Influence of postoperative ectopic inner foveal layer on visual function after removal of idiopathic epiretinal membrane

Abstract

Purpose To investigate the functional and anatomical parameters and their postoperative changes according to the ectopic inner foveal layer (EIFL) staging scheme for idiopathic epiretinal membrane (ERM). Methods In this prospective study, patients with idiopathic ERM underwent pars plana vitrectomy and ERM removal, and were followed-up for 6 months. The associations of EIFL with pre- and postoperative functional and anatomical parameters were analyzed. Results A total of 84 eyes (84 patients) were included: 39 (46.4%), 33 (39.3%), and 12 (14.3%) as EIFL stages 2, 3, and 4, respectively. At 6 months after surgery, the mean best-corrected visual acuity (BCVA) significantly improved in all EIFL stages (P ≤ 0.003); however, metamorphopsia improved only in eyes with EIFL stage 2 (P = 0.039) and 3 (P = 0.011). The aniseikonia and foveal avascular zone (FAZ) area showed no significant postoperative changes in any of the EIFL stages. Both preoperatively and during 6 months after surgery, the EIFL stage showed a significant correlation with BCVA (P ≤ 0.033), metamorphopsia (P ≤ 0.008), central macular thickness (P < 0.001), and FAZ parameters (P ≤ 0.016) at each time point, but not with aniseikonia. Significant correlations of EIFL thickness with BCVA (P = 0.028) and metamorphopsia (P = 0.006) before surgery were not persistent after surgery. Conclusion Both pre- and postoperatively, the staging of EIFL, rather than its thickness, is a simple and adequate surrogate marker for visual acuity and metamorphopsia in eyes with idiopathic ERM.

The effect of ectopic inner foveal layer thickness on metamorphopsia in idiopathic epiretinal membranes

“…[9,12,21] In addition, when these results were evaluated, as Kim et al also stated earlier, in terms of prognosis prediction, the ERM stage in the new classification made according to the presence of EIFL can be considered to be more useful than EIFL thickness. [13] Since we did not see a significant difference in INL and IPL thicknesses before and after surgery, we thought that the formation of metamorphopsia in this patient group may be due to changes in the outer retinal layers. We observed that preoperative CMT and ONL thickness were positively correlated with preoperative MH and MV scores.…”

“…[19] Kim et al, in their study, in which they included 84 patients with stage 2, 3, and 4 ERM, observed a decrease in visual acuity and an increase in metamorphopsia scores as the ERM stage increased in the preoperative period. [13] They reported that EIFL thickness was correlated with metamorphopsia scores in the preoperative period. Alkabes et al examined 60 eyes with stage 3 and stage 4 ERM and found that metamorphopsia scores were significantly correlated with EIFL thickness and CFT.…”

“…Kim et al observed that preoperative EIFL thickness and preoperative metamorphopsia scores were related, but this finding was not present postoperatively. [13] Yanagida et al reported that there was a significant relationship between EIFL thickness and metamorphopsia scores both preoperatively and postoperatively. [14] To the best of our knowledge, both stage 3 and stage 4 ERMs have been included in studies on this subject, including the studies mentioned above.…”

Diabetic Epiretinal Membranes Unveiled: Exploring Staging and Optical Coherence Tomography-Based Classification for Precise Characterization

“…Consequently, an increase in foveal VD and narrowing of the FAZ area are expected mechanical results. 14,15,[17][18][19][20] Our study found a strong positive correlation between CFT and ERM stage in both diabetic and idiopathic ERMs. Additionally, we observed a positive correlation between CFT and foveal VD, while a negative correlation was found between CFT and FAZ area in both types of ERM.…”

Epiretinal membrane related vascular changes in diabetic eyes evaluated with optical coherens tomography angiography

“…This suggests that the influence of ERM is primarily observed in the inner retinal layers and superficial vascular structures, yet it also highlights its impact on the deeper vascular structures due to ERM traction [12] . In the literature, there are cases in which visual abnormalities may be present without any deterioration in the ellipsoid zone or decrease in visual acuity, and this may be related to the effect of the ERM on the inner retinal layers [13] . In a study conducted with OCT-A, it was shown that there were significant changes especially in the SCP in eyes with ERM; the FAZ area created by SCP was smaller in eyes with ERM than in the macular pseudohole and control groups, and it was suggested that ERM caused a decrease in VD with a direct effect on SCP.…”