Ocular Blood Flow Changes Impact Visual Acuity Gain after Surgical Treatment for Idiopathic Epiretinal Membrane

Abstract

Background: Idiopathic epiretinal membrane (iERM) is a common eye disease, which can be treated by surgical removal of the fibrotic tissue. Morphological outcome is generally evaluated by optical coherence tomography (OCT). Here, we investigate the impact of surgery on hemodynamics of the posterior pole, using OCT angiography (OCTA). Methods: Patients with unilateral iERM and indication for treatment were included. OCT and OCTA images of the posterior pole were obtained preoperatively and 3-months after 23G vitrectomy with membrane peeling. Parameters of interest included full retinal perfusion, choriocapillaris perfusion (CCP), Sattler’s layer perfusion (SLP), and Haller’s layer perfusion, which were evaluated longitudinally and also compared to unaffected fellow eyes. Using these parameters, multiple regression analyses were used to predict visual outcomes. Results: Sixty-three iERM eyes were recruited, which initially showed a significant bigger central retinal thickness (p < 0.001) and total macular volume (TMV) (p < 0.001) compared to fellow eyes, while perfusion parameters were alike. Three months later, treated eyes had a statistically significant thicker subfoveal choroid (p = 0.006) and showed an increase of CCP (p = 0.003), while SLP decreased (p = 0.014). Lower preoperative TMV and higher SLP were associated with better postoperative visual outcome. Conclusion: In this OCTA study, iERM itself does not affect the choroidal circulation. However, preoperative choroidal circulation will be a biomarker to know the influence on the choroidal circulation after ERM surgery and may be considered as a predictor for visual outcome.

Epiretinal Membrane Surgery: Structural Retinal Changes Correlate with the Improvement of Visual Function

“…Although it is still difficult to study the alteration of the deep capillary plexus in patients with ERM because of several artifacts, we cannot completely exclude the presence of vascular impairment of the deep capillary plexus preoperatively, which is located near the inner and outer borders of the INL in the parafoveal regions. Furthermore, Rommel et al [ 31 ] showed significant choroidal sublayer perfusion changes postoperatively for ERM with an increase perfusion of choriocapillaris and a decrease perfusion of Sattler’s layer, by using OCT angiography. Additionally, preoperative Sattler’s layer perfusion was suggested as a useful predictive marker for functional results, since a significant correlation was found with postoperative visual function [ 31 ].…”

“…Furthermore, Rommel et al [ 31 ] showed significant choroidal sublayer perfusion changes postoperatively for ERM with an increase perfusion of choriocapillaris and a decrease perfusion of Sattler’s layer, by using OCT angiography. Additionally, preoperative Sattler’s layer perfusion was suggested as a useful predictive marker for functional results, since a significant correlation was found with postoperative visual function [ 31 ].…”

Evaluating Retinal and Choroidal Perfusion Changes After Ocular Massage of Healthy Eyes Using Optical Coherence Tomography Angiography

“…Manual segmentation (F.R.) was performed to get 20 µm slabs of the choriocapillaris (CC), Sattler's layer (SL) and Haller's layer according to previously published protocols [3,17,[19][20][21] (Figure 1D-F).…”

“…OM in turns of compression and decompression is still a treatment option for acute occlusions of retinal arteries, with the intention of inducing IOP fluctuations and retinal arterial dilatation, although evidence is lacking [11][12][13][14]. The development of optical coherence tomography angiography (OCTA) enables the assessment of the retinal and choroidal vascular network in vivo and in real time by creating slab-segmented angiograms in a noninvasive fashion [15][16][17].…”

Preoperative Vision, Gender, and Operation Time Predict Visual Improvement After Epiretinal Membrane Vitrectomy: A Retrospective Study

“…Prognostic factors that have been reported include best-corrected visual acuity (BCVA), central retinal thickness (CRT), pseudohole, cystoid macula edema, intact photoreceptor inner and outer segments, location of ERM, and ocular perfusion. 3 , 5 , 13 In this study, we report the functional and anatomical outcomes of the MIVS using WAVS in fovea-attached type ERM. In addition, we discuss the prognostic factors which contribute to better visual improvement.…”