Morphological plasticity and visual acuity in the natural course of epiretinal membrane-foveoschisis: A longitudinal...

To characterise the natural course of epiretinal membrane-foveoschisis (ERM-F) using optical coherence tomography (OCT) and analyse morphological and visual changes.

Retrospective single-centre study of treatment-naïve idiopathic ERM-F eyes. Functional and morphological changes from baseline to the final visit were assessed. The primary outcome was change in best-corrected visual acuity (BCVA). Secondary outcomes included subtype transitions, progression to lamellar macular hole (LMH) or mixed ERM-F/LMH.

A total of 124 eyes from 113 patients (mean age 67.9 ± 8.0 years) were followed for 58.8 ± 47.4 months. Mean BCVA remained stable (baseline: 0.16 ± 0.15 logMAR; final: 0.18 ± 0.15 logMAR; p = 0.29). Baseline ERM-F subtypes were open-flat (61.3%), open-elevated (24.2%), and closed (14.5%), shifting to 46.8%, 28.2%, and 9.7%, respectively, at the final visit. Conversion to mixed ERM-F/LMH and LMH occurred in 11.3% and 2.4% of eyes, respectively; two eyes (1.6%) developed a normal foveal contour, while two eyes progressed from open-flat ERM-F via mixed ERM-F/LMH phenotype to full-thickness macular hole. Central foveal thickness (CFT) did not change significantly (p = 0.457). Structural changes included increased foveal wall verticalisation and emergence of subfoveal EZ disruption, undermined edges, retinal tissue loss, and foveal bump in a subset of patients. Subfoveal EZ disruption was associated with worse final BCVA on univariable analysis, but not after multivariable adjustment for baseline BCVA and cataract surgery.

ERM-F shows morphological plasticity with generally stable visual outcomes. A minority of eyes progress to mixed ERM-F/LMH or LMH.