Insights Into Epiretinal Membranes: Presence of Ectopic Inner Foveal Layers and a New Optical Coherence Tomography Staging Scheme

This case is submitted by Drs. Francisco J. Ascaso, Maria Rojo, and Enrique Minguez from the Department of Ophthalmology, “Lozano Blesa” University Clinic Hospital, Zaragoza, Spain, for the Diagnostic and Therapeutic Challenges Section of Retina; and commented by Dr. Steven M. Cohen, Clearwater, Flo

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Diagnostic and therapeutic challenges.

Photoreceptor Outer Segment Length: A Prognostic Factor for Idiopathic Epiretinal Membrane Surgery

Proliferative vitreoretinopathy (PVR) is the most common cause for failure of rhegmatogenous retinal detachment repair and is characterized by the growth and contraction of cellular membranes within the vitreous cavity and on both sides of the retinal surface as well as intraretinal fibrosis. Currently, PVR is thought to be an abnormal wound healing response that is primarily driven by inflammatory, retinal, and RPE cells. At this time, surgery is the only management option for PVR as there is no proven pharmacologic agent for the treatment or prevention of PVR. Laboratory research to better understand PVR pathophysiology and clinical trials of various agents to prevent PVR formation are ongoing.

Proliferative Vitreoretinopathy: A Review

PURPOSE. To determine whether there is a significant correlation between the integrity of the foveal microstructures and the best-corrected visual acuity (BCVA) after pars plana vitrectomy for epiretinal membrane (ERM) removal. METHODS. This was a retrospective, interventional case series. Forty-six eyes of 45 patients with an ERM underwent vitrectomy. The foveal area was examined by spectral-domain– optical coherence tomography (SD-OCT) preoperatively and postoperatively. The correlation between the length of the photoreceptor cone outer segment tips (COST) line defect, the inner segment/outer segment junction (IS/OS) line defect, the external limiting membrane (ELM) line defect, and the BCVA was determined. RESULTS. The length of the COST line defect was significantly correlated with the BCVA at postoperative 1, 3, 6, 9, and 12 months (P < 0.001 for all). Forward stepwise regression analyses showed that the postoperative BCVA was significantly correlated with the length of COST line defect (P < 0.001) but not with the IS/OS line and ELM line defects for up to 6 months. The preoperative length of the COST line defect was significantly correlated with the postoperative BCVA at 12 months (P ¼ 0.005), but the lengths of the IS/OS line defect and ELM line defect were not. The factor that best predicted the postoperative BCVA was the length of the preoperative COST line defect (P ¼ 0.04) but not the preoperative BCVA (P ¼ 0.69). CONCLUSIONS. The recovery of the foveal COST line defect is correlated with the BCVA after ERM surgery. The length of the preoperative COST line defect can predict the potential foveal function. (ClinicalTrials.gov number, NCT01549249.)

Correlation between foveal cone outer segment tips line and visual recovery after epiretinal membrane surgery.

Objective To determine the relationship between the morphology of the fovea and visual acuity in patients with an untreated idiopathic epiretinal membrane (ERM). Methods We examined 52 eyes of 45 patients diagnosed with an ERM. The morphology of the foveal area was determined by spectral-domain optical coherence tomography. The relationships between the best-corrected visual acuity (BCVA) and 8 optical coherence tomography features, central retinal thickness, cone outer segment tip (COST) line, photoreceptor inner/outer segment (IS/OS) junction line, foveal bulge of the IS/OS line, external limiting membrane, inner limiting membrane, foveal pit, and ERM over the foveal center, were evaluated. Results Multiple regression analysis showed that intact COST line, IS/OS junction line, and external limiting membrane independently and significantly contributed to the BCVA. The standardized partial regression coefficient β was 0.415 for the COST line, 0.287 for the IS/OS junction line, and 0.247 for the external limiting membrane. However, the other features, eg, foveal bulge, inner limiting membrane, foveal pit, and ERM, were not significantly associated with the BCVA. The central retinal thickness was significantly correlated with the BCVA (r 2  = 0.274; P  Conclusions At an early stage of an ERM, only the photoreceptor structures are significantly associated with the BCVA, and the appearance of the COST line was most highly associated. Detailed examinations of the photoreceptor structures using optical coherence tomography may help find photoreceptor dysfunction in cases of idiopathic ERM.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/1653289/ecs120058_172_177.pdf

Outer Retinal Morphology and Visual Function in Patients With Idiopathic Epiretinal Membrane

Highly reflective foveal region in optical coherence tomography in eyes with vitreomacular traction or epiretinal membrane.

Internal Limiting Membrane Peeling to Prevent Post-vitrectomy Epiretinal Membrane Development in Retinal Detachment.

We describe focal choroidal excavation (FCE) in a case of Vogt–Koyanagi–Harada (VKH) disease and compare the findings with different chorioretinal conditions. A 55-year-old man was diagnosed with VKH based on panuveitis and exudative retinal detachments. Spectral-domain optical coherence tomography demonstrated a dome-shaped protrusion with a nonconforming pattern at the fovea, which had been detected as a conforming pattern 1 year before the onset. The FCE pattern returned into a conforming pattern following corticosteroid therapy. These findings suggest that the natively existent FCE could be affected by pathophysiological changes of VKH as well as other chorioretinal conditions.

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Clinical course of focal choroidal excavation in Vogt–Koyanagi–Harada disease

Objective
To describe the 1-year efficacy of aflibercept in Japanese patients with age-related macular degeneration (AMD) who were resistant to ranibizumab treatment.

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One-year outcome of intravitreal aflibercept injection for age-related macular degeneration resistant to ranibizumab: rapid morphologic recovery and subsequent visual improvement

Ken Watanabe

Papers

Outer Retinal Morphology and Visual Function in Patients With Idiopathic Epiretinal Membrane

Highly reflective foveal region in optical coherence tomography in eyes with vitreomacular traction or epiretinal membrane.

Internal Limiting Membrane Peeling to Prevent Post-vitrectomy Epiretinal Membrane Development in Retinal Detachment.

Clinical course of focal choroidal excavation in Vogt–Koyanagi–Harada disease

One-year outcome of intravitreal aflibercept injection for age-related macular degeneration resistant to ranibizumab: rapid morphologic recovery and subsequent visual improvement