Journal Article

Intraretinal changes in idiopathic versus diabetic epiretinal membranes after macular peeling

Ferrara, Mariantonia, Ilardi, Gennaro, Cennamo, Gilda, Allegrini, Davide, Costagliola, Ciro, Romano, Mario R., Cennamo, Giovanni, Staibano, Stefania, Pafundi, Pia

2018

Overview

Epiretinal traction is not responsible only for epiretinal but also intraretinal changes. This study aims to describe structural and vascular intraretinal changes after macular peeling in idiopathic (iERM) vs diabetic ERM (dERM). We conducted a prospective interventional study on forty-two eyes, 23 with iERMs and 19 with dERMs, undergoing ERM-ILM peeling. We performed SD-OCT preoperatively, 1 and 6 months postoperatively to assess central macular thickness (CMT), intraretinal cysts (IC) and/or continuous ectopic inner foveal layers (CEIFL), superficial and deep capillary free zone (CFZ) area on OCT-A. Glial fibrillary acidic protein (GFAP), as a Müller cells marker, was detected immunohistochemically on ILM specimens, to assess Müller cells iatrogenic damage. The CEIFLs were significantly more common in iERMs (12 (52.2%) in iERMs vs 2 (10.5%) in dERMs, p = 0.004), whereas ICs in dERMs (6 (26.1%) in iERMs vs 17 (89.5%) in dERMs, p<0.001). Median preoperative and postoperative BCVA was 20/50 [20/40-20/66] and 20/33 [20/25-20/40] in iERMs and 20/100 [20/66-20/200] and 20/50 [20/50-20/66] in dERMs, respectively. Median preoperative and postoperative CMT was 423 [370-488] and 364 [329-382] μm in iERM group and 465 [447-503] and 378 [359-433] μm in dERM group, respectively. The BCVA improvement and reduction of CMT thickness were significant in both groups (p<0.001). The presence of CEIFL was associated with lower BCVA in iERMs. Deep CFZ network significantly increased only in dERMs, passing from 0.34 [0.29-0.42] mm2 preoperatively to 0.56 [0.46-0.6] mm2 at 6-month follow-up (p<0.001). The GFAP expression was significantly higher in dERMs (p = 0.001). The intraretinal changes are different in iERMs and dERMs, as increased expression of CEIFLs in iERMs vs ICs in dERMs. The CEIFLs are associated with worse anatomical and functional outcomes in iERMs, whereas GFAP espression in peeled ILMs is higher in dERMs.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Basement Membrane - physiopathology / Basement Membrane - surgery / Biology and Life Sciences / Cysts / Damage assessment / Damage detection / Diabetes / Diabetes mellitus / Diabetic retinopathy / Diabetic Retinopathy - diagnostic imaging / Diabetic Retinopathy - physiopathology / Diabetic Retinopathy - surgery / Edema / Epiretinal Membrane - diagnostic imaging / Epiretinal Membrane - physiopathology / Epiretinal Membrane - surgery / Eye - diagnostic imaging / Eye - physiopathology / Eye diseases / Female / Gene expression / Genetic aspects / Glial fibrillary acidic protein / Humans / Macula Lutea - physiopathology / Macula Lutea - surgery / Male / Medical imaging / Medicine and Health Sciences / Membranes / Neurodegeneration / Neurosciences / Ophthalmologic Surgical Procedures / Peeling / Postoperative Period / Research and Analysis Methods / Retina / Retina - diagnostic imaging / Retina - physiopathology / Retina - surgery / Social Sciences / Surgery / Tomography, Optical Coherence / Visual Acuity - physiology / Vitrectomy - methods