with unilateral FTMH as the study group, and age- and sex-matched individuals without vitreomacular diseases as the control group, all from one medical center. FTMHs were categorized into those with epiretinal proliferation, those without epiretinal proliferation, or those lacking vitreomacular separation. Macular parameters including foveal base width (FBW), central foveolar thickness (CFT), central subfield thickness (CST), central subfield volume, and retinal artery trajectory (RAT) were measured via optical coherence tomography and fundus photography. Comparisons of these parameters were made among lesioned eyes, contralateral healthy eyes and normal controls, as well as among different subgroups. Results: Sixty-eight unilateral FTMH patients (39 women and 29 men) and 68 normal controls were enrolled. The fellow eyes of unilateral FTMH showed larger FBWs (446.8 ± 98.2 μm) than controls (338.4 ± 80.6 μm, p < 0.001). The lesioned and fellow eyes of unilateral FTMH had smaller RAT values (0.19 ± 0.06 and 0.14 ± 0.04) than controls (0.37 ± 0.14, p < 0.001), indicating wider RAT in both groups. No significant macular structure parameter differences were observed among different FTMH subgroups. Females exhibited larger FBW, thinner CFT and CST, and wider RAT than the age-matched males (p < 0.05). Conclusions: Patients with unilateral FTMH had a wider RAT in both the lesioned and healthy eyes and a wider FBW in their healthy fellow eyes than in controls. Such macular structure characteristics may be prone to macular hole formation.

An Association between HTRA1 and TGF-β2 in the Vitreous Humor of Patients with Chorioretinal Vascular Diseases.

Background: The aim of this paper was to investigate the protein concentrations of high-temperature requirement A 1 (HTRA1) and transforming growth factor-β (TGF-β) in the vitreous humor of patients with chorioretinal vascular diseases. Methods: This study measured protein concentrations of HTRA1, TGF-β1-3, and vascular endothelial growth factor A (hereinafter called VEGF) in the vitreous humor from seven eyes of patients with chorioretinal vascular diseases (age-related macular degeneration, diabetic macular edema, and retinal vein occlusion) and six control eyes (idiopathic epiretinal membrane and macular hole). We analyzed the mutual relationship among the protein levels. Results: The protein levels of HTRA1 and VEGF were significantly increased in the chorioretinal vascular disease group compared with the control group (1.57 ± 0.79 ×10-9 mol/mL vs. 0.68 ± 0.79 ×10-9 mol/mL, p = 0.039; 3447.00 ± 3423.47 pg/mL vs. 35.33 ± 79.01 pg/mL, p = 0.046, respectively). TGF-β2 levels were not significantly different between groups (2222.71 ± 1151.25 pg/mL for the chorioretinal vascular disease group vs. 1918.83 ± 744.01 pg/mL for the control group, p = 0.62). The concentration of HTRA1 was strongly associated with TGF-β2 levels in the vitreous humor, independent of VEGF (r = 0.80, p = 0.0010). Conclusions: We revealed that vitreous HTRA1 was increased in patients with chorioretinal vascular diseases and strongly correlated with TGF-β2.

Pre- and postoperative OCT features and surgical outcomes of advanced retinitis pigmentosa with macular hole: case series and literature review

BackgroundMacular hole (MH) is a rare complication of retinitis pigmentosa (RP) and has an adverse impact on residual visual function. At present, the underlying mechanisms are not fully understood and surgical experience is limited.MethodsWe reviewed the medical records and optical coherence tomography (OCT) scans in a cohort of eight eyes of seven RP patients with MH in order to report their OCT features and vitreoretinal surgical prognosis.ResultsThis study includes four lamellar macular holes (LMHs) and four full-thickness macular holes (FTMHs). Pre-operative OCT revealed other macular abnormalities in all eyes, such as epiretinal membrane (ERM), cystoid macular edema (CME), lamellar hole-associated epiretinal proliferation (LHEP) and vitreoretinal traction. MH progression and subjective vision worsening were noted in one LMH eye during a seven-month follow-up. All holes closed after vitrectomy with internal limiting membrane (ILM) peeling. At final follow-up, one eye had improved vision and seven eyes remained stable compared to baseline.ConclusionsThe occurrence of MH in RP is accompanied by various imaging characteristics, such as ERM, CME and LHEP, suggesting a multifactorial pathogenesis. Considering poor vision in most RP patients with potentially progressive MH, surgery appears to be effective in maintaining or improving the central vision in a period of time. Thus, vitrectomy should be performed as soon as possible and flap-assisted techniques or episcleral surgeries are needed for some special cases.

