Predicting Progression of Untreated Macular Pucker Using Retinal Surface En Face Optical Coherence Tomography

Abstract

To review visual outcomes in untreated premacular membrane (PMM) with macular pucker (MP) and evaluate novel predictors of progression. Methods: In this retrospective observation study, we included 342 eyes with untreated PMM with MP between 2012 and 2015. PMMs were characterized by spectral-domain optical coherence tomography (SD-OCT) imaging based on foveal morphologies, number of retinal contraction centers, central subfield thickness (CST), inner segment ellipsoid band integrity, and photoreceptor deformation index. Additionally, the thickened retina portion was identified by en face OCT and processed digitally to calculate its area. Parameters were retrospectively analyzed using multiple regression analyses to identify associations with change in visual acuity (VA) between initial to final follow-up visit. Results: In 468 eyes with untreated PMM, VA and CST did not change significantly during a mean observation period of 448 days (p = 0.52 and 0.35, respectively). Specifically, VA improved or stayed the same in 80% and worsened by 2 lines or more in 20% of eyes. The only consistent predictor of PMM progression was area of retinal thickening: for every 1 mm 2 of retinal thickening at baseline, the odds of having worsened vision at follow-up increased by 6% (OR 1.0606, 95% CI 1.0031-1.1214, p = 0.0387). Conclusions: The majority of eyes with PMM and good visual function at baseline remain stable or spontaneously improve in VA and macular thickness. Area of retinal thickening as evaluated by en face OCT may be a novel predictor of vision loss in untreated PMM with MP.

Three-Dimensional Retinal Displacement Before and After Macular Pucker Surgery

“… 10 The pathogenic mechanism is often and improperly simplified as a “contraction” of the “retinal surface” and the coronal (often and somehow improperly defined as “tangential” in clinical speech) component is regarded as the predominant feature, while ERMs indeed affect the entire retinal structure, and displacement occurs along all three axes as shown by en face 11 (coronal) and sagittal OCT imaging. 12 Artificial intelligence algorithms also found alterations in the inner perifoveal retina to be better predictors of visual impairment 13 than surface indicators, and Li et al 14 found the amount of retinal surface undergoing thickening as the only significant predictor of visual impairment before surgery. A recent meta-analysis, however, found the integrity of EZ, interdigitation zones, and photoreceptor outer segment length as predictors of better visual outcomes after surgery.…”