Microcystoid Macular Edema in Epiretinal Membrane: Not a Retrograde Maculopathy
Andrea Govetto1, Anibal Francone2, Sara Lucchini3
1From 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.
Purpose:
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).
Design:
Single-center, retrospective, interventional, cohort study.
Methods:
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.
Results:
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.
Conclusions:
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.
Insights
Microcystoid macular edema (MME) is common in epiretinal membrane (ERM) surgery but rare in full-thickness macular hole (FTMH) surgery. MME is linked to Müller cell damage, not neurodegeneration, and may resemble cystoid macular edema.
Area of Science:
- Ophthalmology and Visual Sciences
- Retinal Diseases
- Surgical Outcomes
Background:
- Epiretinal membrane (ERM) and idiopathic full-thickness macular hole (FTMH) are common retinal conditions.
- Microcystoid macular edema (MME) is a specific type of macular edema that can occur post-vitrectomy.
- Understanding MME's incidence and pathophysiology is crucial for managing these conditions.
Purpose of the Study:
- To determine the incidence and clinical features of MME in patients with ERM and FTMH.
- To investigate the underlying pathophysiology of MME in these patient cohorts.
- To compare MME occurrence between ERM and FTMH after pars plana vitrectomy with internal limiting membrane (ILM) peeling.
Main Methods:
- Retrospective, single-center cohort study of 172 patients (123 ERM, 49 FTMH).
- Analysis included clinical charts, OCT, and fluorescein angiography (FA) with a minimum 6-month follow-up.
- Histopathology of 3 retinal specimens was performed to assess cellular changes.
Main Results:
- Preoperative MME was present in 21.9% of ERM eyes but none of the FTMH eyes (P < .001).
- Postoperative MME occurred in 15.5% of ERM eyes and 2% of FTMH eyes (P = .014).
- Histopathology suggested Müller cell disruption and iatrogenic damage as causes of MME in ERM.
Conclusions:
- Postoperative MME is a frequent complication after ERM surgery but rare after FTMH surgery.
- MME pathophysiology in ERM is likely due to Müller cell damage during ILM peeling, not neurodegeneration.
- The clinical presentation of MME can overlap with cystoid macular edema (CME).
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