Association between displacement and thickness of macula after vitrectomy in eyes with epiretinal membrane

Abstract

the purpose of this cross-sectional retrospective study was to determine the relationship between the retinal displacements and the retinal thickness in eyes with epiretinal membrane (eRM) after vitrectomy with internal limiting membrane (iLM) peeling. to accomplish this, we measured the retinal thickness using optical coherence tomography (oct) and the retinal displacement using OCT angiography to obtain 3 mm × 3 mm en face images before, and 2, 4, and 8 weeks following the surgery from 20 eyes of 20 patients. The distance between the retinal vessel bifurcations and the fovea was significantly displaced centrifugally and asymmetrically in the 4 quadrants postoperatively (P < 0.001). The foveal avascular zone (FAZ) was significantly enlarged, and the central foveal thickness (CFT) and the inner nuclear layer (INL) thickness were significantly thinner postoperatively. The displacements were significantly correlated with the changes in the FAZ area (r = 0.717, P < 0.001), the CFT (r = − 0.702, P < 0.001), and the INL thickness (r = − 0.702, P < 0.001). In conclusion, the distance between the retinal bifurcations and the fovea was asymmetrically expanded after the surgery and was significantly correlated with the morphological changes. These results indicate that a horizontal macular contraction is correlated with vertical retinal contraction in the eyes with an eRM. An idiopathic epiretinal membrane (ERM) is a relatively common retinochoroidal disorder in older individuals 1,2 , and it can cause an inner retinal displacement of the macula area and a disruption of the foveal structure 3. These alterations cause traction on the retina in the macular area which can lead to visual dysfunction and metamorphopsia. Vitrectomy and removal of the ERM with or without internal limiting membrane (ILM) peeling is used to release the traction and is effective in improving the visual dysfunction, metamorphopsia, and visual acuity 4-6. Thus, it is important to know how the retina in the macular area is displaced in more detail after the surgery because the displacement will affect the visual function. Optical coherence tomography (OCT) enables clinicians to obtain information of the microstructures of the fovea, and earlier studies have reported that the retinal layer at the fovea is thickened and the outer retinal layers are disrupted in eyes with an ERM 7-9. The integrity of the outer retinal layers is important for vision in retinochoroidal disorders, and their alterations have been evaluated 10-12. However, there have been only a few reports on the changes of the inner retinal layers in eyes with ERM after surgery 13. This is important because the integrity of the inner retina is a major determinant of the visual dysfunctions in eyes with an ERM. OCT angiography (OCTA) is a noninvasive and safe technique that can obtain images of the microvasculature of the retina and the choroid. OCTA has enabled clinicians to investigate the retinal vasculature in situ repeatedly in short intervals 14,15. The displacements of the inner retin...

Vascular tortuosity analysis in eyes with epiretinal membrane imaged by optical coherence tomography angiography

“…Retinal vessel movements correlated with decreased BCVA and increased CMT were more common in patients with worsening symptoms. Momota et al quantified the distance between the retinal vessel bifurcations and the fovea using OCTA in eyes with ERM following surgery [ 16 ]. They demonstrated that significant retinal displacement occurred centrifugally and asymmetrically in the four quadrants postoperatively.…”

“…Centripetal tractional force is believed to be the main pathogenesis of ERM [ 16 , 18 ]. In the current study, a decrease in VL/BD was found in the temporal and superior-inferior quadrants postoperatively.…”

“…En face images of the retinal vessels were made from the total retina based on automated layer segmentation performed by the software installed in the OCTA device. The foveal avascular zone (FAZ) area was analyzed using ImageJ software [ 16 ] to calculate the size of FAZ on en face OCTA images, which captured both the superficial and deep capillary plexus. To avoid segmentation error, manual segmentation was performed to assess the total retina, if needed.…”

Stellungnahme von BVA, DOG und RG zur Entwicklung, Diagnostik und Behandlung der epiretinalen Gliose

“…eines "macular pucker" auch ein primäres Peeling der ILM im Rahmen der Versorgung einer rhegmatogenen Amotio bzw. einer PVR-Amotio retinae durch Vitrektomie [3,26,27,29,91,131,146].…”

Rhombus Deformation of Retinal Lateral Displacement After Epiretinal Membrane Removal Revealed by Diffeomorphic Image Registration

“…Previous studies analyzed the retinal structure directly using optical coherence tomography (OCT) images 4,5 or the foveal avascular zone (FAZ) and retinal vasculature position using ophthalmic imaging modalities like fundus photography, 1 infrared fundus photography, 2,6 fundus autofluorescence, 7,8 fluorescein angiography, 9 and OCT angiography (OCTA). [10][11][12] OCT angiography, which can analyze the retinal microvasculature noninvasively with good reproducibility, has been used in recent studies focusing on the FAZ and the position of the retinal vasculature. [10][11][12] The estimation of the FAZ area by OCTA and other ophthalmic examinations has been analyzed in multiple studies and is well established, 13,14 whereas the results of the analysis using the position of the retinal vasculature in the target area and the number of measurement points varied among studies.…”