Govetto Andrea, Francone Anibal, Lucchini Sara, Garavaglia Sonia, Carini Elisa, Virgili Gianni, Radice Paolo, Vogt Denise, Edwards Malia, Spaide Richard F, Romano Mario R
From the Department of Biomedical Sciences, Humanitas University (A.G., M.R.R.), Pieve Emanuele, Milan, Italy; Ophthalmology Department, Humanitas Gavazzeni and Castelli (A.G., M.R.R.), Bergamo, Italy.
Charles Ophthalmic Center (A.F.), Buenos Aires, Argentina.
Am J Ophthalmol. 2025 Apr;272:48-57. doi: 10.1016/j.ajo.2024.12.027. Epub 2025 Jan 3.
To investigate the incidence, clinical spectrum, and pathophysiology of microcystoid macular edema (MME) in 2 cohorts of patients with epiretinal membrane (ERM) and idiopathic full-thickness macular hole (FTMH).
Single-center, retrospective, interventional, cohort study.
Review of clinical charts, structural and en-face optical coherence tomography (OCT), and fluorescein angiography (FA) imaging of ERM and FTMH eyes that underwent surgery with pars plana vitrectomy and internal limiting membrane (ILM) peel, with a minimum follow-up of 6 months. Histopathology analysis of 3 specimens: 2 human retinas and 1 human ILM.
One hundred seventy-two patients with ERM (123) and FTMH (49) were included in the study and followed up a mean of 9.1 ± 4.7 and of 8.2 ± 3.6 months, respectively. Preoperatively, MME was present in 27 of 123 eyes with ERM (21.9%), and in none of 49 eyes with FTMH (P < .001). MME was significantly associated with advanced ERM stages (P < .001). MME was typically located below continuous ERM-ILM adherence areas. FA in 46 ERM eyes showed capillary leakage in 36.4% of eyes without MME or cystoid macular edema (CME), in 39% of eyes with MME, and increased hyperfluorescence in CME. Postoperatively, new-onset MME appeared in 13 of 84 ERM eyes (15.5%) and in 1 FTMH eye (2%, P = .014). MME resolved in 7 of 40 ERM eyes with either preoperative or postoperative MME (17.9%) by 2.8 ± 1.5 months postsurgery. MME showed variable evolution postoperatively. The association between MME and postoperative best corrected visual acuity was significant only in univariate analysis (P = .037). Histopathology analysis showed anatomical continuity between Müller cells and ERM, suggesting a higher risk of iatrogenic damage in ERM eyes during peeling maneuvers.
Postoperative MME was a frequent finding in ERM and a rare occurrence in FTMH, suggesting that ILM peeling alone may not be sufficient to cause MME. The morphology and clinical characteristics of ERM-related MME are unlikely related to neurodegenerative processes and rather attributable to Müller cell disruption and iatrogenic damage. The characteristics of MME and CME may overlap, blurring the differences between the 2 entities.
研究两组视网膜前膜（ERM）和特发性全层黄斑裂孔（FTMH）患者中微囊样黄斑水肿（MME）的发生率、临床谱及病理生理学。
单中心、回顾性、干预性队列研究。
回顾接受玻璃体切割联合内界膜（ILM）剥除手术的ERM和FTMH患眼的临床病历、结构及表面光学相干断层扫描（OCT）以及荧光素血管造影（FA）图像，随访至少6个月。对3个标本进行组织病理学分析：2例人类视网膜和1例人类ILM。
172例ERM（123例）和FTMH（49例）患者纳入研究，平均随访时间分别为9.1±4.7个月和8.2±3.6个月。术前，123例ERM患眼中27例（21.9%）存在MME，49例FTMH患眼中均无MME（P<0.001）。MME与晚期ERM分期显著相关（P<0.001）。MME通常位于连续的ERM-ILM粘连区域下方。46例ERM患眼的FA显示，无MME或囊样黄斑水肿（CME）的患眼中36.4%有毛细血管渗漏，有MME的患眼中39%有毛细血管渗漏，CME患眼中荧光素渗漏增加。术后，84例ERM患眼中13例（15.5%）出现新发MME，1例FTMH患眼（2%，P = 0.014）出现新发MME。40例术前或术后有MME的ERM患眼中7例（17.9%）在术后2.8±1.5个月MME消退。MME术后演变情况各异。MME与术后最佳矫正视力之间的关联仅在单因素分析中有显著意义（P = 0.037）。组织病理学分析显示Müller细胞与ERM之间存在解剖连续性，提示ERM患眼在剥膜操作过程中发生医源性损伤的风险更高。
术后MME在ERM中常见，在FTMH中罕见，提示单纯ILM剥除可能不足以导致MME。ERM相关MME的形态和临床特征不太可能与神经退行性过程有关，而更可能归因于Müller细胞破坏和医源性损伤。MME和CME的特征可能重叠，模糊了这两种病变之间的差异。