Self-supervised contrastive learning improves machine learning discrimination of full thickness macular holes from epiretinal membranes in retinal OCT scans.

There is a growing interest in using computer-assisted models for the detection of macular conditions using optical coherence tomography (OCT) data. As the quantity of clinical scan data of specific conditions is limited, these models are typically developed by fine-tuning a generalized network to classify specific macular conditions of interest. Full thickness macular holes (FTMH) present a condition requiring urgent surgical repair to prevent vision loss. Other works on automated FTMH classification have tended to use supervised ImageNet pre-trained networks with good results but leave room for improvement. In this paper, we develop a model for FTMH classification using OCT B-scans around the central foveal region to pre-train a naïve network using contrastive self-supervised learning. We found that self-supervised pre-trained networks outperform ImageNet pre-trained networks despite a small training set size (284 eyes total, 51 FTMH+ eyes, 3 B-scans from each eye). On three replicate data splits, 3D spatial contrast pre-training yields a model with an average F1-score of 1.0 on holdout data (50 eyes total, 10 FTMH+), compared to an average F1-score of 0.831 for FTMH detection by ImageNet pre-trained models. These results demonstrate that even limited data may be applied toward self-supervised pre-training to substantially improve performance for FTMH classification, indicating applicability toward other OCT-based problems.

Sparing versus Removal of Epiretinal Proliferation in the Surgical Repair of Full-thickness Macular Holes.

To evaluate the efficacy of vitrectomy with epiretinal proliferation (EP) sparing for full-thickness macular hole (FTMH) accompanied by EP. A multicenter, retrospective study. Eyes were divided into two groups: the sparing group (Group S) included eyes in which the EP around the hole was peeled and preserved, whereas the removal group (Group R) included eyes in which the EP was partially or completely removed. The internal limiting membrane was peeling in all eyes. Forty-six eyes were included. Twenty-five eyes were in Group S, and 21 eyes were in Group R, with no difference in preoperative best-corrected visual acuity (BCVA) (P = 0.96). After primary surgery, MHs were closed in all eyes, and there were no complications in either group. Postoperative 12-month BCVA significantly improved in both groups (both P < 0.01), while Group S had better 12-month BCVA than Group R (P = 0.016). In the multivariable analysis, EP sparing was associated with better BCVA at 12 months (P = 0.006) after accounting for the minimal macular hole size and preoperative BCVA. EP sparing and removal were both safe and effective techniques, while EP sparing may provide a favorable outcome for eyes with FTMH and EP.

Assessment of ganglion cell complex thickness and its correlation with retinal sensitivity using microperimetry 6 months after epiretinal membrane surgery

