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Predictive value of ectopic inner foveal layer without internal limiting membrane peeling for idiopathic epiretinal
Bugra Karasu1,2, Ali Rıza Cenk Celebi3
1Department of Ophthalmology, Tuzla State Hospital, İçmeler Mahallesi, Piri Reis Caddesi, No: 74 Tuzla, 34947, Istanbul, Turkey. bugra_karasu@hotmail.com.
Purpose:
To investigate the clinical importance of ectopic inner foveal layer (EIFL) grading (mild to severe) in patients diagnosed with idiopathic epiretinal membrane (iERM) and had pars plana vitrectomy (PPV) with solely ERM peeling.
Materials And Methods:
Patients diagnosed with iERMs who had undergone PPV including only ERM peeling were enrolled in the study, and follow-up findings were recorded at baseline, and at 3, 6, 12 months and final examinations. EIFL was categorized into four grades, from mild to severe. Pre- and postoperative anatomical changes were measured using spectral domain optical coherence tomography (SD-OCT) imaging. The association between EIFL and other SD-OCT parameters with best-corrected visual acuity (BCVA) was assessed before and after PPV surgery.
Results:
One-hundred thirty-eight eyes of 106 patients with mild to severe EIFL were included in the study. Higher EIFL thickness was significantly correlated with lower baseline (r = 0.575, p = 0.020) and final BCVA (r = 0.748, p = 0.001). Although EIFLs continued in advanced-stage cases (stage 3 and 4) (64 eyes [82%]) at the final visit, it was observed in 8 eyes (23%) in the early stage (stage 2) of iERMs. A strong positive correlation was found between EIFL thickness and recurrence rate of ERM (r = 0.876, p < 0.001). Recurrence of ERM was detected in 27 eyes; 2 (7%) at stage 1, 3 (9%) at stage 2, 10 (23%) in stage 3, and 12 (33%) in stage 4 (p < 0.001).
Conclusion:
A negative association was found between the severity of EIFL and postoperative anatomical and visual recovery. In terms of surgical timing, early stages (stages 1 and 2) may be preferred for providing good anatomical and visual recovery and a low recurrence rate following surgery.
Insights
Ectopic inner foveal layer (EIFL) severity negatively impacts visual recovery after idiopathic epiretinal membrane (iERM) surgery. Early intervention for iERM with mild EIFL is recommended for better outcomes and reduced recurrence.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Medical Imaging
Background:
- Idiopathic epiretinal membrane (iERM) affects the macula, potentially impairing vision.
- Ectopic inner foveal layer (EIFL) is a recognized feature in iERM patients.
- The clinical significance of EIFL grading in iERM requires further investigation.
Purpose of the Study:
- To evaluate the clinical importance of ectopic inner foveal layer (EIFL) grading (mild to severe) in patients with idiopathic epiretinal membrane (iERM).
- To assess the association between EIFL severity and outcomes after pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peeling.
Main Methods:
- Retrospective analysis of 138 eyes from 106 patients with iERM undergoing PPV and ERM peeling.
- EIFL was graded from mild to severe.
- Spectral domain optical coherence tomography (SD-OCT) was used to measure anatomical changes.
- Correlation between EIFL, SD-OCT parameters, and best-corrected visual acuity (BCVA) was analyzed pre- and post-surgery.
Main Results:
- Higher EIFL thickness correlated with lower baseline and final BCVA.
- EIFL persisted in 82% of advanced-stage iERMs at final follow-up.
- EIFL thickness showed a strong positive correlation with ERM recurrence rate (r=0.876, p<0.001).
- Recurrence rates increased with iERM stage, from 7% in stage 1 to 33% in stage 4.
Conclusions:
- The severity of EIFL is negatively associated with postoperative anatomical and visual recovery in iERM patients.
- Early surgical intervention (stages 1 and 2) for iERM is associated with better anatomical and visual outcomes.
- Early intervention may also lead to a lower rate of ERM recurrence.
