Inner Macular Changes in Fellow Eye of Patients With Unilateral Idiopathic Epiretinal Membrane.

Purpose: We evaluated a series of fellow eyes (FEs) in patients affected by unilateral idiopathic epiretinal membrane (IERM) with spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCT-A) to determine if a previous defect in the inner retina is present before the mechanical damage to the inner limiting membrane (ILM) caused by posterior vitreous detachment. Methods: In patients with IERM (N = 39), ganglion cell layer (GCL) thickness in FEs was assessed with SD-OCT; in a subgroup (N = 25) the vessel density (VD) at the superficial (SCP) and deep capillary plexus (DCP) was assessed with swept-source OCT-A (SS-OCT-A). These values were then compared with 30 age-matched healthy control eyes (CEs). The statistical analyses used SPSS software version 15.0 (SPSS, Inc., Chicago, IL, USA). Data collected underwent 1-way ANOVA. A level of P < 0.05 was accepted as statistically significant. Results: The GCL thickness in the FEs was significantly lower than in CEs, with a significant thinning in all sectors except temporal ones (mean P < 0.001, superior P = 0.0002, superonasal P < 0.001, inferonasal P < 0.001, and inferior P = 0.002). The VD was significantly lower in the FEs in all sectors of SCP (mean P = 0.009, inner ring P = 0.028, and outer ring P = 0.007). Conclusions: GCL and SCP are significantly reduced in the FEs. These data suggest that a vascular defect in the SCP could cause a cellular loss in the inner retina that may determine the cascade events leading to the IERM proliferation; the diagnosis in a preclinical phase could provide a treatment strategy to prevent the progression of the disease.

ALTERATIONS OF MACULAR BLOOD FLOW IN SUPERFICIAL AND DEEP CAPILLARY PLEXUSES IN THE FELLOW AND AFFECTED EYES OF PATIENTS WITH UNILATERAL IDIOPATHIC EPIRETINAL MEMBRANE.

PURPOSE: Previous research suggests that proliferation of the idiopathic epiretinal membrane (IERM) is related to microbreaks in the inner limiting membrane, which are caused by posterior vitreous detachment. In this study, we used optical coherence tomography angiography to determine whether a vascular defect in the inner retina is present before the mechanical damage caused by posterior vitreous detachment. METHODS: For patients with unilateral IERM (N = 23), optical coherence tomography angiography with blood flow measurement was performed in both eyes at the superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) with 6 mm × 6-mm scans and ETDRS grids centered on the fixation point. These values were then compared with 45 healthy control eyes (CEs). RESULTS: The optical coherence tomography angiography data showed that blood flow was lower in the fellow eyes of IERM patients than in CEs when the whole enface macula (SCP: P = 0.031, DCP: P = 0.004) and extramacular area (SCP: P = 0.048, DCP: P = 0.026) were compared between groups. The blood flow was also lower in the affected eyes compared with CEs in both whole en face macula (SCP: P < 0.001, DCP: P < 0.001) and extramacular areas (SCP: P = 0.011, DCP: P < 0.001). CONCLUSION: Data from this study revealed that blood flow is significantly reduced in the fellow eyes of patients with unilateral IERM when compared with CEs. Overall, the data suggest that a vascular retinal defect could produce changes in the inner retina, preceding and influencing the formation of microbreaks occurring at the time of posterior vitreous detachment in the inner limiting membrane. Understanding the upstream mechanism of inner limiting membrane microbreaks may provide a therapeutic target aimed to ultimately prevent Mu[Combining Diaeresis]ller cells, astrocyte, and fibroblast migration, which cause IERM proliferation.

Posterior vitreous detachment and retinal detachment following cataract extraction.

PURPOSE OF THE REVIEW: Cataract surgery induces considerable vitreous modifications that can lead to posterior vitreous detachment. Studies indicate that these changes, whether combined or not with peripheral retinal degenerations such as lattice areas, carry risk for subsequent retinal breaks or detachment. RECENT FINDINGS: The incidence of retinal detachment increases after cataract extraction, but it decreases with improved surgical technique. Postoperative posterior vitreous detachment is a major promoter of retinal detachment after cataract surgery and is related to onset of most retinal tears leading to retinal detachment. Vitreous body destabilization increases the incidence of retinal detachment after surgery; this destabilization of the vitreous body can result from aggressive surgical technique, intraoperative or postoperative posterior capsule breaks, high myopia and retinal detachment in the fellow eye. These factors can act alone or together to determine the onset of anomalous forms of posterior vitreous detachment; in such cases, retinal breaks frequently develop and culminate in retinal detachment. SUMMARY: Vitreous modifications occurring after cataract extraction in patients without preoperative posterior vitreous detachment may be involved in the onset of postoperative retinal detachment. Careful postoperative follow-up is recommended in these patients to allow early detection of posterior vitreous detachment arising after surgery.

Optical coherence tomography in the evaluation of vitreoretinal disorders of the macula in highly myopic eyes.

A higher incidence of vitreoretinal disorders is found in highly myopic eyes; however, in the same eyes, several factors contribute to make visualization of the macular area most difficult. As a consequence, vitreoretinal macular disorders are often misdiagnosed in these eyes. Ocular coherence tomography (OCT) has proven to be an invaluable technique for the evaluation of the microscopic features of the macula in highly myopic eyes, allowing us to identify which patients are at higher risk of complications, before surgical or parasurgical procedures are embarked upon. Several macular disorders, characteristic of highly myopic eyes, are described.