PurposeTo verify the correlation between the full-macular and the ganglion cell complex (GCC) thickness measurements and retinal sensitivity (RS) assessed by microperimetry (MP) 6 months after surgical peeling for idiopathic epiretinal membrane (ERM).MethodsForty-three were submitted to pars-plana posterior vitrectomy (PPV) with concomitant peeling of internal limiting membrane (ILM) for idiopathic ERM treatment. Best-corrected visual acuity (BCVA) and 3D volumetric high-definition optical coherence tomography (OCT) imaging were preoperatively acquired. Six months after the surgery, BCVA, OCT imaging, and RS measured by MP were assessed. For the OCT parameters, we analyzed both the full-macular and the ganglion cell layer complex (GCC) thicknesses. The MP parameters tested were 44 points covering 20 central degrees (6 mm), with direct correspondence with the nine sectors of the OCT-ETDRS map. This approach enables the direct topographic correlation between the structure and functional measurements. The OCT and MP exam measurements were also performed in 43 eyes of age-matched healthy controls. Correlations between BCVA, RS, and OCT parameters were examined.Results All patients exhibited a substantial improvement in visual acuity following surgery. The RS parameters were significantly lower in patients compared to the controls. The full-macular thickness measurements were thicker than controls preoperatively and significantly reduced postoperatively; however, remaining significantly higher than controls, in the 4 inner sectors, at the fovea and for the average macular thickness. Preoperative GCC measurements were higher than those in controls. There was a significant reduction in GCC thickness in all sectors postoperatively, especially in the outer sectors, as well as in the average macular thickness. A positive correlation was found between full-macular and GCC thickness and RS postoperatively in several sectors.ConclusionsOur results demonstrate that ERM peeling can improve visual acuity in the postoperative period. However, RS may not fully restore, remaining significantly lower when compared to the controls. Both full-macular and GCC thickness measurements were reduced 6 months after surgery. However, significant thinning of the GCC thickness was observed when compared to the normal control eyes, indicating the occurrence of some degree of ganglion cell layer atrophy. We have demonstrated significant correlations among various OCT thickness parameters, particularly for GCC measurements. We believe that GCC integrity may play an important role in visual function after ERM surgery, and that MP may help better understand the correlations between structural and functional findings following ERM surgery.

Anterior Chamber Flare as a Non-Invasive Assessment of Intraocular Immune Status and Ocular Complications in Proliferative Diabetic Retinopathy.

Proliferative diabetic retinopathy (PDR) is a vision-threatening complication of diabetes mellitus (DM). Anterior chamber (AC) flare and intraocular cytokines are potent biomarkers reflecting the intraocular immune status in PDR. This study aimed to elucidate the complex interrelationship between AC flare and intraocular cytokines in PDR eyes. A retrospective observational study was conducted on 19 PDR eyes of 19 patients with type 2 DM, and on 19 eyes of 19 patients with idiopathic macular hole or epiretinal membrane as controls. AC flare was measured before pars plana vitrectomy (PPV). Aqueous humor (AH) and vitreous fluid (VF) samples were collected at the time of PPV, and the quantities of 27 cytokines in both intraocular fluids were analyzed. In the PDR and control groups, Spearman's rank correlation analysis revealed a positive correlation between AC flare and IL-8 level in both AH and VF. Additionally, IL-8 levels in AH correlated positively with IL-8 levels in VF. In the PDR group, receiver operating characteristic curve analysis identified IL-8 level in AH as a significant predictor for both diabetic macular edema (DME) and vitreous hemorrhage (VH) complications. The cut-off values of IL-8 were established at ≥26.6 pg/mL for DME and ≥7.96 pg/mL for VH. Given the positive correlation between AC flare and AH IL-8 level, the present findings suggest that AC flare value may potentially be a non-invasive biomarker for predicting DME.

Two-year outcomes of different subretinal fluid drainage techniques during vitrectomy for fovea-off rhegmatogenous retinal detachments: ELLIPSOID-2 study

BackgroundThe purpose of the study is to compare visual acuity, complications and outer retinal integrity following subretinal fluid (SRF) drainage from the peripheral retinal breaks (PRBs) versus posterior retinotomy (PR)...

SPECTRAL-DOMAIN OCT INSIGHTS INTO IDIOPATHIC EPIRETINAL MEMBRANE SURGERY OUTCOMES.

