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To evaluate postoperative changes in retinal capillary plexus and to assess contributing factors in postoperative visual improvement using optical coherence tomography angiography (OCT-A) in patients with idiopathic epiretinal membrane (iERM) post membrane removal. Patients scheduled for vitrectomy and membrane peel for iERM were enrolled. 35 subjects were included for this study. OCT-A was used to measure the FAZ related parameters and the superficial and deep capillary plexus layers using 3 mm × 3 mm scans. Measurements were taken before surgery and at every post-surgical follow-up. The unaffected fellow eyes were used as controls. Evaluated factors included: BCVA, vessel density (VD) and retinal thickness (RT) in five regions, FAZ area, FAZ perimeter (PERIM), acircularity index (AI) and foveal vessel density (FD). Compared with the control group, the foveal vessel density (FVD) in superficial capillary plexus (SCP) was greater in the epi-retinal membrane group (P   0.05). After surgery there was a reduction in the PRVD in SCP. The FVD in DCP increased and the PRVD in DCP decreased at baseline (p   0.05). D-value of LogMAR BCVA was positively correlated with pre-op LogMAR BCVA (p < 0.0001), FVD in SCP (p < 0.001). It was negatively correlated with FAZ area (P < 0.001) and PERIM (P < 0.05). Vitrectomy and membrane removal led to the decrease of VD in SCP and the increase of PRVD in DCP. Patients with a more severe iERM may receive greater visual improvement with surgery. Trial registration number (TRN) and date of registration. ChiCTR2000031289, retrospectively registered, 2020.03.26.

/pdf/a-study-analyzing-macular-microvasculature-features-after-2g0u1o67ai.pdf

A study analyzing macular microvasculature features after vitrectomy using OCT angiography in patients with idiopathic macular epiretinal membrane.

In Brief Purpose: We evaluated the relationship between macular fluorescein leakage and retinal nerve fiber layer (RNFL) schisis and investigated the visual prognostic values after pars plana vitrectomy (PPV) and idiopathic epiretinal membrane removal. Methods: We analyzed the correlations between preoperative optical coherence tomography (OCT) parameters and macular leakage. The final best-corrected visual acuity and central macular thickness were compared according to the presence or absence of macular leakage and RNFL schisis. Results: In 80 eyes with idiopathic epiretinal membrane treated with PPV and membrane peeling, preoperative macular leakage was associated with the presence of preoperative RNFL schisis and inner nuclear layer microcysts. Eyes with both macular leakage and RNFL schisis showed worse postoperative best-corrected visual acuity than those without both factors. Conclusion: In the presence of macular fluorescein leakage and RNFL schisis, postoperative best-corrected visual acuity is worse, and improvements in the central macular thickness are greater than those in the absence of both factors. Preoperative macular leakage was associated with preoperative retinal nerve fiber layer schisis. Patients with macular leakage and retinal nerve fiber layer schisis showed worse postoperative best-corrected visual acuity than those without both factors. 

Clinical implication of retinal nerve fiber layer schisis and macular fluorescein leakage in primary idiopathic epiretinal membrane

Fluorescein angiography and indocyanine green angiographies are investigations commonly performed for the evaluation of retinal and choroidal vascular circulatory changes. This chapter provides an overview on the principles of fluorescein and indocyanine green angiographies and describe their applications in the assessment of various retinal diseases and how they can be used in the preoperative or postoperative evaluation of macular surgery.

Angiography Using Fluorescein and Indocyanine Green Dye

Epiretinal membranes may lead to centripetal contraction forces on the retina and its vessels. OCT-Angiography (OCT-A) is a recent tool which permits a non-invasive understanding of these vascular changes. This review focuses on the OCT-A findings in idiopathic epiretinal membranes, before and after surgery, and the role of internal limiting membrane peeling. It appears that contraction of the epiretinal membrane is associated with both a reduction in the area and perimeter of the foveal avascular zone and alterations in the superficial and deep capillary plexuses. These changes mainly reflect a vascular shift from the perifoveal to the foveal region, increasing with retinal deformation, but also probable dynamic changes in vascular flow. Membrane peeling allows at least partial improvement of these microvascular parameters. Nevertheless, some limitations of OCT-A, such as segmentation errors on a retina with highly modified architecture, can lead to a selection bias in the studies and should call for caution in the interpretation of the results. Finally, internal limiting membrane peeling contributes to changes in the retinal architecture after surgery, in particular by causing a centripetal movement of the macular capillaries and a displacement of the fovea toward the optic nerve head. This role should be clarified in future studies. 

Apports clinique et physiopathologique de l’OCT-angiographie dans les membranes épirétiniennes

The aim of the current study was to determine the association between fundus fluorescein angiography (FFA) image results, optical coherence tomography (OCT) imaging results and visual functions in patients with idiopathic epiretinal membranes (ERMs). A total of 80 eyes from 40 patients diagnosed with ERM were analyzed. Best-corrected visual acuity (BCVA) and metamorphopsia were measured using the Early Treatment Diabetic Retinopathy Study eye chart and M-charts, respectively. Macular thickness and volume were determined using OCT. Macular vascular leakage and distortion, and foveal avascular zone (FAZ) diameters were assessed using FFA. BCVA and M-chart results confirmed macular degeneration in the affected eyes. The area of macular vascular leakage was positively correlated with macular volume (r=0.50; P=0.001). The ratio of FAZ diameters was negatively correlated with central macular thickness (r=-0.41; P=0.008). The grade of macular vascular distortion was positively correlated with macular thickness (all r≥0.47; P<0.01) and volume (r=0.53; P<0.001). The results of the current study demonstrated that FFA may effectively identify the degree of changes in retinal macular vasculature. Vascular distortion, measured by FFA, may reflect changes in macular structure and visual functions. These results suggest a potential application of FFA in the pre- and post-surgical evaluation of patients with ERMs.

/pdf/pathophysiological-correlations-between-fundus-fluorescein-415ppxsp3a.pdf

Pathophysiological correlations between fundus fluorescein angiography and optical coherence tomography results in patients with idiopathic epiretinal membranes

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Pathophysiological correlations between fundus fluorescein angiography and optical coherence tomography results in patients with idiopathic epiretinal membranes