Department of Ophthalmology, San Gerardo Hospital, Monza, Italy.
Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
Graefes Arch Clin Exp Ophthalmol. 2021 Aug;259(8):2193-2201. doi: 10.1007/s00417-021-05102-6. Epub 2021 Feb 2.
To analyze the functional impact of ectopic inner foveal layers (EIFL), along with other clinical and optical coherence tomography biomarkers, on patients with epiretinal membrane (ERM) and preserved foveal layers' segmentation undergoing ERM removal.
Retrospective review of consecutive patients with ERM who underwent pars plana vitrectomy with ERM peeling from December 2018 to December 2019. Baseline factors including age, gender, lens status, phacoemulsification at the time of surgery, tamponade agent, dye used for ERM and internal limiting membrane (ILM) enhancement, ILM peeling, best-corrected visual acuity (BCVA) and central macular thickness (CMT), presence and thickness of EIFL, thickness of outer nuclear layer (ONL), presence of a cotton ball, subfoveal state of photoreceptors, and presence of cystoid macular edema were included in a multivariable model having the BCVA at 12 months as the main outcome. The changes in EIFL and ONL thickness over time were also analyzed.
Fifty-one patients (58 eyes, 23 eyes in the no EIFL group, and 35 eyes in the EIFL group) were enrolled. The BCVA significantly improved over 12 months after surgery, regardless of the presence of EIFL (p < 0.001). Eyes with no EIFL had better BCVA at month 3 (p = 0.04), but this difference was no longer detectable at 6 and 12 months. The presence of EIFL was not associated with the final BCVA (p = 0.9), while the CMT at 12 months correlated with EIFL thickness (r = 0.8, p = 0.008).
Patients with EIFL could reach optimal visual acuity in the absence of disorganization of the inner retinal layers but should be warned of potentially longer healing times. None of the morphologic signs included in this study precluded good visual recovery on long-term follow-up.
分析内黄斑异位层（EIFL）与其他临床和光学相干断层扫描生物标志物对保留黄斑层分段的视网膜前膜（ERM）患者的功能影响，这些患者接受 ERM 切除。
回顾性分析 2018 年 12 月至 2019 年 12 月期间连续接受平面内玻璃体切除术联合 ERM 剥离的 ERM 患者。基线因素包括年龄、性别、晶状体状态、手术时行白内障超声乳化术、眼内填充物、用于 ERM 和内界膜（ILM）增强的染料、ILM 剥离、最佳矫正视力（BCVA）和中央黄斑厚度（CMT）、EIFL 的存在和厚度、外核层（ONL）的厚度、棉球的存在、下黄斑区光感受器的状态和是否存在囊样黄斑水肿均纳入多元模型，主要结果为 12 个月时的 BCVA。还分析了 EIFL 和 ONL 厚度随时间的变化。
共纳入 51 例患者（58 只眼，无 EIFL 组 23 只眼，EIFL 组 35 只眼）。无论是否存在 EIFL，手术后 12 个月 BCVA 均显著提高（p<0.001）。无 EIFL 的眼在术后 3 个月时 BCVA 更好（p=0.04），但在 6 个月和 12 个月时已无法检测到差异。EIFL 的存在与最终 BCVA 无关（p=0.9），而 12 个月时的 CMT 与 EIFL 厚度相关（r=0.8，p=0.008）。
EIFL 患者即使内层视网膜层的排列紊乱也可能达到最佳视力，但应注意可能需要更长的愈合时间。本研究中包含的形态学特征均未阻止长期随访后的良好视力恢复。