This study aims to assess the prognostic value of a classification system that includes the presence of ectopic inner foveal layers (EIFL) and other anatomical variables identified in spectral-domain optical coherence tomography (SD-OCT) for idiopathic epiretinal membrane (ERM) surgery. A descriptive-analytic, longitudinal, retrospective study was conducted on patients with idiopathic ERMs treated with pars plana vitrectomy (PPV) from January 2017 to December 2021. Clinical data and SD-OCT images were reviewed pre-surgery and 12 months post-surgery. 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. The study included 342 eyes from 323 patients. Post-surgical evaluations showed significant reductions in central foveal thickness (CFT) 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. Presence of macular edema (ME) and ellipsoid zone (EZ) disruption were significant predictors of post-surgical BCVA, while disorganization of the retinal inner layer (DRIL) showed association with visual recovery but was not conclusively predictive. The study highlights the importance of SD-OCT in assessing retinal changes in idiopathic ERMs, demonstrating the prognostic value of EIFL stage scheme and other anatomical variables like EZ disruption and ME presence on BCVA. These findings offer insights for surgical prognostication and the potential for personalized treatment strategies.

Unmasking of molecular players: proteomic profiling of vitreous humor in pathologic myopia

BackgroundThis study aimed to identify the differentially expressed proteins in the vitreous humor (VH) of eyes with and without pathologic myopia (PM), providing insights into the molecular pathogenesis.MethodsA cross-sectional, observational study was conducted. VH samples were collected from patients undergoing vitrectomy for idiopathic epiretinal membrane (ERM), macular hole (MH), or myopic retinoschisis (MRS). Label-free quantitative proteomic analysis identified differential protein expression, with validation using ELISA.ResultsThe proteomic profiling revealed significantly higher expressions of tubulin alpha 1a (TUBA1A) and eukaryotic translation elongation factor 1 alpha 1 (EEF1A1) in PM groups (MH-PM, MRS-PM) compared to controls (MH, ERM). Conversely, xylosyltransferase 1 (XYLT1), versican core protein (VCAN), and testican-2 (SPOCK2) expressions were lower in PM. ELISA validation confirmed these findings.ConclusionsOur study provides novel insights into the molecular mechanisms of PM. The differentially expressed proteins EEF1A1, TUBA1A, XYLT1, VCAN, and SPOCK2 may play crucial roles in chorioretinal cell apoptosis, scleral extracellular matrix (ECM) synthesis, and scleral remodeling in PM. These proteins represent potential new targets for therapeutic intervention in PM, highlighting the importance of further investigations to elucidate their functions and underlying mechanisms in disease pathogenesis.

Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease.

To describe the multimodal imaging features, treatment, and outcomes of patients diagnosed with adult-onset Coats disease. This retrospective study included patients first diagnosed with Coats disease at ≥18 years of age between September 2017 and September 2021. Some patients received anti-vascular endothelial growth factor (VEGF) therapy (conbercept, 0.5 mg) as the initial treatment, which was combined with laser photocoagulation as needed. All the patients underwent best corrected visual acuity (BCVA) and intraocular pressure examinations, fundus color photography, spontaneous fluorescence tests, fundus fluorescein angiography, optical coherence tomography (OCT), OCT angiography, and other examinations. BCVA alterations and multimodal image findings in the affected eyes following treatment were compared and the prognostic factors were analyzed. The study included 15 patients who were aged 24-72 (57.33±12.61)y at presentation. Systemic hypertension was the most common associated systemic condition, occurring in 13 (86.7%) patients. Baseline BCVA ranged from 2.0 to 5.0 (4.0±1.1), which showed improvement following treatment (4.2±1.0). Multimodal imaging revealed retinal telangiectasis in 13 patients (86.7%), patchy hemorrhage in 5 patients (33.3%), and stage 2B disease (Shield's staging criteria) in 11 patients (73.3%). OCT revealed that the baseline central macular thickness (CMT) ranged from 129 to 964 µm (473.0±230.1 µm), with 13 patients (86.7%) exhibiting a baseline CMT exceeding 250 µm. Furthermore, 8 patients (53.3%) presented with an epiretinal membrane at baseline or during follow-up. Hyper-reflective scars were observed on OCT in five patients (33.3%) with poor visual prognosis. Vision deteriorated in one patient who did not receive treatment. Final vision was stable in three patients who received laser treatment, whereas improvement was observed in one of two patients who received anti-VEGF therapy alone. In addition, 8 of 9 patients (88.9%) who received laser treatment and conbercept exhibited stable or improved BCVA. Multimodal imaging can help diagnose adult-onset Coats disease. Anti-VEGF treatment combined with laser therapy can be an option for improving or maintaining BCVA and resolving macular edema. The final visual outcome depends on macular involvement and the disease stage.

Aqueous Humor Cytokines in Idiopathic Epiretinal Membrane: Correlation with Disease Severity.

To analyze the concentration of aqueous humor (AH) cytokines in eyes with idiopathic epiretinal membrane (iERM) and to investigate their potential correlation with disease severity. Retrospective cross-sectional case-control institutional study. A total of 16 eyes of 16 iERM patients and 14 eyes of 14 age-matched healthy controls were enrolled. AH samples were analyzed for various biomarkers using a glass-chip protein array. Cytokines associated with inflammation, fibrosis, angiogenesis, and glial signal transduction were quantified. Significant differences in cytokine concentration were observed between the iERM group and controls, with 19 cytokines elevated in the iERM group (among them IL-6, IL-8, PDGF-AB, PDGF-BB, TGFB-1, TGFB-2, TGFB-3, VEGF A, VEGF C, VEGF D, p < 0,05, 95% confidence interval). Correlation analysis revealed associations between cytokine levels and iERM severity. Notably, stages 2, 3, and 4 of iERM demonstrated increased levels of various biomarkers. This study provides insights into the complex molecular interactions underlying iERM pathogenesis, describing a correlation between neuroinflammation and iERM severity.

Comparison of Surgical Times Between Manual and Robot-Assisted Epiretinal Membrane Peeling.

Epiretinal membranes (ERM) pose a common challenge in vitreoretinal pathology, often causing vision impairment in older adults. The Preceyes Surgical System (PSS) supports the surgical removal of ERM through robot-assisted membrane peeling (RA-MP). This study compares surgical times and iatrogenic hemorrhages between manual membrane peeling (MMP) and RA-MP using PSS. Nine patients underwent RA-MP with PSS, whereas 16 patients (18 eyes) underwent MMP for comparative analysis. Surgical durations were categorized into RA-MP, manual forceps utilization in PSS surgeries (mRA-MP), and traditional MMP. Cumulative manual manipulation duration (cMMP), instrument grasps, and intraoperative hemorrhages were statistically analyzed using the Mann-Whitney U test. RA-MP showed significantly longer peeling times compared to MMP (P < 0.001). Flap initiation grasps were similar between methods (P = 0.86), RA-MP demonstrated a significant reduction in peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001). Although RA-MP resulted in fewer hemorrhages, the difference did not reach statistical significance relative to MMP (P = 0.08). Although RA-MP tended to extend surgical time, it offered advantages in reducing tissue trauma and intraoperative hemorrhages. Further research is needed to explore the learning curve for novice surgeons and evaluate the safety profile of RA-MP. RA-MP may offer potential advantages over manual surgery, particularly in terms of reduced tissue trauma and intraoperative hemorrhages. Despite its longer duration compared with manual techniques, RA-MP may lead to fewer grasping maneuvers and lower rates of hemorrhages, thereby enhancing the safety and precision of vitreoretinal surgeries.

Vitrectomy for cases of diabetic retinopathy.

Microvascular complications of diabetic retinopathy (DR) may require surgical intervention in the form of vitrectomy. Since its inception, diabetic vitrectomy has evolved with introduction of better instruments, newer techniques, and smaller port sizes. Common indications for diabetic vitrectomy include nonresolving vitreous hemorrhage, tractional retinal detachment, epiretinal membrane, progression of fibrovascular membranes despite laser therapy, recalcitrant diabetic macular edema, and neovascular glaucoma. Preoperative systemic stabilization is essential prior to planning surgery. Surgical techniques commonly used in diabetic vitrectomy are segmentation, delamination, and rarely en-bloc dissection. Modification in surgical techniques such as chandelier-assisted bimanual dissection and pharmacological adjuvants improve surgical outcomes in these patients. Prognosis in these patients could be improved with early intervention. Studies evaluating the outcome of vitrectomy in patients with early proliferative DR are required to understand the appropriate time of intervention in patients. Treatment aimed at arresting the progression of DR and gene therapy are avenues that need further evaluation. The following review will focus on covering the epidemiology of DR, indications of vitrectomy, preoperative considerations, surgical procedures of diabetic vitrectomy, methods of membrane dissection, pharmacological adjuvants to vitrectomy, outcomes of diabetic vitrectomy, and future directions of diabetic vitrectomy.

Complications After Pediatric Penetrating Keratoplasty: An IRIS Registry Study.

To describe the frequency of postoperative complications in children undergoing penetrating keratoplasty (PK). This retrospective cohort study included pediatric patients (aged 0-18 years) in the Intelligent Research in Sight (IRIS) Registry who underwent primary PK between January 2013 and December 2020. Patients were identified using Current Procedure Terminology codes. Postoperative complications were identified using International Classification of Diseases Revision 9 and 10 codes and categorized as complications affecting the anterior segment (epithelial defect, infectious keratitis, neurotrophic keratitis, and glaucoma) or posterior segment (vitreous hemorrhage, retinal detachment, choroid detachment, choroidal hemorrhage, endophthalmitis, epiretinal membrane, and proliferative vitreoretinopathy). Of the 544 pediatric patients undergoing PK, 259 (47.6%) experienced postoperative complications. Anterior segment complications (n = 222, 40.8%) were more common than posterior segment complications (n = 96, 17.6%). The most common anterior complication was infectious keratitis (n = 163, 30.0%) with a median onset time of 275 days (IQR 50-560 days) after surgery. Vitreous hemorrhage (n = 52, 9.6%) and retinal detachment (n = 48, 8.8%) were the most common posterior segment complications. Infectious keratitis was the most common postoperative complication in children undergoing PK. More complications occurred in the anterior segment (70%) of the eye as compared with the posterior segment (30%). These findings demonstrate the challenges associated with pediatric PK and may help guide postoperative monitoring and management.

Association of Microvasculature Changes with Visual Outcomes in Idiopathic Epiretinal Membrane Surgery: A Clinical Trial.

Purpose: The purpose of this paper is to evaluate macular microvascular changes and their correlation with visual outcomes after idiopathic epiretinal membrane (iERM) surgery. Methods: Forty-seven eyes operated for iERM were included in this retrospective case series. The foveal avascular zone (FAZ) area, and the vessel density (VD) in the superficial and the deep capillary plexus (SCP and DCP) were evaluated using optical coherence tomography angiography (OCTA). The association between the OCTA parameters and best-corrected visual acuity (BCVA) was examined preoperatively and postoperatively. Regression analyses were conducted to determine the potential predictive factors for visual recovery. Results: At baseline, the FAZ area in iERM eyes was significantly smaller than that in the control eyes (p < 0.001). iERM eyes also had a lower macular VD in both the SCP and the DCP (p < 0.001). Preoperative BCVA was negatively correlated with the FAZ area (r = -0.499, p < 0.001) and macular VD in the DCP (r = -0.422, p = 0.003). A negative correlation was also found between postoperative BCVA and macular VD in both the SCP (r = -0.394, p = 0.006) and the DCP (r = -0.569, p < 0.001). In the bivariate analyses, age, preoperative BCVA, iERM stage, and baseline macular VD in the SCP were significantly associated with BCVA at 6 months post-surgery. Multivariate regression analysis revealed that the preoperative BCVA was the only predictor of visual outcomes in iERM eyes (p < 0.001). Conclusions: Idiopathic epiretinal membrane (iERM) causes microvascular changes, including foveal avascular zone (FAZ) contraction and decreased macular vessel density (VD) in both the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). These changes were significantly correlated with pre- and/or postoperative best-corrected visual acuity (BCVA). However, none of these alterations appeared to have prognostic value for visual outcomes in patients with iERM.